Older Type Research Articles

The Absence of Islet Autoantibodies in Clinically Diagnosed Older-Adult Onset Type 1 Diabetes Suggests an Alternative Pathology, Advocating for Routine Testing in This Age Group

Objective: Islet autoantibodies at diagnosis are not well studied in older-adult onset (>30years) type 1 diabetes due to difficulties of accurate diagnosis. We used a type 1 diabetes genetic risk score (T1DGRS) to identify type 1 diabetes aiming to evaluate the prevalence and pattern of autoantibodies in older-adult onset type 1 diabetes. Methods: We used a 30 variant T1DGRS in 1866 white-European individuals to genetically confirm a clinical diagnosis of new onset type 1 diabetes. We then assessed the prevalence and pattern of GADA, IA2A and ZnT8A within genetically consistent type 1 diabetes across three age groups ( 30years (n=588)). Findings: In autoantibody positive cases T1DGRS was consistent with 100% type 1 diabetes in each age group. Conversely in autoantibody negative cases, T1DGRS was consistent with 93%(56/60) of 30years having type 1 diabetes. Restricting analysis to genetically consistent type 1 diabetes showed similar proportions of positive autoantibodies across age groups (92% 30years)[p=0.87]. GADA was the most common autoantibody in older-adult onset type 1 diabetes, identifying 95% of autoantibody positive cases versus 72% in those <18years. Interpretation: Older adult-onset type 1 diabetes has identical rates but different patterns of positive autoantibodies to childhood onset. In clinically suspected type 1 diabetes in older-adults, absence of autoantibodies strongly suggests non-autoimmune diabetes. Our findings suggest the need to change guidelines from measuring islet autoantibodies where there is diagnostic uncertainty to measuring at least GADA in all suspected adult type 1 diabetes cases. Funding Statement: NJT is funded by a Wellcome Trust funded GW4 PhD (220601/Z/20/Z). M.N.W. is supported by the Wellcome Trust Institutional Support Fund (WT097835MF). KAP is a Wellcome Trust fellow (219606/Z/19/Z) and the genetic risk score analysis in ADDRESS-2 was funded by Diabetes wellness Research foundation pump priming grant. ADDRESS-2 is co-funded by Diabetes UK (grant numbers 09-0003919, 15-005234 & 19/0006119) and the Juvenile Diabetes Research Foundation (grant numbers 9-2010-407 & 3-SRA-2015-35-A-N), supported by the NIHR Clinical Research Network and hosted by Imperial College London. S.M. is currently supported by a Future Leaders Mentorship award from the European Federation for the Study of Diabetes. NO is supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Imperial College London. DJ is funded by the NIHR CRN. Declaration of Interests: We declare no competing interest. Ethics Approval Statement:Ethics for the ADDRESS2 study was granted by the South Central – Berkshire NHS Research Ethics Committee on the 03/10/2010, ref: 10/H0505/85. Ethics for monogenic testing in the ADDRESS2 cohort by the East of England – Essex Research Ethics Committee on the 14/7/2016, ref 16/EE/0306

Аналіз методів прогнозування технічного стану інформаційно-керуючих систем

The article presents the results of analysis and theoretical generalization of scientific works, which consider the problems of determining the condition and resource of technical means of information and management systems in industry. In spite of the specificity of construction and functioning of railway automatics systems, an approach to the synthesis of complex evaluation based on the formation of an integral indicator on the basis of data on the functioning of individual components.The problem of estimating the technical condition and resource of any technical means, and in particular OF the information and control systems, is very topical nowadays, because service methods and exploitation terms of a specific service are grounded on its basis. The issue of the resource intensity determination has become of particular importance during recent years, in connection with the introduction of information and control systems having a fundamentally new elementary basis. Furthermore, operating older relay type systems also demands to determine the date and time of their decommissioning.It should be noted that modern relay control systems used in railway transport, stay in operation for an average period of 35-40 years and or more. As a rule, the same exploitation terms are used during the development of regulatory documents regarding microprocessor system life cycle, without taking into account the fundamental differences in the design and element bases. Moreover, in most cases the decision is usually made administratively and is based on the expertise of a specific manager.This raises the question of formalizing this problem and the issue of the methods and mathematical models development for assessing the state and resource intensity of the railway transport information and control systems.

