Diploid genome assembly of the Malbec grapevine cultivar enables haplotype-aware analysis of transcriptomic differences underlying clonal phenotypic variation.

To preserve their varietal attributes, established grapevine cultivars (Vitis vinifera L. ssp. vinifera) must be clonally propagated, due to their highly heterozygous genomes. Malbec is a France-originated cultivar appreciated for producing high-quality wines and is the offspring of cultivars Prunelard and Magdeleine Noire des Charentes. Here, we have built a diploid genome assembly of Malbec, after trio binning of PacBio long reads into the two haploid complements inherited from either parent. After haplotype-aware deduplication and corrections, complete assemblies for the two haplophases were obtained with a very low haplotype switch-error rate (<0.025). The haplophase alignment identified > 25% of polymorphic regions. Gene annotation including RNA-seq transcriptome assembly and ab initio prediction evidence resulted in similar gene model numbers for both haplophases. The annotated diploid assembly was exploited in the transcriptomic comparison of four clonal accessions of Malbec that exhibited variation in berry composition traits. Analysis of the ripening pericarp transcriptome using either haplophases as a reference yielded similar results, although some differences were observed. Particularly, among the differentially expressed genes identified only with the Magdeleine-inherited haplotype as reference, we observed an over-representation of hypothetically hemizygous genes. The higher berry anthocyanin content of clonal accession 595 was associated with increased abscisic acid responses, possibly leading to the observed overexpression of phenylpropanoid metabolism genes and deregulation of genes associated with abiotic stress response. Overall, the results highlight the importance of producing diploid assemblies to fully represent the genomic diversity of highly heterozygous woody crop cultivars and unveil the molecular bases of clonal phenotypic variation.

Safety Evaluation of Primary Carotid Stenting: Transcranial Doppler and MRI.

BACKGROUND AND PURPOSE: Cerebral emboli are generated by every step of standard carotid angioplasty and stenting. Primary carotid stenting (PCS) is a technique in which the use of balloon angioplasty (BA) is minimized to decrease the embolic load. The primary aim of this study is to establish the number of emboli generated by each step of primary stenting and determine the relationship to new diffusion (DWI) lesions on subsequent magnetic resonance imaging (MRI). METHODS: Eighty-five patients with severe, symptomatic carotid stenosis were prospectively recruited and underwent carotid stenting. Intraoperative transcranial Doppler was performed in 77 patients. The number and size of microemboli for each of seven procedural steps were recorded. Correlation was made with the number and location of new DWI lesions. RESULTS: PCS was performed in 73 patients. BA was required in 12 patients. The mean number of microemboli was 114, and most microemboli were generated by stent deployment, followed by BA. Balloon techniques generated significantly more emboli than primary stenting (p = 0.017). There was a significant relationship between total microemboli and new DWI lesions (p = 0.009), and between new DWI lesions in multiple territories and the severity of pretreatment stenosis (p = 0.002). CONCLUSIONS: During PCS, more emboli are generated by stent deployment than during any other stage of the procedure. When BA is necessary, more malignant emboli are generated but total emboli are unchanged and there is no difference in new diffusion lesions on MRI. PCS is safe and is not inferior to historical controls for the generation of new DWI lesions.

[Congenital cytomegalovirus infection screening in high risk newborn]. / Cribado de infección por citomegalovirus congénito en recién nacidos de alto riesgo.

