text:
Endothelial Function in Hispanic Children/Adolescents at Risk for Type 2 Diabetes
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Type 2 diabetes is now more frequent in children/adolescents, especially in those from minority populations, including Hispanic Americans (HA). Diabetes and the pre-diabetes state markedly increase the risk of cardiovascular disease. Endothelial dysfunction is seen in the earliest stages of atherogenesis, which ultimately leads to cardiovascular disease. The main aim of this study is to evaluate the endothelial function in HA children/adolescents who are at risk for developing type 2 diabetes (obese children/adolescents from the Hispanic population).
The investigators' hypothesis is that endothelial dysfunction is present in this population and that it is associated with metabolic abnormalities linked to the insulin resistance syndrome. The investigators will study 2 groups of 15 individuals each, age 10-18 years. Group 1 will consist of obese (body mass index greater than 85th percentile for age and sex) Hispanic American children/adolescents and group 2 will consist of healthy, non-overweight (body mass index between the 25th and 50 th percentile for age and sex) Hispanic American children/adolescents.
The study will be carried out at the Joslin Diabetes Center. During the first day, participants will have a medical history and full physical examination, a standard OGTT and measurement of blood cell count, plasma glucose, insulin, lipids, HbA1c, BUN, creatinine, electrolytes, estradiol, testosterone, free fatty acids, CRP, endothelial markers, urinary microalbumin and hCG, if appropriate. An OGTT will be performed in order to rule out IGT or Diabetes. Estimations of insulin secretion and insulin sensitivity will be assessed using the homeostasis model assessment (HOMA). In the second day, the body composition and the brachial artery vasodilatory response to hyperemia will be assessed. Those found with diabetes will be tested for GAD-65 and IA2.
The investigators' hypothesis is that Hispanic American children/adolescents at risk for type 2 diabetes have impaired endothelial function and vascular reactivity that are associated with the degree of insulin resistance and its metabolic abnormalities.
|Obesity Insulin Resistance
|Study Type:
|Study Design:
|Time Perspective: Cross-Sectional
|Official Title:
|Endothelial Function in Hispanic Children/Adolescents at Risk for Type 2 Diabetes
- Plasma levels of markers of endothelial activation and vascular inflammation [ Time Frame: cross sectional study - one time evaluation ]
Biospecimen Retention: Samples Without DNA
|Study Start Date:
|May 2001
|Study Completion Date:
|February 2012
|Primary Completion Date:
|May 2010 (Final data collection date for primary outcome measure)
Overweight Hispanic children/adolescents
Lean Hispanic children/adolescents
Detailed Description:
|Ages Eligible for Study:
|10 Years to 18 Years (Child, Adult)
|Sexes Eligible for Study:
|Accepts Healthy Volunteers:
|Sampling Method:
|Probability Sample
Inclusion Criteria:
Group 1:
- Age between 10-18 years;
- Hispanic (we will consider a subject being Hispanic if both parents are reported as Hispanics when asked the following question: "What ethnic group do you consider that you belong to?");
- No history of type 2 diabetes in any first-degree relative;
- Body mass index between the 25th and 50th percentile for age and sex
- Not have participated in any exercise program for the 6 months prior to the beginning of the study.
Group 2:
- Age between 10-18 years;
- Hispanic (same criteria as above);
- Body mass index greater than the 85th percentile for age and sex;
- Not have participated in any exercise program for the 6 months prior to the beginning of the study.
Exclusion Criteria:
- The exclusion criteria include: diabetes, pregnancy, smoking, cardiovascular disease, uncontrolled hypertension, renal disease, proteinuria, cancer, infectious diseases, severe GI diseases, lung disease, electrolyte abnormalities, anemia, endocrine disorders, severe dyslipidemia, peripheral vascular disease, medications: beta-blockers, any diuretic, calcium channel blockers, ACE inhibitors, niacin, glucocorticoids, any antineoplastic agent, antibiotics, psychoactive agents, bronchodilators or insulin.
