The Significance of an Increased Beta-Hydroxybutyrate at Presentation to the Emergency Department in Patients with Diabetes in the Absence of a Hyperglycemic Emergency

© 2019 Barbara Depczynski et al. The significance of hyperketonemia in adults with diabetes presenting to the emergency department with acute illness, not due to a diabetic hyperglycemic emergency, has not been well characterized. Adult patients with diabetes presenting to the emergency department who had venous blood gas and beta-hydroxybutyrate levels measured whilst in the emergency department were retrospectively evaluated for the relationship between BHB and clinical outcomes. Over 6 months, 404 patients with diabetes had at least one beta-hydroxybutyrate level measured in the emergency department. There were 23 admissions for diabetic ketoacidosis (DKA) or hyperosmolar state. Of the remainder, 58 patients had a beta-hydroxybutyrate≥1 mmol/L; this group had a higher glucose at presentation (19.0 (8.8) versus 10.4 (9.9) mmol/L), higher HbA1c (8.8 (5.4) versus 8.0 (3.3)%), lower bicarbonate (22.6 (6.2) versus 24.8 (4.7) mmol/L), and higher anion gap (14.8 (6.1) versus 12.6 (4.2)) than had those with BHB<1 mmol/L. There was no association between the presence of ketosis and the length of stay (4.2 (7.3) versus (3.0) (7.2) days). Acute illness in those with diabetes associated with ketosis in the absence of DKA is associated with worse glycaemic control than in those without ketosis. Ketosis may represent an intermediate state of metabolic dysregulation rather than being associated with a more severe acute illness, as suggested by no relationship between BHB and length of stay

The effects of tourist and boat traffic on parrot geophagy in lowland Peru

© 2017 The Association for Tropical Biology and Conservation. Ecotourism generates important revenue in many developing economies, but poorly regulated ecotourism can threaten the long-term viability of key biological resources. We determined the effects of tourism, boat traffic, and natural disturbances on parrot geophagy (soil consumption) across seven riverine claylicks in the lowlands of Madre de Dios, Peru. Claylick use significantly decreased when visitors did not follow good practice guidelines and tourist numbers exceeded the capacity of the observation blinds. Otherwise, tourist presence and natural disturbance did not have a significant effect. However, large macaws, particularly Red-and-green Macaws (Ara chloropterus), avoided visiting claylicks during periods of peak tourist numbers. Where parrots had multiple geophagy sites to choose from, they preferred sites further from tourist groups. The effect of boat disturbance was greatest on a narrow river with infrequent boat events. On a wider river with heavier traffic, boat disturbance had less of an effect and this effect was inversely proportional to the distance of boats from the claylick. Where visitors followed good-practice tourism guidelines, they had a low overall negative effect on parrot geophagy. We recommend that visitors respect the claylick observation guidelines to minimize anthropogenic disturbance on parrots and maintain these sites for the benefit of wildlife and humans alike

High genetic diversity in a potentially vulnerable tropical tree species despite extreme habitat loss

10.1371/journal.pone.0082632PLoS ONE812-POLN

Alcohol and Cigarette Smoke Components Activate Human Pancreatic Stellate Cells: Implications for the Progression of Chronic Pancreatitis

Background: Chronic pancreatitis, a known complication of alcohol abuse, is characterized histopathologically by prominent fibrosis. Pancreatic stellate cells (PSCs) are responsible for producing this fibrous tissue in chronic pancreatitis and are activated by alcohol. Progression of alcoholic chronic pancreatitis (as assessed by calcification and fibrosis) is thought to be facilitated by concurrent smoking, but the mechanisms are unknown. This study aimed to (a) determine whether human PSCs (hPSCs) and rat PSCs express nicotinic acetylcholine receptors (nAChRs), which are known to bind 2 important components of cigarette smoke, namely nicotine and nicotine-derived nitrosamine ketone (NNK), and (b) examine the effects of cigarette smoke components in the presence and absence of alcohol on PSC activation in vitro. Methods: Western blotting was used to detect the presence of nAChRs in primary cultures of PSCs. Clinically relevant concentrations of cigarette smoke components (either cigarette smoke extract [CSE], NNK, or nicotine) ± ethanol (EtOH) were used to treat primary cultures of PSCs, and stellate cell activation was assessed by cell migration, proliferation, collagen production, and apoptosis. Results: We demonstrate, for the first time, that PSCs express nAChRs (isoforms α3, α7, β, ε) and that the expression of the α7 isoform in hPSCs is induced by CSE + EtOH. We also provide novel findings that PSCs are activated by CSE and NNK (both alone and in combination with EtOH) as evidenced by an increase in cell migration and/or proliferation. Further, we demonstrate that activation of PSCs by CSE + EtOH and NNK + EtOH may be mediated via nAChRs on the cells. Conclusions: PSCs are activated by clinically relevant concentrations of cigarette smoke components (CSE and NNK), alone and in combination with EtOH. Thus, in alcoholics who smoke, progression of pancreatic fibrosis may be facilitated by the combined effects of alcohol and cigarette smoke components on hPSC behavior

IT Infrastructures Sourcing Challenges and Practices of Exploration-for-Exploitation in Public Sector Organizations: A Delphi Study

Managing information technology infrastructures (ITI) in an effective manner represents a major challenge for any organization and even more for public sector organizations (PSOs) that often lack IT resources and are constrained by tight budgets. Despite the importance of these challenges for practitioners, there is a limited number of studies in this field. Applying the organizational ambidexterity (AO) lens to analyze IT managers’ practices of ITI in public sector, with a specific emphasis on sourcing practices, the present study seeks to fill this gap. We present the outcomes of a Delphi study that involved 40 ITI experts from three sectors: public, private, and academic. Public sector practices of exploration-for-exploitation sourcing are discussed in this paper