BACKGROUND: Congenital cytomegalovirus infection (cCMV) is the most frequent cause of congenital infection, 90% of affected newborn (NB) are asymptomatic at birth and 6-15% will develop long term sequalae. It is the main etiology of non-genetic sensorineural hearing loss. AIM: To determine prevalence of CMV in high risk NB. METHODS: Cohort prospective study, including inpatient NB with one or more of following criteria: birth weight < 1,500 g, < 32 weeks gestational age (GA), severe small for gestational age (SGA), suspected congenital infection or "refer" in newborn hearing test, also NB to HIV-infected mothers. Urine CMV polymerase chain reaction was performed within 21 day of life. RESULTS: 193 NB were enrolled. Global cCMV prevalence 2.6% (n: 5) and by risk group: one third (n: 1) in NB with suspected congenital infection, 8.3% in NB with "refer" result in hearing test, 4.9% in NB to HIV-infected mothers, 3.3% in severe SGA and 1.7% in < 1,500 g, none with significant association. Only one symptomatic cCMV was detected who died in neonatal period and the remaining (asymptomatic) cCMV patients have normal hearing follow-up. DISCUSSION: Reported prevalence was comparable to international reports. We recommend cCMV screening, at least in risk groups, being ideal the universal screening. This would allow timely treatment and active follow-up.

Whole genome resequencing and custom genotyping unveil clonal lineages in 'Malbec' grapevines (Vitis vinifera L.).

Grapevine cultivars are clonally propagated to preserve their varietal attributes. However, genetic variations accumulate due to the occurrence of somatic mutations. This process is anthropically influenced through plant transportation, clonal propagation and selection. Malbec is a cultivar that is well-appreciated for the elaboration of red wine. It originated in Southwestern France and was introduced in Argentina during the 1850s. In order to study the clonal genetic diversity of Malbec grapevines, we generated whole-genome resequencing data for four accessions with different clonal propagation records. A stringent variant calling procedure was established to identify reliable polymorphisms among the analyzed accessions. The latter procedure retrieved 941 single nucleotide variants (SNVs). A reduced set of the detected SNVs was corroborated through Sanger sequencing, and employed to custom-design a genotyping experiment. We successfully genotyped 214 Malbec accessions using 41 SNVs, and identified 14 genotypes that clustered in two genetically divergent clonal lineages. These lineages were associated with the time span of clonal propagation of the analyzed accessions in Argentina and Europe. Our results show the usefulness of this approach for the study of the scarce intra-cultivar genetic diversity in grapevines. We also provide evidence on how human actions might have driven the accumulation of different somatic mutations, ultimately shaping the Malbec genetic diversity pattern.

Cribado de infección por citomegalovirus congénito en recién nacidos de alto riesgo / Congenital cytomegalovirus infection screening in high risk newborn

INTRODUCCIÓN: La infección congénita por citomegalovirus (CMVc) es la causa más frecuente de infección intrauterina, 90% de los recién nacidos (RN) son asintomáticos al nacer y 6 a 15% desarrollarán secuelas a largo plazo, siendo la principal etiología de hipoacusia sensorio-neural no-genética. OBJETIVO: Determinar la prevalencia de CMVc en RN de alto riesgo. PACIENTES Y MÉTODO: Estudio de cohorte prospectivo, incluyó RN hospitalizados, con uno o más de los siguientes criterios: peso de nacimiento < 1.500 g, < 32 semanas edad gestacional (EG), pequeños para edad gestacional (PEG) severos, sospecha de infección congénita o que "no pasan" en estudio auditivo al nacer, además de hijos de madre con infección por VIH. Se realizó reacción de polimerasa en cadena para CMV en orina antes de 21 días de vida. RESULTADOS: Se enrolaron 193 RN. Prevalencia global CMVc 2,6% (n: 5) y por grupo de riesgo: 1/3 (n: 1) en RN con sospecha activa de infección congénita, 8,3% en RN con resultado "no pasa" en estudio auditivo, 4,9% en hijos de madre con infección por VIH, 3,3% en PEG severo y 1,7% < 1500 g, ninguno con asociación significativa. Sólo un paciente con CMVc fue sintomático, quien falleció en el período neonatal y los restantes RN con CMVc (asintomáticos) tienen seguimiento auditivo normal. DISCUSIÓN: La prevalencia reportada es comparable a las internacionales. Recomendamos cribado de CMVc, al menos en grupos de riesgo, siendo lo ideal el cribado universal. Esto permitiría su tratamiento oportuno y un seguimiento activo.

