Guideline concordant care for acute low back pain: A mixed-methods analysis of determinants of implementation.

Introduction: We conducted an explanatory, sequential mixed-methods study to measure variation in the use of imaging and physical therapy (PT) for acute low back pain (LBP) and to identify implementation determinants that might explain variation in use across 22 EDs and 27 urgent cares in urban and rural locations within a community-based health system.

Methods: We described the patient population and measured concordance with LBP guideline recommendations on imaging and PT referral from January-June 2023. We conducted key informant interviews with physicians and advanced practice providers (APPs), n = 30, from these 49 sites between July - September 2023 and performed content analysis to identify implementation determinants to guideline concordance.

Finding phylogeny-aware and biologically meaningful averages of metagenomic samples: L2UniFrac.

Motivation: Metagenomic samples have high spatiotemporal variability. Hence, it is useful to summarize and characterize the microbial makeup of a given environment in a way that is biologically reasonable and interpretable. The UniFrac metric has been a robust and widely used metric for measuring the variability between metagenomic samples.

Finding phylogeny-aware and biologically meaningful averages of metagenomic samples: UniFrac.

Metagenomic samples have high spatiotemporal variability. Hence, it is useful to summarize and characterize the microbial makeup of a given environment in a way that is biologically reasonable and interpretable. The UniFrac metric has been a robust and widely-used metric for measuring the variability between metagenomic samples.

Bile acid metabolism is altered in those with insulin resistance after gestational diabetes mellitus.

Background: Bile acids (BAs) are known mediators of glucose metabolism that are altered in type 2 diabetes mellitus (T2DM) and gestational diabetes mellitus (GDM). We hypothesised that post-prandial BA fractions are changed in women with Insulin resistance (IR) after recovery from GDM using homeostatic model assessment (HOMA-IR).

Methods: 45 women median age 44(31-47) with previous GDM, including 20 with HOMA-IR >2.

Metformin in non-diabetic hyperglycaemia: the GLINT feasibility RCT.

Background: The treatment of people with diabetes with metformin can reduce cardiovascular disease (CVD) and may reduce the risk of cancer. However, it is unknown whether or not metformin can reduce the risk of these outcomes in people with elevated blood glucose levels below the threshold for diabetes [i.e.

Canopy of advantage: Who benefits most from city trees?

Urban tree canopy provides a suite of ecological, social, and economic benefits to the residents of urban areas. With an expanding recognition of these benefits among city residents, there is growing concern that access to these benefits is not distributed equally and may represent the presence of an environmental injustice. This study examines the spatial relationship between median household income and tree canopy variables, specifically realized tree canopy cover and potential tree canopy cover, for Toronto, Canada.

De-icing salt contamination reduces urban tree performance in structural soil cells.

Salts used for de-icing roads and sidewalks in northern climates can have a significant impact on water quality and vegetation. Sub-surface engineering systems, such as structural soil cells, can regulate water runoff and pollutants, and provide the necessary soil volume and irrigation to grow trees. However, the ability of such systems to manage de-icing salt contamination, and the impact of this contamination on the trees growing in them, have not been evaluated.

Forecasting Urban Forest Ecosystem Structure, Function, and Vulnerability.

The benefits derived from urban forest ecosystems are garnering increasing attention in ecological research and municipal planning. However, because of their location in heterogeneous and highly-altered urban landscapes, urban forests are vulnerable and commonly suffer disproportionate and varying levels of stress and disturbance. The objective of this study is to assess and analyze the spatial and temporal changes, and potential vulnerability, of the urban forest resource in Toronto, Canada.

Neighbourhood-scale urban forest ecosystem classification.

Urban forests are now recognized as essential components of sustainable cities, but there remains uncertainty concerning how to stratify and classify urban landscapes into units of ecological significance at spatial scales appropriate for management. Ecosystem classification is an approach that entails quantifying the social and ecological processes that shape ecosystem conditions into logical and relatively homogeneous management units, making the potential for ecosystem-based decision support available to urban planners. The purpose of this study is to develop and propose a framework for urban forest ecosystem classification (UFEC).

Expanding the Clinical Spectrum Associated With GLIS3 Mutations.

Context: GLIS3 (GLI-similar 3) is a member of the GLI-similar zinc finger protein family encoding for a nuclear protein with 5 C2H2-type zinc finger domains. The protein is expressed early in embryogenesis and plays a critical role as both a repressor and activator of transcription. Human GLIS3 mutations are extremely rare.

Polymorphic differences in the SOD-2 gene may affect the pathogenesis of nephropathy in patients with diabetes and diabetic complications.

Unlabelled: The effective treatment of diabetes and the prevention of diabetic complications may be improved by a better understanding of the antioxidant function of intracellular defences against oxidative stress. Polymorphisms in antioxidant genes may determine cellular oxidative stress levels as a primary pathogenic role in diabetes and/or in its complications. SOD-2 was investigated in patients with type 1 diabetes mellitus (T1DM) to ascertain if specific genotypes have any protective influences in the pathogenic mechanisms in diabetes and/or in several different complications, including retinopathy, nephropathy and diabetic controls compared to normal healthy controls.

Vegetation placement for summer built surface temperature moderation in an urban microclimate.

