Observational study of the association of first insulin type in uncontrolled type 2 diabetes with macrovascular and microvascular disease

<p>Aims: To compare the risk of vascular disease, HbA1c and weight change, between first prescribed insulins in people with type 2 diabetes.</p> <p>Methods: People included in THIN United Kingdom primary care record database who began insulin (2000–2007) after poor control on oral glucose-lowering agents (OGLD) were grouped by the number of OGLDs in their treatment regimen immediately before starting insulin (n = 3,485). Within OGLD group, Cox regression compared macrovascular (all-cause mortality, myocardial infarction, acute coronary syndrome and stroke) and microvascular disease (peripheral neuropathy, nephropathy, and retinopathy) between insulin type (basal, pre-mix or Neutral Protamine Hagedorn, NPH) while ANCOVAs compared haemoglobin A1c (HbA1c) and weight change.</p> <p>Results: Mean follow-up was 3.6 years. Rates of incident macrovascular events were similar when basal insulin was compared to pre-mix or NPH, adjusted hazard ratio versus basal: pre-mix 1.08 (95% CI 0.73, 1.59); NPH 1.00 (0.63, 1.58) after two OGLDs, and pre-mix 0.97 (0.46, 2.02); NPH 0.77 (0.32, 1.86) after three OGLDs. An increased risk of microvascular disease in NPH versus basal after 3 OGLDs, adjusted hazard ratio1.87 (1.04, 3.36), was not seen after two agents or in comparisons of basal and pre-mix. At one year, after two OGLDs, weight increase was less with basal compared with pre-mix. After three OGLDs, mean HbA1c had reduced less in basal versus pre-mix or NPH at 6–8 and at 9–11 months, and versus pre-mix at 12–14 months.</p> <p>Conclusion: We found no difference in the risk of macrovascular events between first insulins in the medium term when started during poor glycaemia control. The increased risk of microvascular events with NPH warrants further study. In certain groups, first use of basal insulin was associated with less gain in weight and decrease in HbA1c compared to other insulins.</p&gt

Complete Genome Sequence of A388, an Antibiotic-Resistant Acinetobacter baumannii Global Clone 1 Isolate from Greece

Copyright © 2019 Hamidian et al. Acinetobacter baumannii isolate A388, recovered in Greece in 2002, represents a distinct antibiotic-resistant lineage of global clone 1 (GC1) producing the OXA-58 carbapenemase. We present the complete 4.332-Mbp genome sequence (chromosome plus 1 plasmid), generated by combining long (MinION) and short (Illumina HiSeq) read sequencing data

User-generated insight of Rio’s Rocinha favela tour: Authentic attraction or vulnerable living environment?

Urban transformations help shape new opportunities and create/re-create awareness in everyday living environments. It is not transformation in the infrastructural sense, but transformation in the form of a service industry producing socio-economic change that can result in inclusion and exclusion of people in the community—thus affecting the everyday living environment. Within this, we need to consider the tourist gaze and how users who visit/tour vulnerable living environments report perceptions of their experiences on forums such as TripAdvisor, which helps researchers frame understandings of commodification, opportunities/awareness and even authenticity (each addressed in this paper). This paper evaluates TripAdvisor posts of ‘Rio’s Rocinha Favela Tour’. In many respects, the notion of commodification, and even authenticity, runs through each theme, but the analysis and data posted to TripAdvisor challenges us to consider how a favela becomes a consumer product, or a tourist attraction. The Rocinha Favela tour is widely publicised to prospective visitors as a chance to experience a living and working favela. Given Rocinha has become a popular attraction in Rio, this leads to the second theme: opportunity or awareness. Opportunities do exist for people in the community to get involved in tourism, and turning the favela into a product helps shape and maintain awareness. The third theme builds on and relates to the previous two, but focuses more on the semblances of authenticity that emerges. To link the points highlighted in this paper, a discussion of soft power concerns relationships bonded through economic and cultural influence. Because favelas have become distinct attractions, it is cultural appeal and a different (residential) side of the city that persuades travellers to visit. Online and social media platforms for more than a decade now have played an important role today in projecting images and promoting authentic experiences based on user-perceptions, and this paper looks at how the users communicate their experiences

Insights from the revised complete genome sequences of Acinetobacter baumannii strains AB307-0294 and ACICU belonging to global clones 1 and 2

© 2019 The Authors. The Acinetobacter baumannii global clone 1 isolate AB307-0294, recovered in the USA in 1994, and the global clone 2 (GC2) isolate ACICU, isolated in 2005 in Italy, were among the first A. baumannii isolates to be completely sequenced. AB307-0294 is susceptible to most antibiotics and has been used in many genetic studies, and ACICU belongs to a rare GC2 lineage. The complete genome sequences, originally determined using 454 pyrosequencing technology, which is known to generate sequencing errors, were re-determined using Illumina MiSeq and MinION (Oxford Nanopore Technologies) technologies and a hybrid assembly generated using Unicycler. Comparison of the resulting new high-quality genomes to the earlier 454-sequenced versions identified a large number of nucleotide differences affecting protein coding sequence (CDS) features, and allowed the sequences of the long and highly repetitive bap and blp1 genes to be properly resolved for the first time in ACICU. Comparisons of the annotations of the original and revised genomes revealed a large number of differences in the protein CDS features, underlining the impact of sequence errors on protein sequence predictions and core gene determination. On average, 400 predicted CDSs were longer or shorter in the revised genomes and about 200 CDS features were no longer present