BACKGROUND: Congenital cytomegalovirus infection (cCMV) is the most frequent cause of congenital infection, 90% of affected newborn (NB) are asymptomatic at birth and 6-15% will develop long term sequalae. It is the main etiology of non-genetic sensorineural hearing loss. AIM: To determine prevalence of CMV in high risk NB. Methods: Cohort prospective study, including inpatient NB with one or more of following criteria: birth weight < 1,500 g, < 32 weeks gestational age (GA), severe small for gestational age (SGA), suspected congenital infection or "refer" in newborn hearing test, also NB to HIV-infected mothers. Urine CMV polymerase chain reaction was performed within 21 day of life. RESULTS: 193 NB were enrolled. Global cCMV prevalence 2.6% (n: 5) and by risk group: one third (n: 1) in NB with suspected congenital infection, 8.3% in NB with "refer" result in hearing test, 4.9% in NB to HIV-infected mothers, 3.3% in severe SGA and 1.7% in < 1,500 g, none with significant association. Only one symptomatic cCMV was detected who died in neonatal period and the remaining (asymptomatic) cCMV patients have normal hearing follow-up. DISCUSSION: Reported prevalence was comparable to international reports. We recommend cCMV screening, at least in risk groups, being ideal the universal screening. This would allow timely treatment and active follow-up.

Subjetividades de beneficiárias do Programa Bolsa Família em contexto rural / Subjectivities of Bolsa Família Program's beneficiaries in rural context

Este artigo tem por objetivo apresentar uma breve revisão teórica e alguns resultados parciais de uma dissertação de mestrado realizada no PPG em psicologia da Universidade Federal de Pernambuco (UFPE). De desenho qualitativo, o estudo visa analisar as práticas discursivas que constituem os modos de subjetivação de mulheres beneficiárias do Programa Bolsa Família (PBF) no contexto rural da Zona da Mata Sul Pernambucana. As referências teóricas consideram o enfoque da governamentalidade, entendendo que práticas de inclusão social, como o PBF, modificam as subjetividades de seus beneficiários. A população estudada é constituída de uma amostra não probabilística de seis mulheres. A coleta de dados foi realizada através de entrevista semiestruturada, e a análise dos dados se baseia na perspectiva de análise crítica do discurso. Os resultados obtidos questionam o potencial do PBF para gerar mudanças nas relações de gênero. Finalmente, interroga-se a evolução das políticas públicas de inclusão social na sociedade brasileira, abrindo perspectivas para novos estudos sobre as mudanças vivenciadas pela população beneficiária no contexto rural de Pernambuco.

This article aims to present a brief theoretical review and some partial results of a Master's dissertation held at the PPG in Psychology of the Federal University of Pernambuco (UFPE). With qualitative design, the study aims to analyze the discursive practices that constitute the modes of subjectivation of women beneficiaries of the Bolsa Família Program (PBF) in rural context of the Zona da Mata Sul Pernambucana. The theoretical references consider the approach of governmentality, understanding that practices of social inclusion, such as the PBF, modify the subjectivities of its beneficiaries. The study population consists of a non-probabilistic sample of six women. Data collection was performed through a semi-structured interview and data analysis is based on the perspective of critical discourse analysis. The results obtained question the potential of the PBF to generate changes in gender relations. Finally, we discuss the evolution of the public policies of social inclusion in the brazilian society, opening perspectives for new studies on the changes experienced by the beneficiary population in the rural context of Pernambuco.