Evolution in geriatric syndromes and association with survival over 5years in the GERODIAB cohort of older French diabetic patients.

Although one in three patients with diabetes in Western countries is over 70years-old, geriatric syndromes and their relationship with survival remain seldom studied. The present aim of the GERODIAB study was to examine the evolution of geriatric disorders and their relationship with survival in older type 2 patients with diabetes with initial sufficient autonomy. We performed a prospective, observational study over 5years in patients with diabetes aged 70years or above. A total of 987 consecutive type 2 patients with diabetes (mean age 77years, range 70-94years, 65.2% were 75years and above, 52.1% women) were included from 56 French diabetic centres. Individual characteristics, diabetes parameters and geriatric parameters (autonomy, nutrition, cognitive alteration, depression, orthostatic hypotension, falls) were annually recorded. Survival was analysed using the Kaplan-Meier method and proportional hazards regression models. Institutional living, impaired activity and difficulties in instrumental daily activity, cognitive disorders, malnutrition, depression, orthostatic hypotension and hypoglycaemia strongly increased during the follow-up. Institutional living, impaired activity and difficulties in instrumental daily activity, cognitive disorders and hypoglycaemia were strongly associated with reduced survival, but not falls. In hazard ratio models, living in an institution (HR = 2.39; CI = 1.77-3.24; p < 0.0001) and impaired Activity of Daily Living scale score were the most significant and independent predictors of death (HR = 1.59; CI = 1.19-2.13; p = 0.0016), associated with HbA1c ≥ 70mmol/mol (HR = 1.62; CI = 1.12-2.36; p = 0.011). Our findings show the considerable alteration of geriatric parameters and their relationship with decreased survival after a 5-year follow-up in type 2 patients with diabetes, independent of HbA1c and age. They, therefore, confirm the prognostic interest of using yearly geriatric markers in older diabetic patient management, especially the ADL, IADL and MMSE scales. Taking into account these prognostic parameters should contribute to target appropriate HbA1c goals. Registered at clinicaltrials.gov (21/01/2011): NCT01282060.

The Impact of Comorbid Diseases on Postoperative Complications in Children after Adenotonsillectomy: Is It a Myth?

Adenotonsillar surgery remains the second most common surgical practice in pediatric otolaryngology. We aimed to evaluate whether a comorbid disease in children undergoing surgery has any impact on postoperative complication rate. This study was conducted at a tertiary otolaryngology department with 643 children. The study included children with symptoms of obstructive sleep-disordered breathing and recurrent infection who underwent adenotonsillar surgery. Patients with a comorbid disease constituted the study group and otherwise healthy children constituted the control group. The data were evaluated to find out any association among clinical variables such as gender, age, tonsil grade, type and extent of surgery, indication for surgery, body mass index percentile, comorbid diseases and postoperative complications. There were 245 (38.1%) patients with a comorbid disease. The most common comorbidity was cardiovascular diseases (n=68) followed by neurological diseases (n=48). We performed adenoidectomy in 319, tonsillectomy in 44, tonsillotomy in nine, adenotonsillectomy (AT) in 190 and adenoidectomy with tonsillotomy (ATT) in 81 patients. The overall rate of postoperative late complication was 17/643 (2.6%) with post-tonsillectomy hemorrhage being the most common (n=10). There was no association between other clinical variables and the complication but older age (p=0.042) and type of surgery (p<0.001) revealed increased risk. The rates of complications in patients with or without comorbid disease were found 5/245 (2%) and 12/389 (3%), respectively, with no difference (p=0.621). The risk of postoperative complications was increased in older children and in patients undergoing AT and ATT, however, the presence of comorbid disease did not increase likelihood of postoperative complications.

