Introduction to Personalized Medicine in Diabetes Mellitus

The world is facing an epidemic rise in diabetes mellitus (DM) incidence, which is challenging health funders, health systems, clinicians, and patients to understand and respond to a flood of research and knowledge. Evidence-based guidelines provide uniform management recommendations for ?average? patients that rarely take into account individual variation in susceptibility to DM, to its complications, and responses to pharmacological and lifestyle interventions. Personalized medicine combines bioinformatics with genomic, proteomic, metabolomic, pharmacogenomic (?omics?) and other new technologies to explore pathophysiology and to characterize more precisely an individual?s risk for disease, as well as response to interventions. In this review we will introduce readers to personalized medicine as applied to DM, in particular the use of clinical, genetic, metabolic, and other markers of risk for DM and its chronic microvascular and macrovascular complications, as well as insights into variations in response to and tolerance of commonly used medications, dietary changes, and exercise. These advances in ?omic? information and techniques also provide clues to potential pathophysiological mechanisms underlying DM and its complications

Gravitational Wave Detection by Interferometry (Ground and Space)

Significant progress has been made in recent years on the development of gravitational wave detectors. Sources such as coalescing compact binary systems, neutron stars in low-mass X-ray binaries, stellar collapses and pulsars are all possible candidates for detection. The most promising design of gravitational wave detector uses test masses a long distance apart and freely suspended as pendulums on Earth or in drag-free craft in space. The main theme of this review is a discussion of the mechanical and optical principles used in the various long baseline systems in operation around the world - LIGO (USA), Virgo (Italy/France), TAMA300 and LCGT (Japan), and GEO600 (Germany/U.K.) - and in LISA, a proposed space-borne interferometer. A review of recent science runs from the current generation of ground-based detectors will be discussed, in addition to highlighting the astrophysical results gained thus far. Looking to the future, the major upgrades to LIGO (Advanced LIGO), Virgo (Advanced Virgo), LCGT and GEO600 (GEO-HF) will be completed over the coming years, which will create a network of detectors with significantly improved sensitivity required to detect gravitational waves. Beyond this, the concept and design of possible future "third generation" gravitational wave detectors, such as the Einstein Telescope (ET), will be discussed.Comment: Published in Living Reviews in Relativit

Assessing the Association Between Exercise Status and Poor Glycemic Control

Background: Increased physical activity may be associated with greater glycemic control among adults with diabetes mellitus. However, the area is understudied. The objective of the study was to examine the independent association of exercise status with poor glycemic control, adjusting for patient-level covariates. Methods: We studied a population of Kaiser Permanente Northwest members with type 2 diabetes mellitus who were in: 1) good glycemic control (hemoglobin A1c [HbA1c] \u3c 8%; n = 15,891), or 2) poor glycemic control (HbA1c \u3e 9%; n = 3,709). Additional inclusion criteria included an HbA1c test between July 1, 2014, and June 30, 2015, age 18-plus at time of test, and continuous health plan coverage 12 months prior to HbA1c test. The primary independent was current physical activity status — whether an individual exercised 4 or more times per week (yes vs no) — and was assessed as closely as possible to the HbA1c test date. Multiple logistic regression was used to analyze the independent association of exercise status with poor glycemic control, adjusting for demographics, medication adherence, medical comorbidities, health care utilization, receipt of diabetes mellitus care management services and intensity of diabetes mellitus treatments. Results: Those who exercised 4 or more times per week were less likely to have poor glycemic control (odds ratio: 0.75; 95% confidence interval: 0.68–0.82; P \u3c 0.0001) compared with those who exercised 3 or fewer times per week. Conclusion: Increased exercise is independently associated with a lower likelihood of poor glycemic control among an adult population with type 2 diabetes mellitus. Because physical activity is a potentially modifiable factor, further studies are needed to evaluate whether interventions aimed at increasing physical activity result in subsequent gains in glycemic control