Modos de subjetivação de mulheres beneficiárias do Programa Bolsa Família (PBF) do contexto rural da Zona da Mata Pernambucana / Modes of subjectivation of women beneficiaries of the Bolsa Família Program (PBF) in the rural context of Zona da Mata Pernambucana / Modos de subjetivación de mujeres beneficiarias del Programa Bolsa Familia (PBF) del contexto rural de la Zona da Mata Pernambucana

Este artigo apresenta as conclusões de uma pesquisa que interroga as repercussões de uma política pública brasileira de inclusão social nos modos de subjetivação de mulheres beneficiárias. A metodologia de base qualitativa consistiu na análise crítica do discurso obtido dos relatos de seis mulheres beneficiárias do Programa Bolsa Família (PBF) habitantes do contexto rural da Zona da Mata de Pernambuco. A fundamentação teórica privilegia o enfoque da governamentalidade e as críticas feministas ao PBF. Os resultados obtidos confirmam que normas sociais são incorporadas nas subjetividades das mulheres enquanto "mães pobres lutadoras". Concluiu-se que o PBF exerce uma função reforçadora de modos de subjetivação hegemônicos da sociedade neoliberal. Apesar das vantagens e mudanças produzidas pelo PBF, as mulheres beneficiárias enfrentam uma situação de inclusão social fragilizada, condição característica da pobreza nas sociedades capitalistas.

This article presents the conclusions of a research that questions the repercussions of a Brazilian public policy of social inclusion in the modes of subjectivation of beneficiary women. The qualitative methodology consisted of the critical analysis of the discourse obtained from the reports of six women beneficiaries of the Bolsa Família Program (PBF), habitants of the rural context of the Zona da Mata de Pernambuco. The theoretical foundation favors the focus of governmentality and feminist critiques of the PBF. The results obtained confirm that social norms are incorporated in the subjectivities of women as "poor fighter mothers". It was concluded that the PBF exerts a reinforcing function of hegemonic subjectivation modes of neoliberal society. Despite the advantages and changes produced by the PBF, women beneficiaries face a situation of fragile social inclusion, a characteristic condition of poverty in capitalist societies.

Este artículo presenta las conclusiones de una investigación que interroga las repercuciones de una política pública brasileña de inclusión social em los modos de subjetivación de mujeres beneficiarias. La metodología de base cualitativa consistió em el análisis crítico del discurso obtenido de los relatos de seis mujeres beneficiarias del Programa Bolsa Familia (PBF) habitantes del contexto rural de la Zona da Mata de Pernambuco. La fundamentación teórica privilegia el enfoque de la gubernamentalidad y las críticas feministas al PBF. Los resultados obtenidos confirman que normas sociales son incorporadas em las subjetividades de las mujeres em cuanto "madres pobres luchadoras". Se concluye que el PBF ejerce una función reforzadora de modos de subjetivación hegemónicos de la sociedad neoliberal. A pesar de las ventajas y cambios produzidos por el PBF, las mujeres beneficiarias enfrentan una situación de inclusión social fragilizada, condición característica de la pobreza em las sociedades capitalistas.

Secondhand tobacco smoke exposure and pulmonary function: a cross-sectional study among non-smoking employees of bar and restaurants in Santiago, Chile.

INTRODUCTION: The workplace remains a significant source of secondhand smoke (SHS) exposure. This pollutant is known to be associated with respiratory and cardiovascular problems, but its effects on specific pulmonary function parameters remain largely unexplored. The objectives of this study were to measure SHS exposure among non-smoking employees of bar and restaurants in Santiago, Chile and to evaluate the effects of such exposure on pulmonary function. METHODS: Cross-sectional design. The study sample included non-smoking workers from 57 restaurants and bars in Santiago, Chile. The outcome variable was pulmonary function and the exposure variables were urine cotinine concentration, a biomarker for current SHS exposure, and years of SHS exposure in the workplace as proxy of chronic exposure. Personal and occupational variables were also recorded. Data analysis was performed using linear regression models adjusted by confounders. RESULTS: The median age of the workers was 35 years and the median employment duration at the analysed venues was 1 year. Workers in smoking facilities reported greater SHS exposure (36 hours per week) than workers in smoke-free locations (4 hours per week). Urine cotinine levels were inversely correlated with forced vital capacity, but the finding was not statistically significant (ß=-0.0002; 95% CI -0.007 to 0.006). Years of exposure to SHS showed to be significantly associated with forced expiratory flow25/75 (ß=-0.006; 95% CI -0.010 to -0.0004). CONCLUSION: These findings suggest that cumulative exposure to SHS at work may contribute to deterioration of pulmonary function in non-smoking employees.

