Predicting changes in lifestyle and clinical outcomes in preventing diabetes: the Greater Green Triangle Diabetes Prevention Project

Objectives

To analyse how psychosocial determinants of lifestyle changes targeted in the Greater Green Triangle Diabetes Prevention Project conducted in Southeast Australia in 2004-2006 predict changes in dietary behaviour and clinical risk factors.

Methods

A longitudinal pre-test and post-test study design was used. The group program was completed by 237 people at high risk of type 2 diabetes. Associations between changes in the variables were examined by structural equation modelling using a path model in which changes in psychological determinants for lifestyle predicted changes in dietary behaviours (fat and fibre intake), which subsequently predicted changes in waist circumference and other clinical outcomes. Standardised regression weights are presented, with β = ± 0.1 and β = ± 0.3 representing small and medium associations, respectively.

Results

Improvements in coping self-efficacy and planning predicted improvements in fat (β = − 0.15, p < 0.05 and β = − 0.32, p < 0.001, respectively) and fibre intake (β = 0.15, p < 0.05 and β = 0.23, p < 0.001, respectively) which in turn predicted improvements in waist circumference (β = 0.18, p < 0.01 and β = − 0.16, p < 0.05, respectively). Improvements in waist circumference predicted improvements in diastolic blood pressure (β = 0.13, p < 0.05), HDL (β = − 0.16, p < 0.05), triglycerides (β = 0.17, p < 0.01), and fasting glucose (β = 0.15, p < 0.05).

Conclusions

Psychological changes predicted behaviour changes, resulting in 12-month biophysical changes. The findings support the theoretical basis of the interventions.     

Oncodevelopmental alpha-fetoprotein acts as a selective proangiogenic factor on endothelial cell from the fetomaternal unit

The molecular coordination between angiogenesis and vascular remodeling is a critical step for the development of a functional vasculature in the placenta and the uterus during pregnancy. The oncodevelopmental albumin homolog alpha-fetoprotein (AFP) is mainly synthesized in the developing fetus, and its expression has been found to be associated with highly vascularized tumors in the adult. In this study, we investigated the angiogenic activity of AFP and its possible role in the fetomaternal unit. Immunohistochemical studies revealed that the AFP-binding protein(s) is expressed in blood vessels of chorionic villi from placentae of the second and the third but not of the first trimester during pregnancy. At low concentrations, AFP directly stimulates or enhances, respectively, vascular endothelial growth factor-induced proliferation and sprout formation of endothelial cells isolated from the placenta and the uterus possibly by a MAPK-dependent pathway. Furthermore, AFP enhances blood vessel formation in a chick chorioallantoic membrane assay in vivo. Interestingly, AFP has no proliferative or migratory effects on endothelial cells isolated from the umbilical vein in the absence of vascular endothelial growth factor. These data indicate that AFP may act as a specific proangiogenic factor of endothelial cells within the fetomaternal unit during advanced stages in pregnancy.     

Obesity is a risk factor for developing critical condition in COVID‐19 patients: A systematic review and meta‐analysis

The disease course of COVID‐19 varies from asymptomatic infection to critical condition leading to mortality. Identification of prognostic factors is important for prevention and early treatment. We aimed to examine whether obesity is a risk factor for the critical condition in COVID‐19 patients by performing a meta‐analysis. The review protocol was registered onto PROSPERO (CRD42020185980). A systematic search was performed in five scientific databases between 1 January and 11 May 2020. After selection, 24 retrospective cohort studies were included in the qualitative and quantitative analyses. We calculated pooled odds ratios (OR) with 95% confidence intervals (CIs) in meta‐analysis. Obesity was a significant risk factor for intensive care unit (ICU) admission in a homogenous dataset (OR = 1.21, CI: 1.002‐1.46; I2 = 0.0%) as well as for invasive mechanical ventilation (IMV) (OR = 2.05, CI: 1.16‐3.64; I2 = 34.86%) in COVID‐19. Comparing body mass index (BMI) classes with each other, we found that a higher BMI always carries a higher risk. Obesity may serve as a clinical predictor for adverse outcomes; therefore, the inclusion of BMI in prognostic scores and improvement of guidelines for the intensive care of patients with elevated BMI are highly recommended.     

