Effects of long-term HbA1c variability on serious infection risks in patients with type 2 diabetes and the influence of age, sex and ethnicity: A cohort study of primary care data.

AIMS: Long-term HbA1c (glycated haemoglobin) variability is associated with micro- and macrovascular complications in Type 2 diabetes (T2D). We explored prospective associations between HbA1c variability and serious infections, and how these vary by HbA1c level, age, sex and ethnicity. METHODS: 411,963 T2D patients in England, aged 18-90, alive on 01/01/2015 in the Clinical Practice Research Datalink with ≥ 4 HbA1c measurements during 2011-14. Poisson regression estimated incidence rate ratios (IRRs) for infections requiring hospitalisation during 2015-19 by HbA1c Variability Score (HVS) and average level, adjusting for confounders, and stratified by age, sex, ethnicity and average level. Attributable risk fractions (AF) were calculated using reference categories for variability (HVS  1.2) was seen with even modest variability (HVS ≥ 20, 73 % of T2D patients), but only at higher average levels (≥64 mmol/mol, 27 % patients). Estimated AFs were markedly greater for variability than average level (17.1 % vs. 4.1 %). Associations with variability were greater among older patients, and those with lower HbA1c levels, but not observed among Black ethnicities. CONCLUSIONS: HbA1c variability between T2D patients' primary care visits appears to be associated with more serious infections than average level overall. Well-designed trials could test whether these associations are causal

A cultural approach to a Canadian tragedy: the Indian residential schools as a sacred enterprise

For over a century, the Canadian state funded a church-run system of residential schools designed to assimilate Aboriginal children into Euro-Canadian culture. In addition to the problems associated with its ethnocentric philosophy, the school system was also characterised by terrible health conditions and physical and sexual abuse of the students was widespread. Recently, the schools have been the object of the most successful struggle for redress in Canadian history. One particularly puzzling aspect about the school system is that it persisted for so long, despite that many of its failings were known very early in its operation. In this article, this puzzle is addressed via a cultural analysis of a political struggle over the residential schools that occurred within Canadian Anglicanism at the outset of the twentieth century. The article concludes that the meaning of the school system as a sacred enterprise contributed to its persistence

The impact of temperature on marine phytoplankton resource allocation and metabolism

Marine phytoplankton are responsible for ∼50% of the CO2 that is fixed annually worldwide, and contribute massively to other biogeochemical cycles in the oceans1. Their contribution depends significantly on the interplay between dynamic environmental conditions and the metabolic responses that underpin resource allocation and hence biogeochemical cycling in the oceans. However, these complex environment–biome interactions have not been studied on a larger scale. Here we use a set of integrative approaches that combine metatranscriptomes, biochemical data, cellular physiology and emergent phytoplankton growth strategies in a global ecosystems model, to show that temperature significantly affects eukaryotic phytoplankton metabolism with consequences for biogeochemical cycling under global warming. In particular, the rate of protein synthesis strongly increases under high temperatures even though the numbers of ribosomes and their associated rRNAs decreases. Thus, at higher temperatures, eukaryotic phytoplankton seem to require a lower density of ribosomes to produce the required amounts of cellular protein. The reduction of phosphate-rich ribosomes2 in warmer oceans will tend to produce higher organismal nitrogen (N) to phosphate (P) ratios, in turn increasing demand for N with consequences for the marine carbon cycle due to shifts towards N-limitation. Our integrative approach suggests that temperature plays a previously unrecognized, critical role in resource allocation and marine phytoplankton stoichiometry, with implications for the biogeochemical cycles that they drive

Kinesin molecular motor Eg5 functions during polypeptide synthesis

The microtubule motor Eg5 is well known for its functions during mitosis. It is shown that during interphase, Eg5 associates with ribosomes and is required for efficient protein synthesis

Child and Family Interventions

This chapter addresses the issue of behavioral interventions to improve regimen adherence, quality of life, and physical health for children who have chronic health conditions. The chapter reviews child and family intervention approaches addressing three common childhood chronic health conditions – obesity, asthma, and diabetes, as well as global prevalence, physiological complications, and related psychosocial issues for each condition. Many intervention studies employ an ecological model and have foundations in social cognitive and/or self-determination theory. Across conditions, interventions have aimed to improve disease management skills, regimen adherence, and psychological and family functioning through various approaches to treatment. While some interventions with older adolescents target personal motivation and self-management, others utilize support from parents, peers, and changes in the school environment or other community settings. Results indicate that a number of evidence-based interventions utilizing educational, behavioral and psychosocial, psychological, peer, and digital technology approaches that incorporate the family are helpful for managing these conditions, as well as improving psychosocial issues associated with them. The concluding section discusses and summarizes the results of intervention studies for these conditions and addresses future research needs. While most of the intervention studies for obesity, asthma, and diabetes reviewed were conducted in the USA, many techniques addressing family relationships, behavior change, coping skills, and social issues may be applicable to children and families worldwide and may generalize to children with other chronic health conditions