Hypoglycemia with insulin and sulfonylureas

Clinical Inquiries question: In patients with type 2 diabetes mellitus (T2DM), does the combination of insulin and sulfonylurea (SU) increase the risk of hypoglycemia? Evidence-based answer: The incidence of severe hypoglycemia in patients with T2DM taking insulin alone, SU alone, or the combination of insulin and SU is low (strength of recommendation [SOR] A based on a systematic review of randomized controlled trials). The combination of insulin and SU in patients with T2DM does increase the risk of hypoglycemia; however, the clinical significance of this risk is small (SOR B based on 4 large retrospective cohort studies). Of note, patients 65 years and older are at an increased risk of hypoglycemia compared with younger patients, although the clinical significance has not been specified (SOR B based on 2 large retrospective cohort studies).Karyn B. Kolman, MD; Joshua Freeman, MD; Carol L. Howe, MD, MLSDr Kolman is Assistant Professor and Dr Freeman is Clinical Professor in the Department of Family and Community Medicine at the University of Arizona in Tucson. Dr Howe is a librarian in the Health Sciences Library at the University of Arizona.Includes bibliographical reference

Assessing MyPlate Familiarity and Typical Meal Composition using Food Models in Children Aged 7-13

The Dietary Guidelines for Americans serve as a basis for developing federal nutrition education materials for the public, such as MyPlate. MyPlate is a visual cue that uses food groups as a guide to building healthy plates at mealtime. The objective of this study was to determine factors associated with child familiarity with MyPlate guidelines and to determine if typical meals met MyPlate guidelines using food models. A convenience sample of 250 children (aged 7-13 years) and their parent/guardian were recruited at a local science and history museum. Children viewed a picture of the MyPlate icon and were asked to identify the picture. Next, participants used a nine-inch plate to build a typical meal (meals that they would regularly consume) from a buffet of food and beverages models (>65 items to choose from). Research team members took photographs of the plates. A Registered Dietitian Nutritionist determined the percentage of plates that met MyPlate guidelines. Eighty-six percent of children recognized the MyPlate icon upon viewing the image; 7.6% could accurately identify the icon by name. When participants were asked to build a typical meal, however, only 3.43% met MyPlate guidelines. The results of this study suggest that despite being familiar with MyPlate, children built typical meals that did not meet MyPlate guidelines

A Scoping Review of Health Research with Racially/Ethnically Minoritized Adults with Intellectual and Developmental Disabilities

Living with intersectional identities, having a disability, and being a member of a racial or ethnic minoritized group in the U.S., contributes to marginalization that may result in health disparities and health inequities. The purpose of this scoping review is to describe health research regarding adult racial/ethnic minoritized individuals in the U.S with intellectual and developmental disabilities (I/DD). Eight electronic databases were searched to identify literature on the topic published since 2000. Of the 5,229 records, 35 articles were included in the review. Eligible studies included research conducted in the U.S., published in English, and research focused on adults with I/DD with race and/or ethnicity information. The 35 articles included racial/ethnic minoritized individuals who were Black, Latinx/Hispanic, American Indian, and Asian. Twenty-nine of the 35 articles identified health disparities experienced by adults with I/DD from racial/ethnic minoritized groups. Many health disparities were demonstrated in the articles, where adult racial/ ethnic minoritized individuals with I/DD fared worse compared to White adults with I/DD. Additionally, four articles describe differences in health experiences by those from racial or ethnic minoritized backgrounds. Results of this scoping review highlight the need for research that incorporates intentional inclusion of racial/ethnic minoritized people with I/DD and include novel methodologies that allow for the contributions of historically marginalized voices. Future research with an intersectionality approach is recommended to promote equity

Parent Involvement in Diet or Physical Activity Interventions to Treat or Prevent Childhood Obesity: An Umbrella Review

Parents substantially influence children’s diet and physical activity behaviors, which consequently impact childhood obesity risk. Given this influence of parents, the objective of this umbrella review was to synthesize evidence on effects of parent involvement in diet and physical activity treatment and prevention interventions on obesity risk among children aged 3–12 years old. Ovid/MEDLINE, Elsevier/Embase, Wiley/Cochrane Library, Clarivate/Web of Science, EBSCO/CINAHL, EBSCO/PsycInfo, and Epistemonikos.org were searched from their inception through January 2020. Abstract screening, full-text review, quality assessment, and data extraction were conducted independently by at least two authors. Systematic reviews and meta-analyses of diet and physical activity interventions that described parent involvement, included a comparator/control, and measured child weight/weight status as a primary outcome among children aged 3–12 years old were included. Data were extracted at the level of the systematic review/meta-analysis, and findings were narratively synthesized. Of 4158 references identified, 14 systematic reviews and/or meta-analyses (eight treatment focused and six prevention focused) were included and ranged in quality from very low to very high. Our findings support the inclusion of a parent component in both treatment and prevention interventions to improve child weight/weight status outcomes. Of note, all prevention-focused reviews included a school-based component. Evidence to define optimal parent involvement type and duration and to define the best methods of involving parents across multiple environments (e.g., home, preschool, school) was inadequate and warrants further research