Optoelectronic,femtosecond nonlinear optical properties and excited state dynamics of a triphenyl imidazole induced phthalocyanine derivative

A novel zinc phthalocyanine derivative [2(3), 9(10), 16(17), 23(24) tetrakis-4-((4-(1,4,5-triphenyl-1H-imidazol-2-yl)phenyl)ethynyl)phthalocyanine zinc(ii) (PBIPC)] was synthesized by incorporating a triphenyl imidazole moiety at its peripheral positions. The detailed mechanisms of absorption, emission, electrochemical, nonlinear optical (NLO) and photophysical (excited state dynamics) properties of PBIPC were explored. The absorption and emission properties of the compound were studied in different solvents. The incorporation of a triphenyl imidazole moiety at the peripheral position of the zinc phthalocyanine slightly broadened the Soret band. The emission studies revealed fluorescence quantum yields to be in the range of 0.11–0.22. The time-resolved fluorescence data established the radiative lifetimes to be in the nanosecond range. The oxidation and reduction processes were found to be ring centered, which were studied using the cyclic voltammetry (CV) technique. The energy optimized structures and HOMO–LUMO levels were calculated using DFT, TD-DFT analysis and were employed by means of hybrid functional theory (B3LYP) at 6-31G (d,p) basis set in the Gaussian 09 package. Two-photon absorption was observed in the NLO studies performed in the visible wavelength range of 600–800 nm while the nonlinear absorption was dominated by three- and four-photon absorption processes in the NIR wavelength range (1.0–1.5 μm). The molecule exhibited self-focusing behavior for all the wavelengths. Finally, the excited state dynamics of the title molecule PBIPC were investigated using femtosecond transient absorption spectroscopy and the results obtained were understood on the basis of a simple three kinetic model, for excitation wavelengths of 400 nm (Soret band) and 650 nm (Q-band). Both the spectra demonstrated a broad positive transient absorption (TA) data which overlapped with the ground state bleach (GSB), which in turn displayed a red shift over a delay of ∼2 ns. The lifetimes revealed a possibility of intersystem crossing (τ > 1 ns) owing to the triplet state transition.

A novel zinc phthalocyanine derivative PBIPC was synthesized by incorporating a triphenyl imidazole moiety at its peripheral positions.     

Premature compared with late onset of coronary artery disease: young patients show a severe defect in fibrinolytic response to venous occlusion.

Inflammatory processes play a role in the onset of acute cardiovascular events associated with activation of the coagulation system whereas the fibrinolytic system may prevent local thrombus formation. We compared 25 patients with premature coronary artery disease (CAD) (first ST-elevation myocardial infarction, < 55 years old) with 25 sex-matched patients older than 55 years at their first myocardial infarction. Six months after the acute event, patients with late onset of CAD showed a significantly higher increase of tissue-type plasminogen activator activity during venous occlusion compared with patients with premature CAD (P < 0.005). Prothrombin fragment 1+2 was higher in patients with late-onset CAD (P < 0.05), whereas the inflammatory markers C-reactive protein and soluble intercellular cell adhesion molecule-1 were not different in both groups. A multivariate analysis including cardiovascular risk factors showed that the tissue-type plasminogen activator response to venous occlusion was independently associated with patient age at onset of first ST-elevation myocardial infarction. Although in our series high age was associated with a prothrombotic state, a high fibrinolytic capacity might have some beneficial effect and contribute to a delayed onset of adverse cardiovascular events in these patients.     

Environmental Impact of Trace Element Emissions from Geothermal Power Plants

Concentrations of several trace elements were determined in mosses, higher plants and organs of small mammals from a geothermal area in Tuscany (central Italy). Increased deposition of Hg, As, B, and Sb was detected in biological samples collected within a few hundred meters of geothermal power plants. Among the species considered, the moss Hypnum cupressiforme was the most efficient accumulator of trace elements. Contamination levels in a fodder-plant (Hedysarum coronarium) and vegetables grown in the geothermal field did not seem to pose health risks for consumers. However, a statistically significant increase in Hg, B, and As concentrations was found in the kidney and muscle of small mammals living close to geothermal installations. Biological effects of B pollution were detected in two sensitive plant species. In view of plans to increase the exploitation of geothermal resources in the area, adequate measures to monitor the environment should be taken. Mosses are the most suitable accumulative biomonitors for a surveillance network, and studies on small mammal populations should be intensified. Available technologies should be used to diminish atmospheric emissions from geothermal power plants. Received: 12 December 1996/Revised: 27 March 1997     

