Systematic literature review: quality of life associated with insulin pump use in type 1 diabetes

WSTĘP. W niniejszej pracy przedstawiono systematyczny przegląd opublikowanej literatury w celu odpowiedzi na pytanie, czy ciągły podskórny wlew insuliny (CSII) poprawia jakość życia chorych na cukrzycę typu 1. MATERIAŁ I METODY. Przeszukano elektroniczne bazy danych oraz opublikowane wyniki badań, a po konsultacji z dwiema grupami ekspertów wybrano istotne prace, które opublikowano do lipca 2005 roku. Aby zidentyfikować doniesienia spełniające wybrane kryteria selekcji, zastosowano wieloetapowy proces wyboru, a następnie poddawano prace krytycznej ocenie. WYNIKI. Po analizie tytułów i streszczeń do dalszego etapu wybrano 84 potencjalnie odpowiednie prace opublikowane w wymienionym przedziale czasowym. Z tych doniesień wyodrębniono 28 pełnych artykułów, z których 17 spełniało kryteria włączenia do analizy. Z istniejących danych piśmiennictwa wynikają rozbieżne wnioski. Spośród 5 randomizowanych, kontrolowanych badań poddanych analizie z 3 wynikały niejednoznaczne wnioski, w 1 wskazywano na poprawę jakości życia, a w 1 nie dowiedziono korzyści dotyczących jakości życia. WNIOSKI. Wyniki badań przedstawiają sprzeczne wnioski dotyczące poprawy jakości życia chorych na cukrzycę typu 1 stosujących terapię CSII. Istniejące prace mają wady powodujące, że wnioskowanie co do jakości życia pacjentów stosujących terapię pompą insulinową jest trudne. Brakuje przekonujących dowodów, że korzyści ze stosowania CSII nie istnieją lub inaczej - niewłaściwa metodologia i niespójna analiza dotycząca jakości życia utrudniają ocenę tego zagadnienia. Brak udowodnionego korzystnego wpływu na jakość życia prawdopodobnie wiąże się z przedstawionymi uchybieniami w badaniach, a nie z faktem, że terapia polegająca na zastosowaniu pomp insulinowych nie koreluje z poprawą jakości życia chorych.AIM. To review systematically the published literature addressing whether continuous subcutaneous insulin infusion (CSII) provides any quality of life benefits to people with type 1 diabetes. METHODS. Electronic databases and published references were searched and a consultation with two professional groups was undertaken to identify re levant studies published up to July 2005. A multistep selection process was then undertaken to identify those articles which met the specific selection criteria, which were then critically reviewed. RESULTS. Eighty-four potential relevant articles were identified from examination of titles and abstracts published during the specified time frame. Of these, 28 articles were retrieved in full text, of which 17 fulfilled the specific criteria for inclusion. Mixed results emerged from existing literature. Of the five randomized controlled trials, three reported mixed results, with one study reporting quality of life benefits and one reporting no evidence of quality of life benefits. CONCLUSIONS. There is conflicting evidence reported in the various studies on the quality of life benefits of CSII in type 1 diabetes. Existing research is flawed, making a judgement about the quality of life benefits of insulin pump use difficult. There is no strong evidence against quality of life benefits associated with CSII or otherwise, with poor methodology and inconsistent assessment of quality of life clouding the issue. The lack of reported benefit is probably a function of this rather than pump therapy not offering any quality of life benefits

Genetic Interactions with Age, Sex, Body Mass Index, and Hypertension in Relation to Atrial Fibrillation: The AFGen Consortium

It is unclear whether genetic markers interact with risk factors to influence atrial fibrillation (AF) risk. We performed genome-wide interaction analyses between genetic variants and age, sex, hypertension, and body mass index in the AFGen Consortium. Study-specific results were combined using meta-analysis (88,383 individuals of European descent, including 7,292 with AF). Variants with nominal interaction associations in the discovery analysis were tested for association in four independent studies (131,441 individuals, including 5,722 with AF). In the discovery analysis, the AF risk associated with the minor rs6817105 allele (at the PITX2 locus) was greater among subjects ≤ 65 years of age than among those > 65 years (interaction p-value = 4.0 × 10-5). The interaction p-value exceeded genome-wide significance in combined discovery and replication analyses (interaction p-value = 1.7 × 10-8). We observed one genome-wide significant interaction with body mass index and several suggestive interactions with age, sex, and body mass index in the discovery analysis. However, none was replicated in the independent sample. Our findings suggest that the pathogenesis of AF may differ according to age in individuals of European descent, but we did not observe evidence of statistically significant genetic interactions with sex, body mass index, or hypertension on AF risk

Genome-wide association and Mendelian randomisation analysis provide insights into the pathogenesis of heart failure

