July 26th, 2008
Obesity is a complex, multifactorial, chronic disease involving environmental (social and cultural), genetic, physiologic, metabolic, behavioral, and sychological components. It has been increasing at an alarming rate throughout the world over the past two decades to the extent that it is now a pandemic, affecting millions of people globally, and it is the second leading cause of preventable death in the United States. The World Health Organization (WHO) has estimated that more than 300 million people are obese worldwide [1].
Obesity is defined as a condition of excess body fat, and it is associated with a large number of debilitating and life-threatening disorders, such as major
increases in associated cardiovascular, metabolic, and other noncommunicable diseases [2]. It also contributes to increased mortality rates from all causes, including cardiovascular diseases (CVDs) and cancer. The obesity prevalence rate increase is evident in Westernized countries, where obesity has been present for decades, but today it is also particularly noticeable in less developed countries that previously had not experienced problems with overweight and obesity. For example, the prevalence of obesity has increased by about 10 to 40% in the majority of European countries in the last decade, and it currently affects nearly one third of the adult American population, as well as three quarters of the adult population living in urban areas of Western Samoa in the Pacific [3]. Obesity in the developing world reflects the profound changes in society over the past 20 to 30 years that have created an environment that promotes a sedentary lifestyle and the consumption of a high-fat, energy-dense diet, collectively known as the nutrition transition . As poor countries
become more prosperous, they acquire some of the benefits as well as some of the problems of industrialized nations, including obesity (Figure 1.1) [4].
Because the direct measurement of body fat is difficult, the body mass index (BMI), a simple weight-to-height ratio (kg/m 2 ), is typically used to classify overweight and obese adults. Consisten with this, the WHO has recently published international standards for classifying overweight and obesity in adults (Table 1.1). Obesity is defined as a BMI ≥ 30 kg/m , but it can be further subdivided on the basis of the severity of the obesity [1].
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July 26th, 2008
The concept of food intake control has become more complex as our understanding of the subject has increased. Decades ago, the generallyaccepted
theory proposed that there was a central controller with two hypothalamic centers, one for hunger and one for satiety. Research has shown that the
control of food intake is the complex result of an integration of humoral and neural signals among peripheral tissues, such as the gastrointestinal tract and
the adipose tissue, and the brain. Peripheral tissues send feedback signals to the brain which act as hormones travelling through the blood via the arcuate
nucleus, or as neurotransmitters via the vagal nerve and the nucleus tractus solitarius.
Neuropeptides from the GI tract, such as cholecystokinin, glucagon-like peptide-1, peptide YY and ghrelin are important biological messengers that
carry information to the brain about the digestive state of ingested food in the bowel lumen.
Adipose tissue signals, such as those from leptin and insulin which relay information to the brain, clearly demonstrate the importance of body fat tissue
in food intake control. All these signals become integrated into a complex system in different, interconnected hypothalamic centers. The arcuate nucleus is a
very important centre in the floor of the third ventricle occupying almost half of the length of the hypothalamus and belonging to the blood brain barrier.
Feedback signals are integrated and distributed to other hypothalamic centers, such as the paraventricular nuclei, ventromedial hypothalamic and dorsomedial hypothalamic nuclei, and the lateral hypothalamic area as well. Central neurotransmitters, such as neuropeptide Y, agouti-gene related peptide, the pro-opiomelanocortin system and the orexins mediate these signals between the different hypothalamic centers. These mechanisms are influenced by the glucose concentration, which is continuously measured by glucose-sensing neurons in the hypothalamus.
The complexity of this regulation system demonstrates the importance of a balance in genetic, social, behavioral and environmental factors that all contribute
to influencing the control of food intake.
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May 11th, 2008
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May 9th, 2008
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May 6th, 2008
C# is built from the ground up to create scalable, dynamic applications for the Microsoft® .NET® platform. For the pages that make up the user interface of a dynamic Web application C# brings Visual Basic-like WYSIWYG design and coding techniques to the Web.
Imagine this: you drag a button from the toolbox and drop it on a form. Double-click the button and your view switches to the code view with your cursor already positioned in the appropriate event handler. As you type, IntelliSense statement completion helps you create error-free code, fast. Sound easy? It is, and you’ve just created a form for the Web.
In this lab, you will use the Web Forms designer in Visual Studio.NET to create dynamic, scalable, browser-independent UI for a Web application using the C# programming language.
Note: There are additional Web Forms exercises in the Data and Debugger labs.
Web Forms Support in Visual Studio.NET
One of the key benefits of the Web Forms framework over ASP is a clean separation of code from the declarative HTML and XML tags that define the visible elements of a page. Visual Studio.NET separates these two components in a .CS file, which contains the logic for the page, and an ASPX file, which contains the HTML and XML tags.
When you open the ASPX file in Visual Studio, the file is displayed using the Web Forms designer. This designer presents two views of the ASPX file. The Design View lets you edit the visual elements of the form using the familiar drag, drop and click techniques used in Visual Basic programming. HTML View permits you to directly manipulate the declarative HTML and XML tags. You can switch between views by clicking the Design and HTML buttons at the bottom of the page.