Emphasis of spatial cues in the temporal fine structure during the rising segments of amplitude-modulated sounds

The ability to locate the direction of a target sound in a background of competing sources is critical to the survival of many species and important for human communication. Nevertheless, brain mechanisms that provide for such accurate localization abilities remain poorly understood. In particular, it remains unclear how the auditory brain is able to extract reliable spatial information directly from the source when competing sounds and reflections dominate all but the earliest moments of the sound wave reaching each ear. We developed a stimulus mimicking the mutual relationship of sound amplitude and binaural cues, characteristic to reverberant speech. This stimulus, named amplitude modulated binaural beat, allows for a parametric and isolated change of modulation frequency and phase relations. Employing magnetoencephalography and psychoacoustics it is demonstrated that the auditory brain uses binaural information in the stimulus fine structure only during the rising portion of each modulation cycle, rendering spatial information recoverable in an otherwise unlocalizable sound. The data suggest that amplitude modulation provides a means of “glimpsing” low-frequency spatial cues in a manner that benefits listening in noisy or reverberant environments.Human listeners are able to determine the location of a talker against a background of competing voices, even in rooms where walls generate reflections that, taken together, can be more intense than sounds arriving directly from the source. The dominant cues for localization in such complex sound fields are the interaural time differences (ITDs) conveyed in the temporal fine structure (TFS) of low-frequency (<1,500 Hz) sounds (1); normal-hearing listeners can discriminate ITDs as low as 10–20 µs in 500- and 1,000-Hz pure tones to judge the source location (2). In addition to source localization—the focus of the current study—sensitivity to ITDs is also reported to contribute to “spatial unmasking”: different spatial configurations of the signal and background noise enable sources to be heard out, increasing their intelligibility (3, 4).The majority of real-world sounds are strongly modulated in amplitude. Without these modulations humans are completely insensitive to the sound source location after its onset in reverberant environments [the Franssen effect (5)]. Human speech, for example, contains amplitude modulation (AM) rates ranging from those of syllables and phonemes to those conveying information about voice pitch (i.e., from 2 Hz up to about 300 Hz). These modulations act as potent grouping cues, enabling listeners to fuse sounds originating from a single talker, segregating them from competing talkers (6). Despite the importance of AM in real-world listening, however, behavioral measures of ITD sensitivity are commonly assessed for stimuli in which the amplitude is unmodulated. This is especially so when the focus of interest concerns ITDs conveyed in the TFS.Fig. 1 illustrates the signals from a modulated, speech-like sound source arriving at the left and right ears in a listening environment comprising two reflecting walls. Whereas the direct sound arrives from the left-hand side, the two reflections arrive 4 and 8 ms later from the right. Despite the time-averaged interaural cues suggesting a sound originating from the right, listeners perceive this sound to originate from the left.^* Extracting the ITD information from the TFS reveals that left-leading ITDs, corresponding to the true origin of the source, appear reliably, albeit briefly, following each energy minimum in the modulated waveform, whereas other segments, including the modulation peaks, are dominated by right-leading ITDs. Based simply on the average ITD, therefore, it is not self-evident why listeners robustly perceive this sound to originate from the left.Open in a separate windowFig. 1.Acoustic properties of a spoken trilled <r>, low-pass–filtered at 800 Hz, to focus on temporal fine structure ITD. (A) Spatial configuration obtained by virtual acoustics. Direct sound presented from −30° (left leading), together with two delayed copies from the right (+65°; 4-ms delay and +130°, 8-ms delay). The signal has a negative direct-to-reverberant ratio [−4 dB; mean ILD: +3 dB (right louder); mean ITD: +140 µs (right leading)] and an even larger amplitude weighted mean ITD (+252 µs). It might, therefore, come as unexpected that informal tests revealed for all 10 participants a localization of the sound toward the left hand side, similar to the direct sound presented without reverberation. The envelope slope weighted mean ITD (−197 µs) appears to be a better indicator for perceived localization. (B) Acoustic signals at the left and right ear. The regular modulation pattern with ∼45-ms cycle duration is evident. Because the ITD cannot be identified by eye at this scale, the sign of the ITD is indicated by color-coding the Hilbert envelope (pale blue for left-leading ITDs and pale red for right-leading ITDs while within the human physiological range of ±700 μs). The ITD is consistently left-leading at the beginning of each cycle but right-leading during the peak or end of the modulation cycle. (C) A magnified three-cycle segment from B is replotted together with the ITD (green). In this resolution, the fine-structure phase is visible. ITDs outside of the physiologic range occur during incoherent segments and are not plotted. (D) The same segment as in C but without any reflections; only the sound directly from the source arrives at the ears. A constant left-leading ITD is visible.Although studies of spatial hearing suggest a perceptual dominance of early-arriving acoustic information (7), the nondeterministic (and ongoing) nature of speech waveforms considerably complicates assessment of which sound segments underpin its localization. Investigations into the related precedence effect (8) have tended to use pairs (or trains) of transient “clicks” (8, 9) to assess the dominance of the first wave front, but these stimuli have a very different temporal modulation compared with continuous speech signals. Here, we developed a class of stimuli [amplitude-modulated binaural beats (AMBBs)] designed to mimic the variation of ITD in the TFS for sounds heard in complex listening environments (such as that in Fig. 1). AMBBs enable a quantitative analysis of the time-dependent ITD sensitivity of ongoing sounds in the absence of spatial cues associated with the stimulus envelope. The unique property of the AMBB is that the rate at which the sound amplitude is modulated is identical to the binaural beat rate [i.e., each AM cycle accommodates a full 360° rotation in interaural phase difference (IPD)]. By these means, each position within the AM cycle corresponds to a specific IPD (Fig. 2). This common rate of AM and binaural beating is referred to as the AMBB frequency.Open in a separate windowFig. 2.Waveform of the AMBB stimulus; 500-Hz sinusoidally amplitude-modulated tone with a 32-Hz beat frequency and AM rate. (A) Full waveform of one channel. (B) A 45-ms segment of the AMBB from A: f_left < f_right with “start IPD” at modulation minimum IPD_Start = 0. The left channel is in blue, and the right channel is in red. The color of the envelope indicates the sign of the instantaneous IPD (blue, left leading; red, right leading). Some values of the instantaneous IPD are plotted over the signals. All subjects perceived such a stimulus clearly from the right as indicated by the dot within the cranial diagram. (C) Same format as B but now with IPD_Start = −90°. In this particular case, the IPD is right-leading when the amplitude is large (>0.5) and left-leading when the amplitude is small (<0.5). Most subjects perceive this stimulus slightly to the left even though the stimulus intensity is low during left-leading IPDs.The correlated change in IPD and the phase of the AM is typical of reverberant speech (e.g., Fig. 1) and is designed to mimic the rapid changes in ITD commonly encountered in reverberant listening. To this end, AMBBs provide highly controlled means for assessing those moments in time at which the ITD is read out from amplitude-modulated sounds.Note that for beat rates above about 2 Hz, neither binaural beats nor AM alone elicits a lateralized percept in human listeners. The unmodulated binaural beat is perceived as having a diffuse intracranial image (10, 11), whereas diotic AM, in the absence of a binaural beat, obviously favors neither left nor right lateralization. With both binaural beating and AM in combination, however, the resulting AMBB can elicit a compact intracranial image with a lateralization percept that depends on the phase relationship between the AM and binaural beat.     