68 - Flaxseed Lignan Complex Consumption Fails to Reduce Hypertension in Older Type 2 Diabetes Patients

Hypertension in type 2 diabetes patients (T2DP) contributes significantly to myocardial infarction and stroke. Unknown is the impact of flaxseed lignan complex (FLC) on Diabetes Canada’s clinical practice guidelines-defined (DCCPG-D) systolic hypertension (SH) and/or diastolic hypertension (DH) in older T2DP. It was hypothesized that FLC (600 mg secoisolariciresinol diglucoside (SDG)/day) for 3 months would decrease DCCPG-D SH and/or DH in older T2DP. The objective was to test this hypothesis.

Obese Older Type 2 Diabetes Mellitus Patients with Muscle Insulin Resistance Benefit from an Enriched Protein Drink during Combined Lifestyle Intervention: The PROBE Study.

(1) Background: Recent research showed that subtypes of patients with type 2 diabetes may differ in response to lifestyle interventions based on their organ-specific insulin resistance (IR). (2) Methods: 123 Subjects with type 2 diabetes were randomized into 13-week lifestyle intervention, receiving either an enriched protein drink (protein+) or an isocaloric control drink (control). Before and after the intervention, anthropometrical and physiological data was collected. An oral glucose tolerance test was used to calculate indices representing organ insulin resistance (muscle, liver, and adipose tissue) and β-cell functioning. In 82 study-compliant subjects (per-protocol), we retrospectively examined the intervention effect in patients with muscle IR (MIR, n = 42) and without MIR (no-MIR, n = 40). (3) Results: Only in patients from the MIR subgroup that received protein+ drink, fasting plasma glucose and insulin, whole body, liver and adipose IR, and appendicular skeletal muscle mass improved versus control. Lifestyle intervention improved body weight and fat mass in both subgroups. Furthermore, for the MIR subgroup decreased systolic blood pressure and increased VO2peak and for the no-MIR subgroup, a decreased 2-h glucose concentration was found. (4) Conclusions: Enriched protein drink during combined lifestyle intervention seems to be especially effective on increasing muscle mass and improving insulin resistance in obese older, type 2 diabetes patients with muscle IR.

Trends in HbA1c thresholds for initiation of hypoglycemic agents: Impact of changed recommendations for older and frail patients.

AimsLess strict glycated hemoglobin (HbA1c) thresholds have been recommended in older and/or frail type 2 diabetes (T2D) patients than in younger and less frail patients for initiating hypoglycemic agents since 2011. We aimed to assess trends in HbA1c thresholds at initiation of a first hypoglycemic agent(s) in T2D patients and the influence of age and frailty on these trends.Materials and methodsThe groningen initiative to analyze type 2 diabetes treatment (GIANTT) database was used, which includes primary care T2D patients from the north of the Netherlands. Patients initiating a first non‐insulin hypoglycemic agent(s) between 2008 and 2014 with an HbA1c measurement within 120 days before initiation were included. The influence of calendar year, age, or frailty and the interaction between calendar year and age or frailty were assessed using multilevel regression analyses adjusted for confounders.ResultsWe included 4588 patients. The mean HbA1c threshold at treatment initiation was 7.4% up to 2010, decreasing to 7.1% in 2011 and increasing to 7.4% in 2014. This quadratic change over the years was significant (P < 0.001). Patients aged 60 to 79 initiated treatments at lower HbA1c and patients of different frailty at similar HbA1c levels. The interaction between year and age or frailty was not significant (P > 0.05).ConclusionsHbA1c thresholds at initiation of a first hypoglycemic agent(s) changed significantly over time, showing a decrease after 2010 and an increase after 2012. The HbA1c threshold at initiation was not influenced by age or frailty, which is in contrast with recommendations for more personalized treatment.