Heart failure (HF) is a leading cause of morbidity and mortality worldwide. A small proportion of HF cases are attributable to monogenic cardiomyopathies and existing genome-wide association studies (GWAS) have yielded only limited insights, leaving the observed heritability of HF largely unexplained. We report results from a GWAS meta-analysis of HF comprising 47,309 cases and 930,014 controls. Twelve independent variants at 11 genomic loci are associated with HF, all of which demonstrate one or more associations with coronary artery disease (CAD), atrial fibrillation, or reduced left ventricular function, suggesting shared genetic aetiology. Functional analysis of non-CAD-associated loci implicate genes involved in cardiac development (MYOZ1, SYNPO2L), protein homoeostasis (BAG3), and cellular senescence (CDKN1A). Mendelian randomisation analysis supports causal roles for several HF risk factors, and demonstrates CAD-independent effects for atrial fibrillation, body mass index, and hypertension. These findings extend our knowledge of the pathways underlying HF and may inform new therapeutic strategies

On the mechanisms governing gas penetration into a tokamak plasma during a massive gas injection

A new 1D radial fluid code, IMAGINE, is used to simulate the penetration of gas into a tokamak plasma during a massive gas injection (MGI). The main result is that the gas is in general strongly braked as it reaches the plasma, due to mechanisms related to charge exchange and (to a smaller extent) recombination. As a result, only a fraction of the gas penetrates into the plasma. Also, a shock wave is created in the gas which propagates away from the plasma, braking and compressing the incoming gas. Simulation results are quantitatively consistent, at least in terms of orders of magnitude, with experimental data for a D 2 MGI into a JET Ohmic plasma. Simulations of MGI into the background plasma surrounding a runaway electron beam show that if the background electron density is too high, the gas may not penetrate, suggesting a possible explanation for the recent results of Reux et al in JET (2015 Nucl. Fusion 55 093013)

Velocity-space sensitivity of the time-of-flight neutron spectrometer at JET

The velocity-space sensitivities of fast-ion diagnostics are often described by so-called weight functions. Recently, we formulated weight functions showing the velocity-space sensitivity of the often dominant beam-target part of neutron energy spectra. These weight functions for neutron emission spectrometry (NES) are independent of the particular NES diagnostic. Here we apply these NES weight functions to the time-of-flight spectrometer TOFOR at JET. By taking the instrumental response function of TOFOR into account, we calculate time-of-flight NES weight functions that enable us to directly determine the velocity-space sensitivity of a given part of a measured time-of-flight spectrum from TOFOR

Relationship of edge localized mode burst times with divertor flux loop signal phase in JET

A phase relationship is identified between sequential edge localized modes (ELMs) occurrence times in a set of H-mode tokamak plasmas to the voltage measured in full flux azimuthal loops in the divertor region. We focus on plasmas in the Joint European Torus where a steady H-mode is sustained over several seconds, during which ELMs are observed in the Be II emission at the divertor. The ELMs analysed arise from intrinsic ELMing, in that there is no deliberate intent to control the ELMing process by external means. We use ELM timings derived from the Be II signal to perform direct time domain analysis of the full flux loop VLD2 and VLD3 signals, which provide a high cadence global measurement proportional to the voltage induced by changes in poloidal magnetic flux. Specifically, we examine how the time interval between pairs of successive ELMs is linked to the time-evolving phase of the full flux loop signals. Each ELM produces a clear early pulse in the full flux loop signals, whose peak time is used to condition our analysis. The arrival time of the following ELM, relative to this pulse, is found to fall into one of two categories: (i) prompt ELMs, which are directly paced by the initial response seen in the flux loop signals; and (ii) all other ELMs, which occur after the initial response of the full flux loop signals has decayed in amplitude. The times at which ELMs in category (ii) occur, relative to the first ELM of the pair, are clustered at times when the instantaneous phase of the full flux loop signal is close to its value at the time of the first ELM

The Justice Syndicate: how interactive theatre provides a window into jury decision making and the public understanding of law

The Justice Syndicate (TJS) is an interactive performance, featuring an audience who become jurors considering a difficult case. Via iPads, participants receive evidence, witness testimonies and prompts to vote and discuss the case. We compare TJS to other theatre performances in which audiences are juries, arguing it is unique in only having twelve audience members, with no additional spectators. We compare TJS to experiments researching jury decision-making. In its novel use of technology, it offers a scalable method to research group decision-making in jury-style settings, or to give legal practitioners and prospective jurors an experience of the psychological factors affecting jury deliberation. We discuss how different juries can be presented with identical evidence and come to opposing verdicts. We argue that these wildly different outcomes are linked to how the participants – individually and as a group – resolve the tension between what is legal and what is just. This is an Accepted Manuscript of an article published by Taylor & Francis in Law and Humanities on 03 August 2020, available online: http://www.tandfonline.com/10.1080/17521483.2020.180113