Small steps towards a large framework: a workshop approach

This article follows the progress of a project to support DSNs in meeting Standard 3 of the NSF for Diabetes. The workshop format provided the delegates with the opportunity to discuss shared issues and concerns

Identification of the Biotransformation Products of 2-Ethylhexyl 4-(N,N-Dimethylamino)benzoate

Nowadays, 2-ethylhexyl 4-(N,N-dimethylamino)benzoate (EDP) is one of the most widely used UV filters in sunscreen cosmetics and other cosmetic products. However, undesirable processes such as percutaneous absorption and biological activity have been attributed to this compound. The in vitro metabolism of EDP was elucidated in the present work. First of all, the phase I biotransformation was studied in rat liver microsomes and two metabolites, N,N-dimethyl-p-aminobenzoic acid (DMP) and N-monomethyl-p-aminobenzoic acid (MMP), were identified by GC-MS analysis. Secondly, the phase II metabolism was investigated by means of LC-MS. The investigated reactions were acetylation and glucuronidation working with rat liver cytosol and with both human and rat liver microsomes, respectively. Analogue studies with p-aminobenzoic acid (PABA) were carried out in order to compare the well established metabolic pathway of PABA with the unknown biotransformation of EDP. In addition, a method for the determination of EDP and its two phase I metabolites in human urine was developed. The methodology requires a solid-phase extraction prior to LC-MS analysis. The method is based on standard addition quantification and has been fully validated. The repeatability of the method, expressed as relative standard deviation, was in the range 3.4–7.4% and the limit of detection for all quantified analytes was in the low ng mL−1 range

Adaptive Traits Are Maintained on Steep Selective Gradients despite Gene Flow and Hybridization in the Intertidal Zone

Gene flow among hybridizing species with incomplete reproductive barriers blurs species boundaries, while selection under heterogeneous local ecological conditions or along strong gradients may counteract this tendency. Congeneric, externally-fertilizing fucoid brown algae occur as distinct morphotypes along intertidal exposure gradients despite gene flow. Combining analyses of genetic and phenotypic traits, we investigate the potential for physiological resilience to emersion stressors to act as an isolating mechanism in the face of gene flow. Along vertical exposure gradients in the intertidal zone of Northern Portugal and Northwest France, the mid-low shore species Fucus vesiculosus, the upper shore species Fucus spiralis, and an intermediate distinctive morphotype of F. spiralis var. platycarpus were morphologically characterized. Two diagnostic microsatellite loci recovered 3 genetic clusters consistent with prior morphological assignment. Phylogenetic analysis based on single nucleotide polymorphisms in 14 protein coding regions unambiguously resolved 3 clades; sympatric F. vesiculosus, F. spiralis, and the allopatric (in southern Iberia) population of F. spiralis var. platycarpus. In contrast, the sympatric F. spiralis var. platycarpus (from Northern Portugal) was distributed across the 3 clades, strongly suggesting hybridization/introgression with both other entities. Common garden experiments showed that physiological resilience following exposure to desiccation/heat stress differed significantly between the 3 sympatric genetic taxa; consistent with their respective vertical distribution on steep environmental clines in exposure time. Phylogenetic analyses indicate that F. spiralis var. platycarpus is a distinct entity in allopatry, but that extensive gene flow occurs with both higher and lower shore species in sympatry. Experimental results suggest that strong selection on physiological traits across steep intertidal exposure gradients acts to maintain the 3 distinct genetic and morphological taxa within their preferred vertical distribution ranges. On the strength of distributional, genetic, physiological and morphological differences, we propose elevation of F. spiralis var. platycarpus from variety to species level, as F. guiryi

Insulin initiation in adults: evidence based or context driven

Aim. To describe insulin initiation practices across the United Kingdom (UK) and identify factors influencing current practice. Background. The number of people commencing insulin therapy has escalated in recent years; due to increased incidence of diabetes and the evidence that improvements in glycaemic control can reduce and delay the onset of diabetic complications. However, the process of insulin initiation is not well described and the optimal way to start insulin therapy is unclear. There is currently a strong emphasis on moving diabetes care from secondary to primary care and this change in policy may also influence insulin initiation. Methods. A quantitative, cross-sectional, nationwide survey of diabetes specialist nurses (DSNs) and practice nurses (PNs) was completed in 2006. Data were gathered using a postal questionnaire, 1310 were returned (37·7% response rate). Results. Almost all DSNs working in secondary, or across primary and secondary, care initiate insulin in people with type 1 diabetes, but only 37·7% of DSNs working in primary care or 2·5% of PNs (p < 0·001). Most DSNs initiate insulin in adults with type 2 diabetes compared with only 37·7% of PNs (p < 0·001). Only 23·5% of respondents initiate insulin for those with gestational diabetes (GD), most working in secondary care (p < 0·001). The most commonly used insulin regimen was multiple injection in type 1 diabetes (43·9%), a twice-daily mixture (19·2%) and night only basal insulin (17·9%) in type 2 diabetes and multiple injection in GD (46·8%). Analogue insulins were more frequently used than non-analogues in type 1 and 2 diabetes but almost equally in those with GD. Conclusion. Despite the drive for much more diabetes care to be delivered in primary care insulin initiation remains largely the province of secondary care, and regardless of the contested nature of the evidence base, analogue insulins are widely used. Relevance to clinical practice. The focus of this study was on one aspect of diabetes care (insulin initiation), however the findings illustrate that whilst policy relating to the care of people with a long-term condition such as diabetes may change, the practice implications in terms of community provision and availability of appropriate expertise are complex

Insulin initiation in adults: evidence based or context driven?

Aim.  To describe insulin initiation practices across the United Kingdom (UK) and identify factors influencing current practice. Background.  The number of people commencing insulin therapy has escalated in recent years; due to increased incidence of diabetes and the evidence that improvements in glycaemic control can reduce and delay the onset of diabetic complications. However, the process of insulin initiation is not well described and the optimal way to start insulin therapy is unclear. There is currently a strong emphasis on moving diabetes care from secondary to primary care and this change in policy may also influence insulin initiation. Methods.  A quantitative, cross-sectional, nationwide survey of diabetes specialist nurses (DSNs) and practice nurses (PNs) was completed in 2006. Data were gathered using a postal questionnaire, 1310 were returned (37·7% response rate). Results.  Almost all DSNs working in secondary, or across primary and secondary, care initiate insulin in people with type 1 diabetes, but only 37·7% of DSNs working in primary care or 2·5% of PNs (p &#60; 0·001). Most DSNs initiate insulin in adults with type 2 diabetes compared with only 37·7% of PNs (p &#60; 0·001). Only 23·5% of respondents initiate insulin for those with gestational diabetes (GD), most working in secondary care (p &#60; 0·001). The most commonly used insulin regimen was multiple injection in type 1 diabetes (43·9%), a twice-daily mixture (19·2%) and night only basal insulin (17·9%) in type 2 diabetes and multiple injection in GD (46·8%). Analogue insulins were more frequently used than non-analogues in type 1 and 2 diabetes but almost equally in those with GD. Conclusion.  Despite the drive for much more diabetes care to be delivered in primary care insulin initiation remains largely the province of secondary care, and regardless of the contested nature of the evidence base, analogue insulins are widely used. Relevance to clinical practice.  The focus of this study was on one aspect of diabetes care (insulin initiation), however the findings illustrate that whilst policy relating to the care of people with a long-term condition such as diabetes may change, the practice implications in terms of community provision and availability of appropriate expertise are complex