Type 2 diabetes: a cohort study of treatment, ethnic and social group influences on glycated haemoglobin

OBJECTIVES: To assess whether in people with poorly controlled type 2 diabetes (HbA1c>7.5%) improvement in HbA1c varies by ethnic and social group. DESIGN: Prospective 2-year cohort of type 2 diabetes treated in general practice. SETTING AND PARTICIPANTS: All patients with type 2 diabetes in 100 of the 101 general practices in two London boroughs. The sample consisted of an ethnically diverse group with uncontrolled type 2 diabetes aged 37–71 years in 2007 and with HbA1c recording in 2008–2009. OUTCOME MEASURE: Change from baseline HbA1c in 2007 and achievement of HbA1c control in 2008 and 2009 were estimated for each ethnic, social and treatment group using multilevel modelling. RESULTS: The sample consisted of 6104 people; 18% were white, 63% south Asian, 16% black African/Caribbean and 3% other ethnic groups. HbA1c was lower after 1 and 2 years in all ethnic groups but south Asian people received significantly less benefit from each diabetes treatment. After adjustment, south Asian people were found to have 0.14% less reduction in HbA1c compared to white people (95% CI 0.04% to 0.24%) and white people were 1.6 (95% CI 1.2 to 2.0) times more likely to achieve HbA1c controlled to 7.5% or less relative to south Asian people. HbA1c reduction and control in black African/Caribbean and white people did not differ significantly. There was no evidence that social deprivation influenced HbA1c reduction or control in this cohort. CONCLUSIONS: In all treatment groups, south Asian people with poorly controlled diabetes are less likely to achieve controlled HbA1c, with less reduction in mean HbA1c than white or black African/Caribbean people

Atlantic multidecadal variability and the U.K. acsis program

Abstract Atlantic multidecadal variability (AMV) is the term used to describe the pattern of variability in North Atlantic sea surface temperatures (SSTs) that is characterized by decades of basinwide warm or cool anomalies, relative to the global mean. AMV has been associated with numerous climate impacts in many regions of the world including decadal variations in temperature and rainfall patterns, hurricane activity, and sea level changes. Given its importance, understanding the physical processes that drive AMV and the extent to which its evolution is predictable is a key challenge in climate science. A leading hypothesis is that natural variations in ocean circulation control changes in ocean heat content and consequently AMV phases. However, this view has been challenged recently by claims that changing natural and anthropogenic radiative forcings are critical drivers of AMV. Others have argued that changes in ocean circulation are not required. Here, we review the leading hypotheses and mechanisms for AMV and discuss the key debates. In particular, we highlight the need for a holistic understanding of AMV. This perspective is a key motivation for a major new U.K. research program: the North Atlantic Climate System Integrated Study (ACSIS), which brings together seven of the United Kingdom’s leading environmental research institutes to enable a broad spectrum approach to the challenges of AMV. ACSIS will deliver the first fully integrated assessment of recent decadal changes in the North Atlantic, will investigate the attribution of these changes to their proximal and ultimate causes, and will assess the potential to predict future changes.</jats:p

The Compostable Plastic Poly(lactic) Acid Causes a Temporal Shift in Fungal Communities in Maturing Compost

The compostable biopolymer, poly(lactic) acid (PLA), is increasingly being used as an alternative to conventional plastics for short shelf-life products, disposable bags and packaging, and in agriculture. Despite the increase in the amount of PLA entering composting systems, few studies have examined the impact of PLA degradation on the compost microbial community. Thermophilic fungi play an import role in the composting process as they secrete hydrolytic enzymes capable of breaking down an array of complex natural polymers. In this study, the impact of PLA hydrolysis on the compost fungal community was examined by terminal restriction fragment length polymorphism and 454 sequencing. At 25°C, the effect of PLA on the surrounding compost community was relatively small and no physical changes were observed to the PLA films. However, when incubated at 50°C, where physical disintegration of PLA was occurring, a clear divergence between the compost populations in the presence and absence of PLA was evident after 2 months but became closer to the population in the absence of PLA after 4 months indicating that, after causing an initial perturbation after 2 months, the population began to return to that seen in the absence of PLA. The only exception was in the population containing 50% (w/w) PLA film, which remained divergent after 4 months and was associated with a marked acidification of the compost. Thus, 454-pyrosequencing revealed that the presence of PLA caused a strong selection for a Thermomyces sp. that was present only at low abundance in the absence of PLA