VenSAR on EnVision: taking Earth Observation radar to Venus

Venus should be the most Earth-like of all our planetary neighbours: its size, bulk composition and distance from the Sun are very similar to those of Earth. How and why did it all go wrong for Venus? What lessons can be learned about the life story of terrestrial planets in general, in this era of discovery of Earth-like exoplanets? Were the radically different evolutionary paths of Earth and Venus driven solely by distance from the Sun, or do internal dynamics, geological activity, volcanic outgassing and weathering also play an important part? EnVision is a proposed ESA Medium class mission designed to take Earth Observation technology to Venus to measure its current rate of geological activity, determine its geological history, and the origin and maintenance of its hostile atmosphere, to understand how Venus and Earth could have evolved so differently. EnVision will carry three instruments: the Venus Emission Mapper (VEM); the Subsurface Radar Sounder (SRS); and VenSAR, a world-leading European phased array synthetic aperture radar that is the subject of this article. VenSAR will obtain images at a range of spatial resolutions from 30 m regional coverage to 1 m images of selected areas; an improvement of two orders of magnitude on Magellan images; measure topography at 15 m resolution vertical and 60 m spatially from stereo and InSAR data; detect cm-scale change through differential InSAR, to characterise volcanic and tectonic activity, and estimate rates of weathering and surface alteration; and characterise of surface mechanical properties and weathering through multi-polar radar data. These data will be directly comparable with Earth Observation radar data, giving geoscientists unique access to an Earth-sized planet that has evolved on a radically different path to our own, offering new insights on the Earth-sized exoplanets across the galaxy

Dominantly acting ABCC8 mutations in patients with medically unresponsive hyperinsulinaemic hypoglycaemia

Flanagan SE, Kapoor RR, Banerjee I, Hall C, Smith VV, Hussain K, Ellard S. Dominantly acting ABCC8 mutations in patients with medically unresponsive hyperinsulinaemic hypoglycaemia

Views from within a narrative : Evaluating long-term human-robot interaction in a naturalistic environment using open-ended scenarios

Open Access This article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited. Date of acceptance: 16/06/2014This article describes the prototyping of human–robot interactions in the University of Hertfordshire (UH) Robot House. Twelve participants took part in a long-term study in which they interacted with robots in the UH Robot House once a week for a period of 10 weeks. A prototyping method using the narrative framing technique allowed participants to engage with the robots in episodic interactions that were framed using narrative to convey the impression of a continuous long-term interaction. The goal was to examine how participants responded to the scenarios and the robots as well as specific robot behaviours, such as agent migration and expressive behaviours. Evaluation of the robots and the scenarios were elicited using several measures, including the standardised System Usability Scale, an ad hoc Scenario Acceptance Scale, as well as single-item Likert scales, open-ended questionnaire items and a debriefing interview. Results suggest that participants felt that the use of this prototyping technique allowed them insight into the use of the robot, and that they accepted the use of the robot within the scenarioPeer reviewe

Transmembrane helix dynamics of bacterial chemoreceptors supports a piston model of signalling.

Transmembrane α-helices play a key role in many receptors, transmitting a signal from one side to the other of the lipid bilayer membrane. Bacterial chemoreceptors are one of the best studied such systems, with a wealth of biophysical and mutational data indicating a key role for the TM2 helix in signalling. In particular, aromatic (Trp and Tyr) and basic (Arg) residues help to lock α-helices into a membrane. Mutants in TM2 of E. coli Tar and related chemoreceptors involving these residues implicate changes in helix location and/or orientation in signalling. We have investigated the detailed structural basis of this via high throughput coarse-grained molecular dynamics (CG-MD) of Tar TM2 and its mutants in lipid bilayers. We focus on the position (shift) and orientation (tilt, rotation) of TM2 relative to the bilayer and how these are perturbed in mutants relative to the wildtype. The simulations reveal a clear correlation between small (ca. 1.5 Å) shift in position of TM2 along the bilayer normal and downstream changes in signalling activity. Weaker correlations are seen with helix tilt, and little/none between signalling and helix twist. This analysis of relatively subtle changes was only possible because the high throughput simulation method allowed us to run large (n = 100) ensembles for substantial numbers of different helix sequences, amounting to ca. 2000 simulations in total. Overall, this analysis supports a swinging-piston model of transmembrane signalling by Tar and related chemoreceptors