•GooD4Mum is a quality improvement study for diabetes prevention after gestational diabetes.•15 general practices in Victoria, Australia participated in GooD4Mum collaborative study.•Diabetes ...screening rates doubled (30%–60%) and 20% increase in BMI monitoring.•Improving screening and monitoring of women with previous gestational diabetes is feasible.
Gestational diabetes (GDM) and Type 2 diabetes pose tremendous health and economic burdens as worldwide incidence increases. Primary care-based systematic diabetes screening and prevention programs could be effective in women with previous GDM. GooD4Mum aimed to determine whether a Quality Improvement Collaborative (QIC) would improve postpartum diabetes screening and prevention planning in women with previous GDM in general practice.
Fifteen general practices within Victoria (Australia) participated in a 12-month QIC, consisting of baseline and four quarterly audits, guideline-led workshops and Plan-Do-Study-Act feedback cycles after each audit. The primary outcome measures were the proportion of women on local GDM registers completing a diabetes screening test and a diabetes prevention planning consultation within the previous 15 months.
Diabetes screening increased with rates more than doubled from 26% to 61% and postpartum screening increased from 43%–60%. Diabetes prevention planning consultations did not show the same level of increase (0%–10%). The recording of body mass index improved overall (51%–69%) but the number of women with normal body mass index did not.
GooD4Mum supported increased diabetes screening and the monitoring of high risk women with previous GDM in general practice.
The short chain fatty acids acetate, propionate and butyrate are produced when dietary fibre is fermented by the colonic bacteria. We have previously shown that sodium butyrate induces apoptosis in 3 ...colorectal tumour cell lines. We have extended our study to 3 adenoma and 4 carcinoma cell lines and investigated whether propionate and acetate also induce apoptosis. All 3 short chain fatty acids induced apoptosis at physiological concentrations, but of the 3, butyrate was the most effective. Since these fatty acids are produced as a result of bacterial fermentation of dietary fibre, this may in part explain the correlation between a high-fibre diet and low colorectal cancer incidence. Sodium butyrate induced apoptosis in all 7 of the cell lines studied; however, 2 of the 4 carcinoma cell lines (PC/JW/FI and S/KS/FI) were more resistant to butyrate-induced apoptosis than the 3 adenoma cell lines, suggesting that at least some carcinomas may evolve mechanisms to protect the cells from the induction of apoptosis. The bile acid deoxycholic acid has previously been reported as a possible tumour promoter in the large intestine and its levels are reduced by dietary fibre. Concentrations of between 10 nM and 0.1 mM had no effect on either the proliferation or apoptosis of colonic tumour cells in vitro. However, a significant induction of apoptosis was obtained at a concentration of 0.5 mM. These results may have significance for the aetiology of colorectal cancer.
A new method of designing ‘brass’ air-column instruments to include structural and acoustical interactions in the optimisation process is introduced and used to generate initial results. It is based ...upon a coupling between the air-column and structure when their resonant frequencies approach each other, which accentuates the lip to wall coupling effect. The degree of wall vibration and the frequencies at which it occurs can be controlled by variation of the structure’s stiffness. The method detailed in this paper enables optimisation of the solid wall thickness variation along the bore of the instrument. The acoustic optimisation of the internal profile and subsequent structural optimisation of the wall thicknesses is carried out based on acoustic and structural resonance constraints, with secondary objectives of structural integrity and weight minimisation. The intention is to be able to optimise the sound of the instrument to include the wall vibrations effect, based upon a specified target output.
Early-onset hypertensive disorders (HD) of pregnancy and small-for-gestational age infants (SGA) are associated with placental vascular thrombosis, these often recur and are also associated with ...inheritable thrombophilia. Aspirin reduces the recurrence risk.
Adding low-molecular-weight heparin (LMWH) to aspirin at < 12 weeks gestation reduces the recurrence of HD in women with previous early-onset HD (pre-eclampsia, hemolysis, elevated liver enzymes and low platelets HELLP syndrome and eclampsia) and/or SGA, in the context of inheritable thrombophilia without antiphospholipid antibodies.
In a multicenter randomized control trial (RCT), 139 women included were< 12 weeks gestation.
previous delivery< 34 weeks gestation with HD and/or SGA; inheritable thrombophilia (protein C deficiency, protein S deficiency, activated protein C resistance, factor V Leiden heterozygosity and prothrombin gene G20210A mutation heterozygosity); and no antiphospholipid antibodies detected.
either daily LMWH (dalteparin, 5000 IU weight-adjusted dosage) with aspirin 80 mg or aspirin 80 mg alone.
recurrent HD onset (i) < 34 weeks gestation and (ii) irrespective of gestational age.
recurrent SGA, preterm birth, maternal/neonatal hospitalization, spontaneous abortion and individual HD. Analysis by intention-to-treat.