Abiotic and biotic environmental degradation of the bioplastic polymer poly(lactic acid): A review

© 2017 Elsevier LtdPoly(lactic acid) (PLA) is a compostable bioplastic manufactured by the polymerization of lactic acid monomers derived from the fermentation of starch as a feedstock. Since its first commercialisation in the late 1990's, PLA production has grown annually and currently it estimated that worldwide production will reach at least 800,000 tons by 2020 with Japan and the USA the two major producers. PLA is used as a replacement to conventional petrochemical based plastics, principally as food packaging containers and films and more recently, in electronics and in the manufacture of synthetic fibres. Consequently, there has been a marked increase in PLA contamination in the environment as well as increasing amounts being diverted to commercial composting facilities. This review focuses on the development, production, stability and degradation of PLA in a range of differing environments and explores our current knowledge of the environmental and biological factors involved in PLA degradation

Corrigendum to "Biodegradation of polyester polyurethane during commercial composting and analysis of associated fungal communities" [Bioresour. Technol. 158 (2014) 374-377].

The authors regret to inform that the name of the second author was misspelt in the article. Please read the name as Petrus Nzerem instead of Petrus Nzeram. The corrected author name is shown above. The authors would like to apologise for any inconvenience caused

A reversal of climatic trends in the North Atlantic since 2005

In the mid-1990s the North Atlantic subpolar gyre warmed rapidly, which had important climate impacts, such as increased hurricane numbers, and changes to rainfall over Africa, Europe and North America. Evidence suggests that the warming was largely due to a strengthening of the ocean circulation, particularly the Atlantic Meridional Overturning Circulation (AMOC). Since the mid-1990s direct and indirect measurements have suggested a decline in the strength of the ocean circulation, which is expected to lead to a reduction in northward heat transport. Here we show that since 2005 a large volume of the upper North Atlantic Ocean has cooled significantly by approximately -0.45C or 1.5x10^22 J, reversing the previous warming trend. By analysing observations and a state-of-the-art climate model, we show that this cooling is consistent with a reduction in the strength of the ocean circulation and heat transport, linked to record low densities in the deep Labrador Sea. The low density in the deep Labrador Sea is primarily due to deep ocean warming since 1995, but a long-term freshening also played a role. The observed upper ocean cooling since 2005 is not consistent with the hypothesis that anthropogenic aerosols directly drive Atlantic temperatures

Decadal prediction of the North Atlantic subpolar gyre in the HiGEM high-resolution climate model

This paper presents an analysis of initialised decadal hindcasts of the North Atlantic subpolar gyre (SPG) using the HiGEM model, which has a nominal grid-spacing of 90 km in the atmosphere, and 1/3 ∘∘ in the ocean. HiGEM decadal predictions (HiGEM-DP) exhibit significant skill at capturing 0–500 m ocean heat content in the SPG, and outperform historically forced transient integrations and persistence for up to a decade ahead. An analysis of case-studies of North Atlantic decadal change, including the 1960s cooling, the mid-1990s warming, and the post-2005 cooling, show that changes in ocean circulation and heat transport dominate the predictions of the SPG. However, different processes are found to dominate heat content changes in different regions of the SPG. Specifically, ocean advection dominates in the east, but surface fluxes dominate in the west. Furthermore, compared to previous studies, we find a smaller role for ocean heat transport changes due to ocean circulation anomalies at the latitudes of the SPG, and, for the 1960s cooling, a greater role for surface fluxes. Finally, HiGEM-DP predicts the observed positive state of the North Atlantic Oscillation in the early 1990s. These results support an important role for the ocean in driving past changes in the North Atlantic region, and suggest that these changes were predictable

Human α2β1HI CD133+VE epithelial prostate stem cells express low levels of active androgen receptor

