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OBJECTIVES/GOALS: The impact of baseline BMI on glycemic response to group medical visits (GMV) and weight management (WM)-based interventions is unclear. Our objective is to determine how baseline BMI class impacts patient responses to GMV and interventions that combine WM/GMV. METHODS/STUDY POPULATION: We will perform a secondary analysis of Jump Start, a randomized, controlled trial that compared the effectiveness of a GMV-based low carbohydrate diet-focused WM program (WM/GMV) to traditional GMV-based medication management (GMV) on diabetes control. The primary and secondary outcomes will be change in hemoglobin A1c (HbA1c) and weight at 48 months, respectively. Study participants will be stratified into BMI categories defined by BMI 27-29.9kg/m2, 30.0-34.9kg/m2, 35.0-39.9kg/m2, and ≥40.0kg/m2. Hierarchical mixed models will be used to examine the differential impact of the WM/GMV intervention compared to GMV on changes in outcomes by BMI class category. RESULTS/ANTICIPATED RESULTS: Jump Start enrolled 263 overweight Veterans (BMI ≥ 27kg/m2) with type 2 diabetes. At baseline, mean BMI was 35.3 and mean HbA1c was 9.1. 14.5% were overweight (BMI 27–29.9) and 84.5% were obese (BMI ≥ 30). The proposed analyses are ongoing. We anticipate that patients in the higher BMI obesity classes will demonstrate greater reductions in HbA1c and weight with the WM/GMV intervention relative to traditional GMV. DISCUSSION/SIGNIFICANCE OF IMPACT: This work will advance the understanding of the relationship between BMI and glycemic response to targeted interventions, and may ultimately provide guidance for interventions for type 2 diabetes.
Detrital zircon populations from six samples of upper Triassic sandstone (Algarve Basin) were analysed, yielding mostly Precambrian ages. zircon age populations of the Triassic sandstone sampled from the western and central sectors of the basin are distinct, suggesting local recycling and/or lateral changes in their sources. Our findings and the available detrital zircon ages from the Palaeozoic terranes of SW Iberia, Nova Scotia and NW Morocco were jointly examined using the Kolmogorov–Smirnov test and multidimensional scaling diagrams. The obtained results enable direct discrimination of competing Laurussian-type and Gondwanan-type sediment sources, involving recycling and mixing relationships. The detrital zircon populations of the Algarve Triassic sandstone are very different from those of the lower–upper Carboniferous Mértola and Mira formations (South Portuguese Zone), upper Devonian – lower Carboniferous Horta da Torre, Represa and Santa Iria formations (Pulo do Lobo Zone), and the late Carboniferous Santa Susana and early Permian Viar basins, which are ruled out as potential sources. The detrital zircon populations of Triassic sandstone from the central sector and those from the Ossa–Morena Zone Ediacaran–Cambrian siliciclastic rocks, upper Devonian – Carboniferous Ronquillo, Tercenas, Phyllite-Quartzite and Brejeira formations (South Portuguese Zone), and Frasnian siliciclastic rocks of the Pulo do Lobo Zone are not statistically distinguishable. Thus, sedimentation in the central sector was influenced by Gondwanan- and Laurussian-type putative sources exposed in SW Iberia, in contrast to the western sector, where Meguma Terrane and Sehoul Block Cambrian siliciclastic rocks allegedly constituted the main (Laurussian-type) sources. These findings provide insights into the denudation of distinctive source terranes distributed along the late Palaeozoic suture zone that juxtaposed the Laurussian and Gondwanan margins.
The transition to turbulence in Taylor–Couette flow often occurs via a sequence of supercritical bifurcations to progressively more complex, yet stable, flows. We describe a subcritical laminar–turbulent transition in the counter-rotating regime mediated by a transient intermediate state in a system with an axial aspect ratio of
and a radius ratio of
. In this regime, flow visualization experiments and numerical simulations indicate the intermediate state corresponds to an aperiodic flow featuring interpenetrating spirals. Furthermore, the reverse transition out of turbulence leads first to the same intermediate state, which is now stable, before returning to an azimuthally symmetric laminar flow. Time-resolved tomographic particle image velocimetry is used to characterize the experimental flows; these measurements compare favourably to direct numerical simulations with axial boundary conditions matching those of the experiments.
To investigate the nutrition education provided by primary-care physicians (PCP).