The U.S. Soybean Industry

U.S. soybean production has increased sevenfold since 1950, making soybeans the second highest valued crop after corn. Soybean production has risen in response to increasing world demand for soybeans and the derivative products, oil and meal. The U.S. share of the world export market has ranged from 65-80 percent during the 1980's. Soybean oil accounts for 75 percent of the fats and oils used in edible oil products. Soybean meal is the major high protein feed fed to livestock in the United States. This report describes the U.S. soybean industry from producers to consumers and provides a single source of economic and statistical information on soybeans

Delivery System Partnerships Empower Large Pragmatic Trials: The Case of Diabetes Prevention in Kaiser Permanente

Background/Aims: Successful pragmatic trials require close partnership between researchers and health care organizations. We describe the process by which we engaged clinical and operational leaders from three Kaiser Permanente (KP) regions to design a trial to test alternative population-based models for diabetes prevention. Methods: The study leveraged ongoing efforts in each region to develop a populationwide approach to diabetes prevention. Working with clinical leaders from KP Northwest (KPNW), we designed an initial study that we then took to the leadership of KP Southeast and KP Hawaii. We also obtained the endorsement of KP’s national Care Management Institute (CMI). After submitting a successful letter-of-intent to the Patient-Centered Outcomes Research Institute, we worked with our health plan partners to develop a full proposal that is presently under review. Results: Throughout the proposal development process, we consulted key regional and national health plan stakeholders on various design issues. We also included the KPNW lead for diabetes management as a full co-investigator and regular member of our weekly planning meetings. As a direct result of these interactions, we dropped our initial three-arm design in favor of a two-arm design because it became clear that our planned low-intensity arm would likely be obsolete by the time the grant was funded. We also decided to focus our study on those at highest risk for progressing to diabetes since this was where the organization clearly intended to focus its greatest energy. Finally we leveraged an ongoing demonstration project being coordinated by the CMI to evaluate an online diabetes prevention curriculum that was seen as a scalable model for providing a proven lifestyle change program to our members nationwide. We incorporated this program into our intervention design and conducted interviews with patients to better understand their perspective regarding the overall usefulness of the program and barriers to participation. To meet the needs of members who preferred face-face classes, we also partnered with local diabetes programs in our communities to provide this option. Discussion: Our process of stakeholder engagement directly informed the design of the trial and helped to ensure strong institutional support for the study should it be funded

Delivery System Partnerships Empower Large Pragmatic Trials: The Case of Diabetes Prevention in Kaiser Permanente

Background/Aims: Successful pragmatic trials require close partnership between researchers and health care organizations. We describe the process by which we engaged clinical and operational leaders from three Kaiser Permanente (KP) regions to design a trial to test alternative population-based models for diabetes prevention. Methods: The study leveraged ongoing efforts in each region to develop a populationwide approach to diabetes prevention. Working with clinical leaders from KP Northwest (KPNW), we designed an initial study that we then took to the leadership of KP Southeast and KP Hawaii. We also obtained the endorsement of KP’s national Care Management Institute (CMI). After submitting a successful letter-of-intent to the Patient-Centered Outcomes Research Institute, we worked with our health plan partners to develop a full proposal that is presently under review. Results: Throughout the proposal development process, we consulted key regional and national health plan stakeholders on various design issues. We also included the KPNW lead for diabetes management as a full co-investigator and regular member of our weekly planning meetings. As a direct result of these interactions, we dropped our initial three-arm design in favor of a two-arm design because it became clear that our planned low-intensity arm would likely be obsolete by the time the grant was funded. We also decided to focus our study on those at highest risk for progressing to diabetes since this was where the organization clearly intended to focus its greatest energy. Finally we leveraged an ongoing demonstration project being coordinated by the CMI to evaluate an online diabetes prevention curriculum that was seen as a scalable model for providing a proven lifestyle change program to our members nationwide. We incorporated this program into our intervention design and conducted interviews with patients to better understand their perspective regarding the overall usefulness of the program and barriers to participation. To meet the needs of members who preferred face-face classes, we also partnered with local diabetes programs in our communities to provide this option. Discussion: Our process of stakeholder engagement directly informed the design of the trial and helped to ensure strong institutional support for the study should it be funded