Long-term trajectories of BMI predict carotid stiffness and plaque volume in type 2 diabetes older adults: a cohort study

BackgroundHigh body mass index (BMI) is a risk factor for type 2 diabetes and cardiovascular disease. However, its relationships with indices of carotid stiffness and plaque volume are unclear. We investigated associations of long-term measurements of BMI with indices of carotid stiffness and atherosclerosis among non-demented diabetes patients from the Israel Diabetes and Cognitive Decline (IDCD) study.MethodsCarotid ultrasound indices [carotid intima media thickness (cIMT), distensibility, elastography and plaque volume] were assessed in N = 471 participants. Mean BMI across all MHS diabetes registry measurements and trajectories of BMI were calculated. BMI was categorized into three trajectory groups representing: a relatively stable normal weight (n = 185, 44%), overweight trajectory (n = 188, 44.8%) and a trajectory of obesity (n = 47, 11.2%). Linear and logistic regressions estimated associations of carotid indices with mean BMI and BMI trajectories.ResultsCompared to the normal weight trajectory, an obesity trajectory was associated with carotid distensibility (β = − 3.078, p = 0.037), cIMT (β = 0.095, p = 0.004), and carotid elastography (β = 0.181, p = 0.004) but not with plaque volume (β = 0.066, p = 0.858). Compared with the normal weight trajectory, an obesity trajectory was associated with increased odds for impaired carotid distensibility (OR = 2.790, p = 0.033), impaired cIMT (OR = 5.277, p = 0.001) and large carotid plaque volume (OR = 8.456, p = 0.013) but not with carotid elastography (OR = 1.956, p = 0.140). Mean BMI was linearly associated with Distensibility (β = − 0.275, p = 0.005) and cIMT (β = 0.005, p = 0.026).ConclusionsLong-term measurements of adiposity are associated with indices of carotid stiffness and plaque volume among older type 2 diabetes adults.

Circulating Agonist Autoantibody to 5-Hydroxytryptamine 2A Receptor in Lean and Diabetic Fatty Zucker Rat Strains

Circulating neurotoxic autoantibodies to the 5-hydroxytryptamine 2A receptor were increased in older adult type 2 diabetes in association with certain neurodegenerative complications. The male Zucker diabetic fatty (ZDF) rat is a model system for studies of obese, type 2 diabetes mellitus. The aim of the current study was to test for (and compare) circulating neurotoxic autoantibodies to the 5-hydroxytryptamine 2A receptor in the Zucker diabetic fatty rat and age-matched lean Zucker rat strains. Plasma from lean and Zucker diabetic fatty rat (obtained at different developmental stages) was subjected to protein G affinity chromatography. The resulting immunoglobulin G fraction was tested for neurotoxicity (acute neurite retraction, accelerated neuron loss) in N2A mouse neuroblastoma cells and for binding to a linear synthetic peptide corresponding to the second extracellular loop of the 5-hydroxytryptamine 2A receptor. The male Zucker diabetic fatty rat (fa/fa) and two Zucker lean strains (+/?) and (fa/+) harbored autoantibodies to the 5-hydroxytryptamine 2A receptor which appeared spontaneously around 7-8.5 weeks of age. The circulating autoantibodies persisted until at least 25 weeks of age in the Zucker diabetic fatty rat and in the Zucker heterozygote (fa/+), but were no longer detectable in 25-week-old lean (+/?) Zucker rats. Autoantibody-induced acute neurite retraction and accelerated loss in mouse neuroblastoma N2A cells was dose-dependently prevented by selective antagonists of the 5-hydroxytryptamine 2A receptor. It was also substantially prevented by co-incubation with antagonists of RhoA/Rho kinase-mediated signaling (Y27632) or Gq11/phospholipase C/inositol triphosphate receptor-coupled signaling. These data suggest that neurotoxic 5-hydroxytryptamine 2A receptor-targeting autoantibodies increase in the aging male Zucker diabetic fatty rat and in male Zucker lean rats harboring a heterozygous mutation, but not in age-matched, older Zucker lean rats lacking a known leptin receptor mutation. The Zucker genetic strain may be useful in studies of the role of humoral and/or innate immunity in late neurodegeneration.

