Naresuan University Journal
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Reduced lower limb muscle strength and volume in patients with Type 2 diabetes in relation to neuropathy, intramuscular fat and vitamin D levels
No full textOBJECTIVE: Muscle weakness and atrophy of the lower limbs may develop in patients with diabetes, increasing their risk of falls. The underlying basis of these abnormalities has not been fully explained. The aim of this study was to objectively quantify muscle strength and size in patients with type 2 diabetes mellitus (T2DM) in relation to the severity of neuropathy, intramuscular noncontractile tissue (IMNCT), and vitamin D deficiency.RESEARCH DESIGN AND METHODS: Twenty patients with T2DM and 20 healthy control subjects were matched by age, sex, and BMI. Strength and size of knee extensor, flexor, and ankle plantar and dorsiflexor muscles were assessed in relation to the severity of diabetic sensorimotor polyneuropathy (DSPN), amount of IMNCT, and serum 25-hydroxyvitamin D (25OHD) levels.RESULTS: Compared with control subjects, patients with T2DM had significantly reduced knee extensor strength (P = 0.003) and reduced muscle volume of both knee extensors (P = 0.045) and flexors (P = 0.019). Ankle plantar flexor strength was also significantly reduced (P = 0.001) but without a reduction in ankle plantar flexor (P = 0.23) and dorsiflexor (P = 0.45) muscle volumes. IMNCT was significantly increased in the ankle plantar (P = 0.006) and dorsiflexors (P = 0.005). Patients with DSPN had significantly less knee extensor strength than those without (P = 0.02) but showed no difference in knee extensor volume (P = 0.38) and ankle plantar flexor strength (P = 0.21) or volume (P = 0.96). In patients with <25 nmol/L versus >25 nmol/L 25OHD, no significant differences were found for knee extensor strength and volume (P = 0.32 vs. 0.18) and ankle plantar flexors (P = 0.58 vs. 0.12).CONCLUSIONS: Patients with T2DM have a significant reduction in proximal and distal leg muscle strength and a proximal but not distal reduction in muscle volume possibly due to greater intramuscular fat accumulation in distal muscles. Proximal but not distal muscle strength is related to the severity of peripheral neuropathy but not IMNCT or 25OHD level.</p
The sharing economy: A pathway to sustainability or a nightmarish form of neoliberal capitalism?
No full textThe sharing economy seemingly encompasses online peer-to-peer economic activities as diverse as rental (Airbnb), for-profit service provision (Uber), and gifting (Freecycle). The Silicon Valley success stories of Airbnb and Uber have catalysed a vibrant sharing economy discourse, participated in by the media, incumbent industries, entrepreneurs and grassroots activists. Within this discourse the sharing economy is framed in contradictory ways; ranging from a potential pathway to sustainability, to a nightmarish form of neoliberalism. However, these framings share a common vision of the sharing economy (a niche of innovation) decentralising and disrupting established socio-technical and economic structures (regimes). Here I present an analysis of the online sharing economy discourse; identifying that the sharing economy is framed as: (1) an economic opportunity; (2) a more sustainable form of consumption; (3) a pathway to a decentralised, equitable and sustainable economy; (4) creating unregulated marketplaces; (5) reinforcing the neoliberal paradigm; and, (6) an incoherent field of innovation. Although a critique of hyper-consumption was central to emergence of the sharing economy niche (2), it has been successfully reframed by regime actors as purely an economic opportunity (1). If the sharing economy follows this pathway of corporate co-option it appears unlikely to drive a transition to sustainability
Inter-professional perspectives of dementia services and care in England: Outcomes of a focus group study
No full textMany people living with dementia are supported at home using a variety of health and social care services. This paper reports the findings from a focus group study undertaken with staff in community mental health teams to explore areas for improvement in relation to national policies and recommendations for dementia care. Two focus groups were held with staff (n = 23) in 2011 to discuss topics including service delivery, information and communication, and provision of health and community care for people with dementia. Respondents identified problems with information sharing and incompatible electronic systems; inflexibility in home care services; and poor recognition of dementia in hospital settings. General practitioners had developed a greater awareness of the disease and some community services worked well. They felt that budgetary constraints and a focus on quality indicators impeded good dementia care. Key areas suggested by staff for improvements in dementia care included the implementation of more flexible services, dementia training for health and social care staff, and better quality care in acute hospital settings
Beyond traditional school value-added models: A multilevel analysis of complex school effects in Chile
No full textSchool value-added studies have largely demonstrated the effects of socioeconomic and demographic characteristics of the schools and the pupils on performance in standardised tests. Traditionally, these studies have assessed the variation coming only from the schools and the pupils. However, recent studies have shown that the analysis of academic performance could significantly benefit from additional complexity in the model structure, incorporating non-hierarchical and unexplored levels of variation. Using data on secondary students from the Chilean National Pupil Database (2004?2006), this study shows how the traditional value-added models fall short in addressing the complex phenomenon of academic performance, because they largely overestimate school effects. A 4-level contextualised value-added model for progress in Mathematics was implemented and shown to avoid the masking of classroom and locality effects found in the traditional models. We also analyse the effects of important structural factors in Chile such as family income and school type
T1-weighted Dynamic Contrast-enhanced MR Imaging of the Lung in Asthma: Semiquantitative Analysis for the Assessment of Contrast Agent Kinetic Characteristics.
No full textPurpose To evaluate the contrast agent kinetics of dynamic contrast material-enhanced (DCE) magnetic resonance (MR) imaging in healthy lungs and asthmatic lungs by using non-model-based semiquantitative parameters and to explore the relationships with pulmonary function testing and eosinophil level. Materials and Methods The study was approved by the National Research Ethical Committee (reference no. 11/NW/0387), and written informed consent was obtained from all individuals. Ten healthy subjects and 30 patients with asthma underwent pulmonary function tests, blood and sputum eosinophil counts, and 1.5-T DCE MR imaging within 7 days. Semiquantitative parameters of contrast agent kinetics were calculated from the relative signal intensity-time course curves on a pixel-by-pixel basis and were summarized by using whole-lung median values. The distribution heterogeneity was assessed by using the regional coefficient of variation. DCE MR imaging readouts were compared between groups by using one-way analysis of variance, and the relationships with pulmonary function testing and eosinophil counts were assessed by using Pearson correlation analysis. Results Asthmatic patients showed significantly lower peak enhancement (P <.001) and initial areas under the relative signal intensity curve in the first 60 seconds (P = .002) and significantly reduced late-phase washout slope (P = .002) when compared with healthy control subjects. The distribution heterogeneity of bolus arrival time (P = .029), time to peak (P = .008), upslope of the first-pass peak (P = .011), and late-phase washout slope (P = .032), estimated by using the median coefficient of variation, were significantly higher in asthmatic patients than in healthy control subjects. These imaging readouts also showed significant linear correlations with measurements of pulmonary function testing but not with eosinophil level in patients with asthma. Conclusion The contrast agent kinetic characteristics of T1-weighted DCE MR images of asthmatic lungs are different from those of healthy lungs and are related to measurements of pulmonary function testing but not to eosinophil level. (©) RSNA, 2015 Online supplemental material is available for this article