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May 5th, 2008
XML is great for portable data. If you want a quick way to query XML documents for pieces of data relevant to your application, XPath is a high-performance mechanism to get this done. XPath is specified by W3C and is a general query language specification for extracting information from XML documents. XPath functionality has its own namespace in the .NET Framework. The System.Xml.XPath namespace has four classes that work together to provide efficient XML data searches.
The classes provided by System.Xml.XPath are: XPathDocument, XPathExpression, XPathNavigator, and XPathNodeIterator. XPathDocument is used to cache your XML document in a high-performance oriented cache for XSLT processing. To query this cache, you will need an XPath expression. This can be done with just a string that contains an XPath expression or you can use the XPathExpression class. If you want performance, you will use the XPathExpression class because it compiles once and can be rerun without requiring subsequent compiles. The XPath expression is provided to a select method on the XPathNavigator class. The XPathNavigator object will return an XPathNodeIterator object from executing the Select method. After calling this method, the XPathNodeIterator returned represents the set of selected nodes. You can use MoveNext on the XPathNodeIterator to walk the selected node set.
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May 5th, 2008
The goals of diabetes management are to control blood glucose levels and to screen and treat related conditions such as high blood pressure, lipid abnormalities, high cholesterol, and other complications of diabetes. This means that you will need to
learn how to monitor your blood glucose levels, and you will also have more frequent laboratory tests and visits to your doctor than do people without diabetes. This chapter tells you both how you will monitor your glucose levels and what other
tests your doctor may do to evaluate your diabetes.
Monitoring Glucose Levels
When you have diabetes, your glucose levels fl uctuate much more than those of people without diabetes. In people without diabetes, fasting glucose levels in the morning are usually between 60 and 100 mg/dl. Before each meal, the levels are
below 100 mg/dl. The peak values one to two hours after a meal are in the 120s and usually stay below 140, even after a meal rich in carbohydrates.
With current therapies, it is diffi cult to achieve normal glucose levels when you have diabetes. Even when levels are below 100 mg/dl before meals, they frequently go above the 140 range after meals. This is especially true if you take insulin, in
which case aiming for normal glucose levels can signifi cantly increase the risk of hypoglycemia (see Chapter 7). The only time doctors attempt to achieve normal glucose levels in insulin-treated patients is during pregnancy, when the target for
premeal blood glucose level is 60 to 100 mg/dl, postmeal peak level (usually about one and a half to two hours after a meal) is less than 130 mg/dl, and bedtime and 2 A.M. levels are around 100 mg/dl.
If you are insulin-treated and are not pregnant, your doctor will aim for premeal glucose levels between 90 and 130 mg/dl and postmeal levels less than 180 mg/dl.
These targets are just general guidelines and will vary from person to person. Some people can and do achieve much lower levels, whereas for others these targets are too tight, and they will get unacceptably frequent low glucose reactions.
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Posted in Uncategorized | 298 Comments »
May 5th, 2008
About 50 percent of new cases of type 1 diabetes occur in childhood and adolescence. In fact, over the past twenty years, type 1 diabetes has been occurring earlier in childhood. There has also been an increase in the incidence of type 2 diabetes in childhood. As with diabetes in adults, it is important to distinguish between type 1 and type 2 diabetes because the treatments of the two types are different.
Your Role as a Parent
When you discover that your child has diabetes, you will probably be very upset. Being a parent is hard work in the best of circumstances, and your child’s diabetes will add a whole other dimension to being a parent. You will need to learn everything you can about diabetes in addition to all your other parenting duties. This may be overwhelming, but with patience and perseverance and the support of your child’s diabetes care team, you will be able to help your child manage the disease so that he or she can have the disease but still do all a child needs to do. Your child’s diabe-tes care team (ideally a pediatric endocrinologist, diabetes educator, nutritionist, and psychologist) will help you, your child, and your family learn the following survival skills for managing the diabetes:
How to monitor the glucose levels
How to recognize and treat low and high glucose levels
How to adjust insulin and/or oral medications for foods and exercise
How to treat the diabetes when your child is ill
How to involve other family members, other caregivers, and the staff at
your child’s school
How to transfer responsibilities as your child grows up
more about diabetes
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May 4th, 2008
Type 2 Diabetes
Type 2 diabetes is the most common form of diabetes in the world. It affects about
17 million people in the United States. In the past, it occurred mostly in middleaged
and older individuals, but nowadays it is often seen in younger people, including
children and teenagers. There are more new cases of type 2 diabetes in the
United States than ever before, and there are many reasons for this:
Obesity increases the risk for diabetes, and there has been a dramatic
increase in the prevalence of obesity (number of people who are obese).
The increase in the rate of diabetes parallels the increase in the rate of
obesity .
Diabetes occurs more frequently in older individuals, and the population is
aging.
Ethnic minorities, especially African-Americans, Hispanics, and Asian-
Americans, have a higher risk of type 2 diabetes, and there has been an
increase in these populations in the United States.
There is a heightened awareness of diabetes because it has been widely
reported in the media in recent years, and so people may be diagnosed
earlier than before.
Recent changes in the way diabetes is diagnosed (measuring fasting
glucose rather than doing a two-hour oral glucose tolerance test) have also
made it easier to diagnose diabetes.
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