The Missing Women of Sande: A Necessary Exercise in Museum Decolonization

The Missing Women of Sande: A Necessary Exercise in Museum Decolonization

Dermoscopy of plaque psoriasis differs with plaque location, its duration, and patient's sex.

Literature data on dermoscopic features of psoriasis vulgaris are inconsistent. The aim of the study was to evaluate whether dermoscopic features of psoriatic plaques differ with anatomic location or any clinical characteristics. Clinical evaluation and videodermoscopy of psoriatic plaques located on the face, chest, abdomen, forearms, lower legs, back, and scalp were performed in 50 patients with psoriasis vulgaris. A total of 306 plaques were evaluated. Videodermoscopy with a 20-fold magnification revealed red dots and globules in 306/306 (100%) plaques, arranged in diffuse (170/306, 56%), patchy (117/306, 38%), or polygonal (19/306, 6%) pattern. A 70 fold magnification of these vessels revealed the presence of bushy vessels (213/306, 70%) and twisted loops (107/306, 35%), with the latter occurring more commonly on the scalp and face (P<.001). In lesions lasting less or equal 5weeks on forearms and scalp, patchy distribution of the scale predominated, whereas in older lesions-diffuse type (forearm P=.005, scalp P=.017). Diffuse distribution of the scale in lesions located on the face was more common in women, than men (P=.003). Videodermoscopic picture of psoriatic plaques may differ with the anatomic location and duration of the psoriatic plaque and with patient's sex.

987-P: Efficacy and Safety Comparison between U-100 Human Regular Insulin and Rapid-Acting Insulin When Delivered by V-Go Wearable Insulin Delivery in an Older Type 2 Diabetes Population

The price of insulin has risen substantially and been associated with higher out-of-pocket costs and quicker entry into the Medicare coverage gap, negatively impacting diabetes care in older adults. Evidence from a large health plan supports Human Regular Insulin (HRI), when used effectively, as a viable treatment option for many patients with T2D including older adults. In a recently completed multi-site, 14-week randomized, parallel, study (N=113), non-inferiority was demonstrated when switching from Rapid Acting Insulin (RAI) to HRI delivered by V-Go with a mean change ETD in A1C of -0.22% (95% CI -0.67, 0.22); p=0.007 favoring HRI and no statistical differences in insulin dose, weight or hypoglycemia. We explored these outcomes using mixed-effects models in a post-hoc analysis in pts ≥ 65 years of age. The intent to treat population consisted of 53 pts randomized to continue therapy with RAI (n=25) or switch to HRI (n=28). Non-inferiority for change in A1C between groups was demonstrated in this population. Insulin dose and hypoglycemia events were similar between groups. No severe hypoglycemia or moderate or severe adverse events were reported in either group. Similar to the overall study findings, use of HRI delivered by V-Go is an effective insulin therapy option in an older population and may decrease financial burdens. Disclosure D.R. Sutton: Employee; Spouse/Partner; Valeritas, Inc. Speaker’s Bureau; Self; Amarin Corporation, AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Merck &amp; Co., Inc., Novo Nordisk A/S, Valeritas, Inc. P.F. Mora: Speaker’s Bureau; Self; Dexcom, Inc., Insulet Corporation, Janssen Pharmaceuticals, Inc., Merck &amp; Co., Inc., Novo Nordisk Inc., Sanofi US, Valeritas, Inc. A. Gore: Advisory Panel; Spouse/Partner; Janssen Pharmaceuticals, Inc. Consultant; Spouse/Partner; Janssen Pharmaceuticals, Inc. Consultant; Self; Novo Nordisk Inc. Speaker’s Bureau; Spouse/Partner; Janssen Pharmaceuticals, Inc. Speaker’s Bureau; Self; Janssen Pharmaceuticals, Inc., Merck &amp; Co., Inc. B. Baliga: Speaker’s Bureau; Self; Amarin Corporation, AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Lilly Diabetes, Novo Nordisk Inc., Senseonics, Valeritas, Inc. R.F. Goldfaden: None. C.C. Nikkel: Employee; Self; Valeritas, Inc. Stock/Shareholder; Self; Valeritas, Inc. J.H. Sink: Employee; Self; Valeritas, Inc. B.A. Adams-Huet: Consultant; Self; Valeritas, Inc. Funding Valeritas, Inc.