Transplantation related toxicity and mortality in older autologous hematopoietic cell transplantation recipients

With advances in supportive care, autologous hematopoietic cell transplant (AHCT) is increasingly being performed for patients older than 60 years. We analyzed patients receiving an AHCT for multiple myeloma or lymphoma in a contemporary cohort (2010–2012), with consistent treatment and supportive care and compared outcomes [CTCAE grade 3–5 toxicities, nonrelapse mortality (NRM) and overall‐survival (OS)] of younger (40–59 years, n = 77) versus older (≥60 years, n = 67) recipients. The proportion of patients with neutropenic infections was higher in the older group (64% vs. 44%; P = 0.02). The proportion of patients with any grade 3–5 toxicity was also higher in the older group (84% vs. 67%, P = 0.03). In multivariate analysis, older age was significantly associated with higher odds (OR: 2.57, 95% CI:1.09–6.05) of grade 3–5 toxicity. The NRM was 3% (older) vs. 0% (younger) at 1 year. The probability of OS at 2 years was lower in the older group (76% vs. 90%, P = 0.04). Though AHCT can be performed safely in older recipients, the higher toxicity and slightly higher NRM in this population needs attention. Studies focusing on risk‐stratification in older patients would further help predict toxicity. Further studies addressing enhanced supportive care needs for older patients who are most likely to benefit are indicated.