Please refer to this study by its ClinicalTrials.gov identifier: NCT01926925
|Principal Investigator:
|Enrique Caballero, MD
|Joslin Diabetes Center
|Responsible Party:
|Enrique Caballero, Clinical Investigator/Director Latino Diabetes Initiative, Joslin Diabetes Center
|ClinicalTrials.gov Identifier:
|NCT01926925 History of Changes
|Other Study ID Numbers:
|Study First Received:
|August 19, 2013
|Last Updated:
|August 20, 2013
Keywords provided by Enrique Caballero, Joslin Diabetes Center:
Type 2 diabetes, Endothelium, children/adolescents
Additional relevant MeSH terms:
Diabetes Mellitus, Type 2
Insulin Resistance
Diabetes Mellitus
Glucose Metabolism Disorders
Metabolic Diseases
Endocrine System Diseases
ClinicalTrials.gov processed this record on September 21, 2017


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The Elder Scrolls V: Skyrim
Review by Sir Chris
"The Sky is the Limit."
There are certain games that serve as benchmarks for genres even years after their release. The Elder Scrolls V: Skyrim makes a compelling case that it could be the next game to do just that. The region of Skyrim is not only big on paper, but serves as an even bigger place to roam and to settle in to as the game is played. Without a doubt, there has never been a game as fully imagined as Skyrim.
The game places you in humble beginnings. You are, to no surprise for people familiar with the Elder Scrolls series, a prisoner when the game begins. Events unfold, a dragon tries to eat you, and suddenly you are a prisoner no more. This is where players will take note that Skyrim conducts itself a bit differently than previous Elder Scrolls series because the places you need to go to progress the story are nearby. Skyrim sets the tone early that it is going to be paying more attention to the main storyline than in previous games and it will lead you around for the first few hours of the game until you are well grounded and ready to take up your destiny. When the shackles come off, shackles that you won't even know you are wearing because the immersion never wavers, the game truly begins to shine.
The main storyline, like the other games in the series, is only the tip of the iceberg. It will continually bring you to new and exciting parts of the world if you follow it and from there the temptation to stray from the path is too great to resist. You don't have any reason to feel bad though, because while the dragons are the main objective of the game there are plenty of vampires, necromancers, and undead to slaughter to make the world a better place.
Like most games of the genre there will be simple fetch quests and missions with brief objectives. Befitting their nature, these tasks can be found in the Miscellaneous section of your quest log where only the barebones details are displayed such as look for this with a marker displayed on your map. Stories of greater importance, including the main storyline as well as major side stories such as the guild quests and several others of their type, get quests with as much description and background information as the main quest itself. These quests can be viewed for sub-objectives at any time in the quest log to check your progress or looked at after completion if you want to reminisce about past conquests. There are nine major cities throughout the game that each have their own major storylines to work through that is completely independent of the dragons that are running amuck throughout the world. It all feels very natural when put together. The dragons are feared and could possibly signal the end of days, but that will not stop the civil war that is being waged for all of Skyrim, nor the many rebellions and fights for survival in the outermost reaches of the land. It will be up to you to end the conflict one way or another. Perhaps the most interesting of these quests is the choice to either join the rebellion, the Stormcloaks, or to help the empire retain control. You will have a meaningful impact on the world with the choices laid out in front of you. The world is yours to shape how you please.