Stem cells are thought to be the cell of origin in malignant transformation in many tissues, but their role in human prostate carcinogenesis continues to be debated. One of the conflicts with this model is that cancer stem cells have been described to lack androgen receptor (AR) expression, which is of established importance in prostate cancer initiation and progression. We re-examined the expression patterns of AR within adult prostate epithelial differentiation using an optimised sensitive and specific approach examining transcript, protein and AR regulated gene expression. Highly enriched populations were isolated consisting of stem (α(2)β(1)(HI) CD133(+VE)), transiently amplifying (α(2)β(1)(HI) CD133(-VE)) and terminally differentiated (α(2)β(1)(LOW) CD133(-VE)) cells. AR transcript and protein expression was confirmed in α(2)β(1)(HI) CD133(+VE) and CD133(-VE) progenitor cells. Flow cytometry confirmed that median (±SD) fraction of cells expressing AR were 77% (±6%) in α(2)β(1)(HI) CD133(+VE) stem cells and 68% (±12%) in α(2)β(1)(HI) CD133(-VE) transiently amplifying cells. However, 3-fold lower levels of total AR protein expression (peak and median immunofluorescence) were present in α(2)β(1)(HI) CD133(+VE) stem cells compared with differentiated cells. This finding was confirmed with dual immunostaining of prostate sections for AR and CD133, which again demonstrated low levels of AR within basal CD133(+VE) cells. Activity of the AR was confirmed in prostate progenitor cells by the expression of low levels of the AR regulated genes PSA, KLK2 and TMPRSS2. The confirmation of AR expression in prostate progenitor cells allows integration of the cancer stem cell theory with the established models of prostate cancer initiation based on a functional AR. Further study of specific AR functions in prostate stem and differentiated cells may highlight novel mechanisms of prostate homeostasis and insights into tumourigenesis

Healthy Living after Cancer: A dissemination and implementation study evaluating a telephone-delivered healthy lifestyle program for cancer survivors

© 2015 Eakin et al. Background: Given evidence shows physical activity, a healthful diet and weight management can improve cancer outcomes and reduce chronic disease risk, the major cancer organisations and health authorities have endorsed related guidelines for cancer survivors. Despite these, and a growing evidence base on effective lifestyle interventions, there is limited uptake into survivorship care. Methods/Design: Healthy Living after Cancer (HLaC) is a national dissemination and implementation study that will evaluate the integration of an evidence-based lifestyle intervention for cancer survivors into an existing telephone cancer information and support service delivered by Australian state-based Cancer Councils. Eligible participants (adults having completed cancer treatment with curative intent) will receive 12 health coaching calls over 6 months from Cancer Council nurses/allied health professionals targeting national guidelines for physical activity, healthy eating and weight control. Using the RE-AIM evaluation framework, primary outcomes are service-level indicators of program reach, adoption, implementation/costs and maintenance, with secondary (effectiveness) outcomes of patient-reported anthropometric, behavioural and psychosocial variables collected at pre- and post-program completion. The total participant accrual target across four participating Cancer Councils is 900 over 3 years. Discussion: The national scope of the project and broad inclusion of cancer survivors, alongside evaluation of service-level indicators, associated costs and patient-reported outcomes, will provide the necessary practice-based evidence needed to inform future allocation of resources to support healthy living among cancer survivors. Trial registration: Australian and New Zealand Clinical Trials Registry (ANZCTR) - ACTRN12615000882527(registered on 24/08/2015

Ocean impact on decadal Atlantic climate variability revealed by sea-level observations

Decadal variability is a notable feature of the Atlantic Ocean and the climate of the regions it influences. Prominently, this is manifested in the Atlantic Multidecadal Oscillation (AMO) in sea surface temperatures. Positive (negative) phases of the AMO coincide with warmer (colder) North Atlantic sea surface temperatures. The AMO is linked with decadal climate fluctuations, such as Indian and Sahel rainfall1, European summer precipitation2, Atlantic hurricanes3 and variations in global temperatures4. It is widely believed that ocean circulation drives the phase changes of the AMO by controlling ocean heat content5. However, there are no direct observations of ocean circulation of sufficient length to support this, leading to questions about whether the AMO is controlled from another source6. Here we provide observational evidence of the widely hypothesized link between ocean circulation and the AMO. We take a new approach, using sea level along the east coast of the United States to estimate ocean circulation on decadal timescales. We show that ocean circulation responds to the first mode of Atlantic atmospheric forcing, the North Atlantic Oscillation, through circulation changes between the subtropical and subpolar gyres—the intergyre region7. These circulation changes affect the decadal evolution of North Atlantic heat content and, consequently, the phases of the AMO. The Atlantic overturning circulation is declining8 and the AMO is moving to a negative phase. This may offer a brief respite from the persistent rise of global temperatures4, but in the coupled system we describe, there are compensating effects. In this case, the negative AMO is associated with a continued acceleration of sea-level rise along the northeast coast of the United States9, 10