Health Inequalities Among Elderly Type 2 Diabetes Mellitus Patients in Japan.

The influence of socioeconomic status (SES) on health inequalities has received much attention worldwide. This study examined the effect of SES on the following older type 2 diabetes mellitus patient health outcomes: oral hypoglycemic agent (OHA) medication adherence (proportion of days covered, PDC), risk of hospitalization for diabetic macrovascular complications, and in-hospital death. A retrospective cohort design using 2013–2016 claims data was used. Subjects were 58,349 diabetes patients aged >74 years in 2013. Age, sex, residential area, and comorbidities were controlled for. Logistic regression was conducted to assess the effects of income on PDC; survival analysis was used to assess the effects on hospitalization and in-hospital death. Regressions were conducted separately by sex. Compared with the lowest income group, adjusted PDC odds ratios for medium- and high-income males, respectively, were 1.35 (95% CI: 1.27–1.43) and 1.41 (95% CI: 1.30–1.54); females: 1.17 (95% CI: 1.11–1.23) and 1.24 (95% CI: 1.13–1.35). Adjusted hazard ratios (AHRs) for male hospitalization were 0.88 (95% CI: 0.80–0.96) and 0.88 (95% CI: 0.79–0.99); females: 1.00 (95% CI: 0.93–1.07) and 0.95 (95% CI: 0.83–1.08). AHRs for male in-hospital death were 0.83 (95% CI: 0.75–0.91) and 0.62 (95% CI: 0.54–0.70); females: 0.94 (95% CI: 0.87–1.02) and 0.77 (95% CI: 0.65–0.92). Results revealed sex-specific health inequalities among older Japanese diabetes patients. Subjects with worse SES had significantly poorer OHA medication adherence (both sexes), higher hospitalization risk for diabetes complications (males), and higher in-hospital death risk (both sexes).

Abstract 301: Differential Outcomes for Geriatric Patients in Cardiac Intensive Care Unit Compared to Medical Intensive Care Unit

Background: The number of older adults admitted to cardiac intensive care units (CICU) have been increasing over the past decade, but it is not known if outcomes vary between CICU and medical intensive care units (MICU). We aimed to describe survival and length of stay (LOS) in older adults admitted to CICU and MICU. Methods: All patients admitted to the CICU or MICU at Beth Israel Deaconess Medical Center from 2001-2012 were identified from MIMIC-III, a large single-center critical care database containing deidentified clinical data for 38,597 patients. Our primary outcomes were ICU mortality and ICU LOS. Regression analyses were performed adjusting for age, gender, ICU setting and Oxford Acute Severity of Illness Score (OASIS), a severity score developed and validated in critically ill patients for ICU mortality. Results: We included 21,088 MICU patients (48.3% female) and 7,726 CICU patients (42% female). Unadjusted mortality was 13.7% in MICU and 12.5% in CICU (p=0.11). When adjusted for age, gender and OASIS, there was no difference in mortality between MICU and CICU (OR 0.62, 95% CI 0.34-1.13, p=0.15). However, we found a significant interaction between older age and type of ICU with mortality (p=0.03) but not with ICU LOS (p=0.15). In patients &gt;75 years (6,837 in MICU and 3,161 in CICU), each 5-year interval of older age was associated with higher mortality when adjusted for gender and OASIS in the CICU (OR 1.05, 95% CI 1.02-1.08 p=0.002), but not in the MICU (OR 1.01, 95% CI 0.99-1.03, p=0.15, Figure). Conclusion: Older adults admitted to the CICU had higher adjusted mortality by age group after age 75, as opposed to older MICU patients in whom mortality was high but remained unchanged after age 75.