The game introduces a completely new style to level up your character: the Perk system. You gain experience towards the next level by taking action. Using magic, using weaponry, even things such as pickpocketing and successfully creating potions. Enemies dying and completing quests themselves do not give you experience, but it is the actions you take in completing them that reward you. Unlike previous games you won't be restricted to just a few major skills that dictate how you gain levels. Once you gain a level you can place a point in one of Magicka, Hit Points, or Stamina which increases the pool of said stat by ten. You also gain one point to put into a perk of your choice. Perks increase the usefulness of one of your trees. For example, the first archery perk grants the player twenty percent more damage when using a bow. As you go further into a perk tree the advantages grow larger ranging from making spells more powerful to being able to create the best armor in the game with blacksmithing. The perks are rather passive though and do not offer new abilities often; they merely augment the things you can already do. With that said they are another way to completely customize your character and make it unique. The level scaling from Oblivion has also been heavily reduced. While there are still some leveled pieces in the game, with the new perk system it no longer feels like a punishment to level up. While some powerful creatures will level with you the rewards of the deepest part of the perk trees ensure that those foes stand no chance against the power you will wield.
New to the game are the Dragon Shout abilities. Scattered throughout the games many dungeons are tablets that have on them words written in the dragon language for you to learn. Once learned the words are unlocked by spending a dragon soul, gained by defeating any dragon in the game, to grant you powerful abilities that can exceed anything else in the game in combat worth or utility. One shout freezes enemies in front of you solid for several seconds while another can be used to blow enemies, as well as hapless NPCs if you are so inclined, far away from you.
The combat is rewarding no matter what type of character you choose to create. If you put the time and effort in any type of combat will do your hard work justice. From destroying your enemies with lightning bolts, to summoning something to devour everything in sight, to a good ole hammer to the face, the combat allows you to feel empowered. There is no wrong way to build your character in this game and the combat reflects that well. You could play this game for hundreds of hours and never get bored of using the tools at your disposal.
Bethesda redid the graphics engine from Oblivion and this is evident from the start. The character models are much improved, with much more variety. However it is in the environments that Skyrim shines the brightest by not shining at all. The world of Skyrim has been coated with a very fine coat of dullness that makes the game much more beautiful and unique than anything else out there. Instead of trying to make everything glossy the world has a sense of coldness about it that perfectly matches the setting of the game. If you have a powerful machine to run the game at max settings you are not going to be disappointed by the visuals, which are bar none the best of any open world game to date. There is one spot in the game where there is a roaring river and if you look at the river at just the right angle you can see a flowing undercurrent that is traveling the opposite direction of the prevailing current on top of the river. The little details like that are what set Skyrim apart graphically. Unfortunately there are several minor glitches and graphical issues that pop up now and then in an extended play through. Textures that will sometimes not quite be right even on the best settings. It is a very minor flaw and frankly one that almost has to be forgiven with all of the amazing art direction and technical prowess the game wields otherwise.
The immersion would not be complete if Skyrim did not offer a beautiful soundtrack to go along with the rest of the game. Fortunately there is no reason to worry about that because it has one of the most beautiful soundtracks to date. The music in the game is breathtaking and adds so much to the game. If you close your eyes in the middle of an open field, assuming a dragon doesn't swoop down to eat you, it is easy to forget you are playing a video game and not listening to a new take on classical themes. The music is almost always on point and along with much improved voice acting allows Skyrim to sound amazing at every turn.
Skyrim is not a perfect game, but it is as close as can be reasonably expected for such a massive game world. In time all of the issues for the PC version will either be patched away with minor fixes or mods will be created by the player base to enhance an already amazing game. The parts that make up Skyrim are good to great, but when everything comes together as it so often does in the game it creates an experience that is unforgettable. If it is possible there is almost too much to do in this game, as it practically floods the map with dungeons, forts, and caves for you to explore and to clear out in the name of adventure and loot. If you were not a fan of previous entries in the series do not let that deter you from buying this game. It is leaps and bounds ahead of even the much heralded Oblivion in almost every way. If you are a fan of the series you have no excuse not to pick up this game and shout your way into history. There be dragons on the horizon; you alone spell their doom.
Score: 9.7/10 which rounds up to 10/10.
Reviewer's Rating: 5.0 - Flawless
Originally Posted: 11/18/11
Game Release: The Elder Scrolls V: Skyrim (US, 11/11/11)
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