Urban vegetation can mitigate increases in summer air temperature by reducing the solar gain received by buildings. To quantify the temperature-moderating influence of city trees and vine-covered buildings, a total of 13 pairs of temperature loggers were installed on the surfaces of eight buildings in downtown Toronto, Canada, for 6 months during the summer of 2008. One logger in each pair was shaded by vegetation while the other measured built surface temperature in full sunlight.

p21(WAF1/CIP1) Expression is Differentially Regulated by Metformin and Rapamycin.

The mammalian target of rapamycin (mTOR) pathway plays an important role in the development of diabetic nephropathy and other age-related diseases. One of the features of DN is the elevated expression of p21(WAF1/CIP1). However, the importance of the mTOR signalling pathway in p21 regulation is poorly understood.

AKR1B10 is induced by hyperglycaemia and lipopolysaccharide in patients with diabetic nephropathy.

Aldose reductase family member B10 (AKR1B10) belongs to the aldo-keto reductase gene superfamily and is closely related to aldose reductase (AKR1B1). It has been shown that AKR1B10 is present in many of the same human tissues as AKR1B1. The objective of this study was to investigate whether AKR1B10 has a role in diabetic nephropathy (DN) by investigating its response to high glucose and inflammation, both of which have been associated with the development and progression of DN.

Raising awareness of polycystic ovary syndrome.

Aim: To identify women's experience of receiving information about polycystic ovary syndrome (PCOS), and develop an information booklet.

Method: Women from Cornwall with a diagnosis of PCOS participated in focus groups to discuss their experiences of the condition.

Findings: Participants described difficulties in sourcing credible and helpful information about PCOS.

Hydrogen sulfide induces heme oxygenase-1 in human kidney cells.

Hydrogen sulfide (H2S) has been shown to have a potential protective role in a number of disease states including diabetes and various kidney disorders; however, the mechanisms involved are still unclear. The aim of this study was to investigate if H2S effects the expression of the antioxidant enzyme heme oxygenase-1 (HO-1) in human kidney cells. Human mesangial cells and human podocytes were cultured at normal physiological glucose concentration (5.

A spatio-temporal index for heat vulnerability assessment.

The public health consequences of extreme heat events are felt most intensely in metropolitan areas where population density is high and the presence of the urban heat island phenomenon exacerbates the potential for prolonged exposure. This research develops an approach to map potential heat stress on humans by combining temperature and relative humidity into an index of apparent temperature. We use ordinary kriging to generate hourly prediction maps describing apparent temperature across the Greater Toronto Area, Canada.

Structure of a forested urban park: implications for strategic management.

Informed management of urban parks can provide optimal conditions for tree establishment and growth and thus maximize the ecological and aesthetic benefits that trees provide. This study assesses the structure, and its implications for function, of the urban forest in Allan Gardens, a 6.1 ha downtown park in the City of Toronto, Canada, using the Street Tree Resource Analysis Tool for Urban Forest Managers (STRATUM).

Type 2 diabetes and cardiovascular disease in polycystic ovary syndrome: what are the risks and can they be reduced?

Polycystic ovary syndrome (PCOS) is a risk factor for Type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD), but these risks are poorly defined. This study aimed to evaluate the evidence for these risks and whether screening and risk reduction are feasible. Medline reviews and data quality analysis were used using standard tools.

The effect of closed-kinetic chain exercises and open-kinetic chain exercise on the muscle activity of vastus medialis oblique and vastus lateralis.

Patellofemoral pain syndrome (PFPS) is one of the most prevalent musculoskeletal conditions of the lower limb. The muscle imbalance between the vastus medialis oblique (VMO) and vastus lateralis (VL) muscles is one of the main factors leading to the development of PFPS. The disparity in research and the necessity to add to the existing literature base led to the development of this study.

A predominantly neolithic origin for European paternal lineages.

The relative contributions to modern European populations of Paleolithic hunter-gatherers and Neolithic farmers from the Near East have been intensely debated. Haplogroup R1b1b2 (R-M269) is the commonest European Y-chromosomal lineage, increasing in frequency from east to west, and carried by 110 million European men. Previous studies suggested a Paleolithic origin, but here we show that the geographical distribution of its microsatellite diversity is best explained by spread from a single source in the Near East via Anatolia during the Neolithic.

Assessing the impact of a new delivery method of insulin on glycemic control using a novel trial design.

Objective: The purpose of the trial was to examine the impact of inhaled human insulin (INH) on patient or physician willingness to adopt insulin after oral diabetes agent failure.

Research Design And Methods: The EXPERIENCE trial was a one-year randomized controlled trial conducted at primary, secondary and tertiary care facilities in Europe and North America. The primary study endpoint was difference in glycated hemoglobin (A(1c)) between randomized groups at 26 weeks, and results from that phase have been reported previously.

The effect of the availability of inhaled insulin on glycaemic control in patients with Type 2 diabetes failing on oral therapy: the evaluation of Exubera as a therapeutic option on insulin initiation and improvement in glycaemic control in clinical practice (EXPERIENCE) trial.

Aim: To examine the impact of inhaled human insulin (Exubera, EXU) on patient or physician willingness to adopt insulin after oral glucose-lowering agent failure.

Methods: During a randomized controlled trial in primary, secondary and tertiary care in Europe and North America, 739 patients using >or= 2 oral glucose-lowering agents with glycated haemoglobin (HbA(1c)) >or= 8.0% were assigned to two treatment groups: Group 1 (standard care with the option of EXU) or Group 2 (standard care only).