Comparison of the quality of life in individuals with spinal cord injury wearing either reciprocating gait orthosis or hip knee ankle foot orthosis: a cross-sectional study

Background The quality of life (QoL) for patients with spinal cord injuries (SCI) is lower than that for healthy individuals. The main purpose of prescribing orthoses for these individuals is to improve their mobility and QoL. The hip knee ankle foot orthosis (HKAFO) has been the conventional choice for such patients, whilst the reciprocating gait orthosis (RGO) is a more contemporary option. Although the impact of these two types of orthoses on the biomechanics of walking has been previously evaluated in patients with SCI, there has been no specific comparison of their relative effects on QoL. Objectives This study aimed to evaluate the Sickness Impact Profile (SIP-68) QoL questionnaire’s total score and its sub-scores in patients with SCIs wearing either RGOs or HKAFOs. Methods This study was performed on 22 participants (11 participants wearing RGOs and 11 wearing HKAFOs). QoL scores were evaluated in each group of patients using the total and sub-scores from the SIP-68 questionnaire. Results There were no significant differences in the total SIP-68 scores between the RGO and HKAFO groups (p = .57). However, emotional stability and emotional independence sub-scores were significantly lower for the RGO users than for the HKAFO users (p = .03 and p = .01), respectively. Conclusions Based upon this preliminary study, participants wearing RGOs or HKAFOs had similar QoL scores. However, those wearing RGOs may experience better emotional stability, communication, and emotional independence. This preliminary study does not provide definite conclusions since a large randomized control trial is required to compare the effects of these orthoses on the QoL scores in patients with SCIs. Implications for rehabilitation Our main aim in the current investigation was to shed light on the question that does the biomechanical superiority of the RGO to the HKAFO leads to better quality of life in SCI subjects who are using RGO. Regarding the fact that the primary goal of rehabilitation of people with SCI is to improve their quality of life, it seems that the more complicated newer orthosis (RGO) has no difference with the older type (HKAFO) in achieving the rehabilitation goals. More studies will in fact be necessary to find a definitive answer for this important question. According to the findings of our study, it seems to be more appropriate to prescribe RGO for male participants with higher body weight.

Emerging electromagnetic interferences between implantable cardioverter-defibrillators and left ventricular assist devices.

AimsTo investigate the prevalence of electromagnetic interference (EMI) between left ventricular assist devices (LVADs) and implantable cardioverter-defibrillators (ICDs)/pacemakers (PMs).Methods and resultsA retrospective single-centre study was conducted, including all patients undergoing HeartMate II (HMII) and HeartMate 3 (HM3) LVAD implantation (n = 106). Electromagnetic interference was determined by the inability to interrogate the ICD/PM. Overall, 85 (mean age 59 ± 8, 79% male) patients had an ICD/PM at the time of LVAD implantation; 46 patients with HMII and 40 patients with HM3. Among the 85 LVAD patients with an ICD’s/PM’s, 11 patients (13%) experienced EMI; 6 patients (15%) with an HMII and 5 patients (11%) with an HM3 (P = 0.59). Electromagnetic interference from the HMII LVADs was only present in patients with a St Jude/Abbott device; 6 of the 23 St Jude/Abbott devices. However, in the HM3 patients, EMI was mainly present in patients with Biotronik devices: 4 of the 18 with only one (1/25) patient with a Medtronic device. While initial interrogation of these devices was not successful, none of the 11 cases experienced pacing inhibition or inappropriate shocks.ConclusionIn summary, the prevalence of EMI between ICDs in the older and newer type of LVAD's remains rather high. While HMII patients experienced EMI with a St Jude/Abbott device (which was already known), HM3 LVAD patients experience EMI mainly with Biotronik devices. Prospective follow-up, preferably in large registries, is warranted to investigate the overall prevalence and impact of EMI in LVAD patients.

Vibrotactile perception on the sole of the foot in an older group of people with normal glucose tolerance and type 2 diabetes.