Association of homocysteine and smoking with cerebral microemboli in patients with mechanical heart valves: a transcranial Doppler study.

Objectives: Microembolic signals (MES) on transcranial Doppler (TCD) predict stroke and cognitive decline. Plasma levels of total homocysteine (tHcy), a prothrombotic factor, are higher in patients with microemboli in carotid stenosis and in patients with paradoxical embolism. In this study we assessed the association between the level of tHcy and the number of MES in patients with mechanical heart valves (MHVs). Methods: TCD monitoring was performed to detect MES before and after breathing 100% oxygen and repeated every 2-4 weeks up to six times. Results: Twenty-five patients with MHVs (mean age: 63.60±10.15 years) participated in this study; 15 were men (66.47±7.25 years) and 10 were women (59.30±12.60 years). In total, there were 126 study visits. In multiple regression, higher tHcy was associated with more MES in both preoxygenation (OR 1.34 (95% CI 1.07 to 1.68, P=0.009)) and postoxygenation (OR 1.40 (95% CI 1.07 to 1.83, P=0.01)) phases. Current smoking and the length of time between the operation and monitoring also correlated with a higher number of MES before and after breathing oxygen, particularly in women. Conclusions: Higher tHcy and smoking were associated with a higher MES count in both preoxygenation and postoxygenation phases. Because smoking can be stopped and hyperhomocysteinaemia is treatable, these are clinically important findings.

Occupational exposure to polycyclic aromatic hydrocarbons: A cross-sectional study in bars and restaurants in Santiago, Chile.

OBJECTIVE: To evaluate indoor polycyclic aromatic hydrocarbon (PAH) concentrations in bars and restaurants and identify the main determinants of airborne PAH concentrations. METHODS: This study included 57 bars/restaurants in Santiago, Chile. PAH concentrations (ng/m(3) ) were measured using photoelectric aerosol sensor equipment (PAS 2000CE model). Nicotine concentrations (µg/m(3) ) were measured using active sampling pumps followed by gas-chromatography. Linear regression models were used to identify determinants of PAH concentrations. RESULTS: PAH concentrations were higher in venues that allowed smoking compared to smoke-free venues. After adjusting, the air PAH concentrations were 1.40 (0.64-3.10) and 3.34 (1.43-7.83) ng/m(3) higher for tertiles 2 and 3 of air nicotine compared to the lowest tertile. CONCLUSIONS: In hospitality venues where smoking is allowed, secondhand smoke exposure is a major source of PAHs in the environment. This research further supports the importance of implementing complete smoking bans to protect service industry workers from PAH exposure. Am. J. Ind. Med. 59:887-896, 2016. © 2016 Wiley Periodicals, Inc.

Transcranial Doppler is Complementary to Echocardiography for Detection and Risk Stratification of Patent Foramen Ovale.