An integrative review was used to examine literature on nutrition care provided by PCP from 2012 to 2018. A literature search was conducted in MEDLINE, PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL) and Scopus using key search terms.
USA, Netherlands, Germany, Denmark, UK, Lebanon, Australia and New Zealand.
Sixteen qualitative and quantitative studies were analysed thematically using meta-synthesis informed by the COM-B model of behaviour (capability, motivation and opportunity), to understand the influences on PCP behaviours to provide nutrition care. PCP perceive that they lack nutrition capability. While PCP motivation to provide nutrition care differs based on patient characteristics and those of their own, opportunity is influenced by medical educators, mentors and policy generated by professional and governmental organisations.
The development of PCP capability, motivation and opportunity to provide nutrition care should begin in undergraduate medical training, and continue into PCP training, to create synergy between these behaviours for PCP to become confident providing nutrition care as an integral component of disease prevention and management in contemporary medical practice.
A new fossil site in a previously unexplored part of western Madagascar (the Beanka Protected Area) has yielded remains of many recently extinct vertebrates, including giant lemurs (Babakotia radofilai, Palaeopropithecus kelyus, Pachylemur sp., and Archaeolemur edwardsi), carnivores (Cryptoprocta spelea), the aardvark-like Plesiorycteropus sp., and giant ground cuckoos (Coua). Many of these represent considerable range extensions. Extant species that were extirpated from the region (e.g., Prolemur simus) are also present. Calibrated radiocarbon ages for 10 bones from extinct primates span the last three millennia. The largely undisturbed taphonomy of bone deposits supports the interpretation that many specimens fell in from a rock ledge above the entrance. Some primates and other mammals may have been prey items of avian predators, but human predation is also evident. Strontium isotope ratios (87Sr/86Sr) suggest that fossils were local to the area. Pottery sherds and bones of extinct and extant vertebrates with cut and chop marks indicate human activity in previous centuries. Scarcity of charcoal and human artifacts suggests only occasional visitation to the site by humans. The fossil assemblage from this site is unusual in that, while it contains many sloth lemurs, it lacks ratites, hippopotami, and crocodiles typical of nearly all other Holocene subfossil sites on Madagascar.
Exploring language, culture and education among immigrants in the United States, this volume discusses the range of experiences in raising children with more than one language in major ethno-linguistic groups in New York. Research and practice from the fields of speech-language pathology, bilingual education, and public health in immigrant families are brought together to provide guidance for speech-language pathologists in differentiating language disorders from language variation, and for parents on how to raise their children with more than one language. Commonalities among dissimilar groups, such as Chinese, Korean, and Hispanic immigrants are analyzed, as well as the language needs of Arab-Americans, the home literacy practices of immigrant parents who speak Mixteco and Spanish, and the crucial role of teachers in bridging immigrants' classroom and home contexts. These studies shed new light on much-needed policy reforms to improve the involvement of culturally and linguistically diverse families in decisions affecting their children's education.
Objectives: Previous research has demonstrated an association between emotion recognition and apathy in several neurological conditions involving fronto-striatal pathology, including Parkinson’s disease and brain injury. In line with these findings, we aimed to determine whether apathetic participants with early Huntington’s disease (HD) were more impaired on an emotion recognition task compared to non-apathetic participants and healthy controls. Methods: We included 43 participants from the TRACK-HD study who reported apathy on the Problem Behaviours Assessment – short version (PBA-S), 67 participants who reported no apathy, and 107 controls matched for age, sex, and level of education. During their baseline TRACK-HD visit, participants completed a battery of cognitive and psychological tests including an emotion recognition task, the Hospital Depression and Anxiety Scale (HADS) and were assessed on the PBA-S. Results: Compared to the non-apathetic group and the control group, the apathetic group were impaired on the recognition of happy facial expressions, after controlling for depression symptomology on the HADS and general disease progression (Unified Huntington’s Disease Rating Scale total motor score). This was despite no difference between the apathetic and non-apathetic group on overall cognitive functioning assessed by a cognitive composite score. Conclusions: Impairment of the recognition of happy expressions may be part of the clinical picture of apathy in HD. While shared reliance on frontostriatal pathways may broadly explain associations between emotion recognition and apathy found across several patient groups, further work is needed to determine what relationships exist between recognition of specific emotions, distinct subtypes of apathy and underlying neuropathology. (JINS, 2019, 25, 453–461)