Objectives:To evaluate vibrotactile sense in an older group of people with normal glucose tolerance and type 2 diabetes relative to other sensory tests.Methods:Vibration perception thresholds on the sole of the foot (Multifrequency vibrametry and Biothesiometer) were compared to the results from evaluation of touch (monofilament), electrophysiology (sural nerve) and thermal sensation (Thermotest®).Results:Vibration perception and temperature thresholds, as well as sural nerve function, differed between normal glucose tolerance and type 2 diabetes. Measuring vibration perception thresholds at lower frequencies with multifrequency vibrametry versus biothesiometer provided correlations similar to sural nerve amplitude. Temperature thresholds correlated with vibration perception thresholds and sural nerve function. Monofilaments revealed pathology in only a few participants with type 2 diabetes.Conclusions:In an older group of people, vibration perception thresholds show a correlation similar to sural nerve amplitude on tactile and non-tactile surfaces. Measuring a vibration perception threshold on a tactile surface in type 2 diabetes provides no clear advantage over measuring it on the medial malleolus. In older type 2 diabetes subjects, both large and small diameter nerve fibers are affected.

Effect of environmental conditions and genotype on nectar secretion in sunflower (Helianthus annuusL.)

The sunflower crop provides an important honey flow for beekeepers. In France, beekeepers observed a decrease in honey yield from this crop these past years compared to the 1980s–1990s. They suspect the new cultivars to be less productive in nectar compared to the older ones, but no data is available to support this, and it is known that climate conditions have a strong impact on nectar secretion. This study aimed to explore the effect of abiotic environmental conditions on nectar secretion in sunflower, as well the range of variation of this secretion in a sample of current cultivars. Thirty-four current sunflower hybrid cultivars were sampled in test plots for their nectar secretion under varying conditions of temperature, air humidity and soil moisture. Air humidity controlled the sugar concentration of nectar, and thus its volume. To study nectar secretion independently from this effect, analyses subsequently focused on nectar sugar mass per floret. The nectar sugar mass increased with temperature up to an optimum of 32 °C, while the variation range of soil water tension was not sufficient to detect an effect on nectar sugar mass. This varied by up to 100% among the 34 cultivars (from 101 to 216 μg sugar per staminate floret in average), with a similar range to those reported in the literature for older cultivars. Likewise, oleic cultivars, a new type introduced since the early 2000s, were found to secrete the same amounts of nectar as linoleic cultivars, an older conventional type. The more self-fertile cultivars also showed no reduction in nectar secretion. Finally, we tested the method that measures the nectar gross secretion rate in one hybrid, and we observed that this hybrid secreted in average 28 μg sugar per hour per staminate floret. The potential benefits of this method were discussed.

Linearized Inverse Schrödinger Potential Problem at a Large Wavenumber

We investigate recovery of the (Schr\"odinger) potential function from many boundary measurements at a large wavenumber. By considering such a linearized form, we obtain a H\"older type stability which is a big improvement over a logarithmic stability in low wavenumbers. Furthermore we extend the discussion to the linearized inverse Schr\"odinger potential problem with attenuation, where an exponential dependence of the attenuation constant is traced in the stability estimate. Based on the linearized problem, a reconstruction algorithm is proposed aiming at the recovery of the Fourier modes of the potential function. By choosing the large wavenumber appropriately, we verify the efficiency of the proposed algorithm by several numerical examples.

Ive Tabar’s Political Body Art Performances

This article is an attempt to define a new paradigm of body use in the medical performances of the Slovenian body artist Ive Tabar. By profession Tabar is a medical technician. Between 1999 and 2007 he enacted four political body art performances in the Kapelica gallery in Ljubljana and Loža in Koper entitled Evropa I, II, III and IV. At first sight these were body art performances of ‘the older type’, in which the body is the site of the performance and which Tabar invasively subjected to various medical instruments and processes. But in actual fact Tabar has enacted a crucial shift in his performative practice related to his attitude to pain: instead of endorsing pain as an ontological condition of the body art practice, he offers us the body as a tool for the political message of the performance.