BACKGROUND: In patients with patent foramen ovale (PFO), strategies are needed to identify patients at higher risk, who might benefit from PFO closure. METHODS: We studied the frequency of detection of a right-to-left shunt (RLS) using transesophageal echocardiography (TEE) among patients with cryptogenic stroke and transcranial Doppler (TCD) to detect RLS, and analyzed the prediction of recurrent stroke according to TCD shunt grade, by detection of RLS on TEE, and by atrial septal aneurysm or mobility. RESULTS: Among 334 patients with TCD, 69.8% were female, with a mean (SD) age of 53 (14) years, with a median follow-up of 420 days. There were 284 cases with TCD and TEE; 54 (19%) had atrial septal aneurysm or mobility. Echocardiography failed to show a RLS in 43 (15.1%) of the patients who had TCD and TEE, even in some patients with high-grade shunts on TCD: 18 (42%) were grade 3 or higher on TCD. Survival free of stroke or transient ischemic attack was predicted significantly by TCD shunt grade < 2 (P = 0.028), shunt grade < 3 (P = 0.03), and shunt grade < 4 (P < 0.0001); this was attenuated by adjustment for risk factors in Cox regression (P = 0.08). Neither RLS on TEE (P = 0.47), or atrial septal aneurysm or mobility (P = 0.08), predicted events. CONCLUSIONS: Our findings suggest that TCD might be more sensitive than TEE for detection of RLS, which misses some cases with substantial RLS, and might be valuable for prediction of recurrent stroke or transient ischemic attack in patients with PFO. TCD complements TEE for management of suspected paradoxical embolism.

Expression of grapevine AINTEGUMENTA-like genes is associated with variation in ovary and berry size.

Fruit size is a highly important trait for most fruit and vegetable crops. This trait has been a main selection target and could be involved in divergent selection processes leading to the differentiation between modern table and wine cultivars. Even though its determination is highly influenced by cultural practices, several regions within the grapevine genome have been identified affecting berry size, either directly or indirectly through their effect on seed content. Using grapevine seeded cultivars, we have analyzed the relationship between ovary cell number and the final size of ovaries and berry fruits. We also performed the characterization of the grapevine AINTEGUMENTA-LIKE family, since it is well reported in Arabidopsis that AINTEGUMENTA (ANT) regulates cell proliferation and organ growth in flower organ primordia by maintaining the meristematic competence of cells during organogenesis. Here we show that orthologous grapevine gene expression associate with flower developmental stages suggesting a similar biological role for this gene family in this species. Moreover, we detected a correlation between those organs size and the level of expression of VviANT1 the grapevine homolog of AtANT. This grapevine gene also co-localizes in linkage group 18 with the confidence interval of a previously detected QTL for berry size. Thus our results suggest the involvement of ANT in the regulation of berry size in grapevine.

Relationships among gene expression and anthocyanin composition of Malbec grapevine clones.

Anthocyanin profiles are commonly used for grapevine cultivar identification because it is currently accepted that this trait is closely related to their genetic characteristics. Nevertheless, the extent of the variation for the anthocyanin profiles among clones of the same cultivar has not yet been studied in depth. The relative concentration of anthocyanins of 131 Malbec clones grown in the same vineyard was investigated by HPLC-DAD and the use of comprehensive statistic procedures. Complementarily, the expression level of structural and regulatory genes was studied via real time polymerase chain reaction. Significant variation was identified among the profiles of the clones, mainly due to variations in the amounts of malvidin derivatives. Finally, the differential expression in F3'5'H, OMT1 and AM2 genes seems to be related to the malvidin content variation. This work shows the existence of variation for the anthocyanin profiles among clones from the same grapevine cultivar and the putative involvement of genes related to hydroxylation, methylation, and transport of anthocyanins on the basis of such variation.

Diabetes, intracranial stenosis and microemboli in asymptomatic carotid stenosis.

BACKGROUND: The risk of stroke in patients with asymptomatic carotid stenosis (ACS) is now so low that it is important to have methods to identify those patients most likely to benefit from intervention, or who may require special consideration in choice of medical therapy. We studied the prediction of stroke, death or transient ischemic attacks (stroke/death/TIA) in patients with ACS by intracranial arterial stenosis, and microemboli on transcranial Doppler (TCD), and the effect of diabetes mellitus on microemboli, intracranial stenosis and risk of events. METHODS: Patients with ACS > 60% by Doppler ultrasound were recruited from the Stroke Prevention Clinic of University Hospital, London, Canada. All 339 participants underwent TCD for detection of intracranial stenosis and detection of microemboli, and carotid ultrasound to measure extracranial stenosis and total carotid plaque area. Participants were followed for three years, to determine the risk of stroke/death/TIA. RESULTS: Stroke/death/TIA occurred in 38% of patients with microemboli versus 10% without (p=0.0001), and in 18% of patients with intracranial stenosis, versus 10% without (p=0.042). Diabetics were significantly more likely to have intracranial stenosis (45% vs. 29%, p =0.014), microemboli (38% vs. 10%, p <0.0001), and had significantly higher risk of stroke/death/TIA over three years (21% vs. 11% without; p=0.024). Survival free of stroke, TIA or death was significantly better without microemboli or intracranial stenosis (p<0.0001). CONCLUSIONS: Diabetes, microemboli and intracranial stenosis predicted higher risk of stroke, death or TIA than did extracranial stenosis or total plaque area; diabetics may need more intensive therapy.