Low-molecular-weight heparin with aspirin reduced recurrent HD onset < 34 weeks gestation (risk difference RD 8.7%: confidence interval CI of RD 1.9–15.5%; P = 0.012; number needed to treat NNT 12). Recurrent HD irrespective of gestational age was not different between the arms. No women withdrew as a result of adverse effects.
http://www.isrctn.org) (isrctn87325378).
Adding LMWH to aspirin at < 12 weeks gestation reduces recurrent HD onset < 34 weeks gestation in women with inheritable thrombophilia and prior delivery for HD/SGA <34 weeks. However, close monitoring of the mother and fetus remains important throughout pregnancy.
Objectives This report sought to study the impact of the balloon-expandable SAPIEN XT (Edwards Lifesciences, Irvine, California) transcatheter heart valve (THV) stent frame geometry and position on ...outcomes of transcatheter aortic valve replacement (TAVR). Background Post-implant THV geometry and position might impact atrioventricular conduction, hemodynamic performance, and annular sealing. Methods Eighty-nine consecutive patients who underwent TAVR with a Sapien XT THV had pre- and post-implant multidetector computed tomography, transthoracic echocardiography, and electrocardiograms performed to assess THV stent geometry, atrioventricular conduction, and hemodynamic performance. Results The THV Circularity (THV eccentricity <10% eccentricity = minimum stent diameter/maximum stent diameter) and under-expansion (THV area/nominal THV area <90%) were present in 97.8% (2 of 89) and 0%, respectively. Low THV implantation was associated with new left bundle branch block and complete heart block (3.4 ± 2.0 mm vs. 5.5 ± 2.9 mm, p = 0.01) and with the need for permanent pacemaker implantation (3.5 ± 2.0 mm vs. 7.1 ± 2.5 mm, p = 0.001). In contrast, labeled THV size and THV area oversizing was not associated with atrioventricular conduction disturbances. The relation between inflow stent frame area and annular area was related to paravalvular regurgitation (p = 0.025). Labeled prosthesis size but not prosthesis expansion or eccentricity was related to valve gradient (p = 0.005) and effective orifice area (p < 0.001). Conclusions Low implantation depth of balloon-expandable THVs is associated with clinically significant new conduction disturbances and permanent pacemaker implantation. Importantly, annular area oversizing was not associated with these complications.
There can be a tendency, even within companies who practice concurrent engineering, to limit customer involvement to the initial and final stages of the new product development process only. This ...invites the possibility that the customers' opinions will be lost or at least diluted during the intermediate stages of the process. A joint research project involving Loughborough University and the Central University of Technology, Free State has provided evidence, through several case studies, that physical models created via rapid prototyping enable the customer to be involved throughout the development process. The benefits associated with using physical models are discussed, showing that these models have a unique role to play in promoting customer involvement. The authors propose the method termed Customer Interaction with Functional Prototypes, which has been implemented during several new product development projects carried out in both academic and industrial environments. At present, the Customer Interaction with Functional Prototypes method is suitable for facilitating customer interaction primarily with the aesthetic and ergonomic aspects of simple consumer products or with stand-alone subsystems of more complex products. The method compliments the use of virtual prototyping and design analysis required to optimize the functional aspects of a product through the application of engineering science.
The death ligand TRAIL (Apo2L) has potential for cancer therapy, since tumour cells are thought to be more sensitive than normal cells. We investigated whether sensitivity to TRAIL increases during ...the adenoma to carcinoma transition of colorectal carcinogenesis. Under the same culture conditions, we compared the extent of TRAIL-induced apoptosis in four premalignant adenoma and three carcinoma cell lines. Although TRAIL induced some apoptosis in adenoma cultures, the carcinoma cell lines were significantly more sensitive (P<0.001). This finding was recapitulated in an in vitro model of tumour progression in which conversion of the adenoma cell line AA/C1 to a tumorigenic phenotype was associated with increased TRAIL sensitivity (P<0.001). Increased TRAIL sensitivity during colorectal carcinogenesis has been previously attributed to changes in the balance between TRAIL receptors TRAIL-R1 and -R2 and "decoy" receptors TRAIL-R3 and -R4 during malignant progression. To address this, cell surface receptor expression was measured by flow cytometry. In summary, during colorectal carcinogenesis, there is a marked increase in sensitivity to TRAIL-induced apoptosis associated with progression from benign to malignant tumour that could be exploited for colon cancer therapy, but alterations in cell surface TRAIL receptor expression may not be the primary reason for this change.
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