Diabetes and Technology for Increased Activity (DaTA) study: results of a remote monitoring intervention for prevention of metabolic syndrome.

OBJECTIVE: An increasingly aged, overweight, and sedentary population has resulted in elevated risk of cardiovascular disease (CVD). The escalating incidence of diabetes and other chronic illnesses, deficits in health care budgets, and physician shortages, especially in rural communities, have prompted investigations of feasible solutions. The Diabetes and Technology for Increased Activity (DaTA) study was designed to test the effectiveness of a lifestyle intervention driven by self-monitoring of blood glucose (BG), blood pressure (BP), physical activity (PA), and weight to positively impact CVD risk factors in a medically underserviced rural population with a high incidence of metabolic syndrome (MS). RESEARCH DESIGN AND METHODS: Conducted in a community-based research setting, this single-center open feasibility study used smart phones to transmit BP, BG, pedometer, weight, heart rate, and activity measurements to a database. Technology allowed participants to interface with the clinical team and self-monitor their personal health indicators. RESULTS: Twenty-four participants aged 30 to 71 years completed the 8-week intervention. Participants had significant improvement in clinic (p = .046) and self-monitored diastolic BP (p = .001), body mass index (p = .002), and total cholesterol (p = .009), and steps per day. Daily PA increased as well as participants' interest in and willingness to make lifestyle changes that impact health outcomes. CONCLUSIONS: The DaTA study demonstrated that self-monitoring of the risk factors for MS and increased PA improved the participant's CVD risk profile. Considering the 8-week time period of this intervention, results are encouraging. This lifestyle intervention, which uses education and technology as tools, confirms the utility of remote health monitoring.

Remote monitoring technologies for the prevention of metabolic syndrome: the Diabetes and Technology for Increased Activity (DaTA) study.

OBJECTIVES: Remote monitoring technologies are ideally suited for rural communities with limited access to health care. In an 8-week pilot study, we examined the feasibility of implementing and conducting a technology-intensive intervention in an underserviced rural setting. Our goal was to test the utility of self-monitoring technologies, physical activity, and education as tools to manage health indicators for the development of the cardiovascular complications (CVCs) of type 2 diabetes. RESEARCH DESIGN AND METHODS: The Diabetes and Technology for Increased Activity study was an open single-center study conducted in a community-based research setting. All 24 participants were provided with a Blackberry™ Smartphone, blood pressure monitor, glucometer, and pedometer. Smartphones transmitted measurements and survey results to the database, interfaced participants with the clinical team, and allowed for self-monitoring. RESULTS: Outcomes were improved body composition, improved markers of CVC risk factors, increased daily exercise, and interest in or awareness of lifestyle changes that impact health outcomes. Participants had excellent compliance for measurements, as self-monitoring provided a sense of security that improved from week 4 to week 8. CONCLUSIONS: Our team gained substantial insight into the operational requirements of technology-facilitated health care, including redefined hours of service; data reporting, management, and access protocols; and the utility of real-time clinical measures by remote monitoring. We developed an understanding of knowledge translation strategies as well as successful motivational and educational tools. Importantly, remote monitoring technology was found to be feasible and accepted in a rural setting.