Environmental Indicators for the Coastal Region of the U.S. Great Lakes

The goal of this research collaboration was to develop indicators that both estimate environmental condition and suggest plausible causes of ecosystem degradation in the coastal region of the U.S. Great Lakes. The collaboration consisted of 8 broad components, each of which generated different types of environmental responses and characteristics of the coastal region. These indicators included biotic communities of amphibians, birds, diatoms, fish, macroinvertebrates, and wetland plants as well as indicators of polycyclic aromatic hydrocarbon (PAH) photo-induced toxicity and landscape characterization. These components are summarized below and discussed in more detailed in 5 separate reports (Section II). Stress gradients within the U.S. Great Lakes coastal region were defined from 207 variables (e.g., agriculture, atmospheric deposition, land use/land cover, human populations, point source pollution, and shoreline modification) from 19 different data sources that were publicly available for the coastal region. Biotic communities along these gradients were sampled with a stratified, random design among representative ecosystems within the coastal zone. To achieve the sampling across this massive area, the coastal region was subdivided into 2 major ecological provinces and further subdivided into 762 segment sheds. Stress gradients were defined for the major categories of human-induced disturbance in the coastal region and an overall stress index was calculated which represented a combination of all the stress gradients. Investigators of this collaboration have had extensive interactions with the Great Lakes community. For instance, the Lake Erie Lakewide Area Management Plan (LAMP) has adopted many of the stressor measures as integral indicators of the condition of watersheds tributary to Lake Erie. Furthermore, the conceptual approach and applications for development of a generalized stressor gradient have been incorporated into a document defining the tiered aquatic life criteria for defining biological integrity of the nation’s waters. A total of 14 indicators of the U.S. Great Lakes coastal region are presented for potential application. Each indicator is summarized with respect to its use, methodology, spatial context, and diagnosis capability. In general, the results indicate that stress related to agricultural activity and human population density/development had the largest impacts on the biotic community indicators. In contrast, the photoinduced PAH indicator was primarily related to industrial activity in the U.S. Great Lakes, and over half of the sites sampled were potentially at risk of PAH toxicity to larval fish. One of the indicators developed for land use/land change was developed from Landsat imagery for the entire U.S. Great Lakes basin and for the period from 1992 to 2001. This indicator quantified the extensive conversions of both agricultural and forest land to residential area that has occurred during a short 9 year period. Considerable variation in the responses were manifest at different spatial scales and many at surprisingly large scales. Significant advances were made with respect to development of methods for identifying and testing environmental indicators. In addition, many indicators and concepts developed from this project are being incorporated into management plans and U.S. 8 EPA methods documents. Further details, downloadable documents, and updates on these indicators can be found at the GLEI website - http://glei.nrri.umn.edu

The Alliance of Genome Resources: Building a Modern Data Ecosystem for Model Organism Databases.

Model organisms are essential experimental platforms for discovering gene functions, defining protein and genetic networks, uncovering functional consequences of human genome variation, and for modeling human disease. For decades, researchers who use model organisms have relied on Model Organism Databases (MODs) and the Gene Ontology Consortium (GOC) for expertly curated annotations, and for access to integrated genomic and biological information obtained from the scientific literature and public data archives. Through the development and enforcement of data and semantic standards, these genome resources provide rapid access to the collected knowledge of model organisms in human readable and computation-ready formats that would otherwise require countless hours for individual researchers to assemble on their own. Since their inception, the MODs for the predominant biomedical model organisms [Mus sp (laboratory mouse), Saccharomyces cerevisiae, Drosophila melanogaster, Caenorhabditis elegans, Danio rerio, and Rattus norvegicus] along with the GOC have operated as a network of independent, highly collaborative genome resources. In 2016, these six MODs and the GOC joined forces as the Alliance of Genome Resources (the Alliance). By implementing shared programmatic access methods and data-specific web pages with a unified look and feel, the Alliance is tackling barriers that have limited the ability of researchers to easily compare common data types and annotations across model organisms. To adapt to the rapidly changing landscape for evaluating and funding core data resources, the Alliance is building a modern, extensible, and operationally efficient knowledge commons for model organisms using shared, modular infrastructure

Breast-Cancer-Specific Mortality in Patients Treated Based on the 21-Gene Assay: A SEER Population-Based Study

The 21-gene Recurrence Score assay is validated to predict recurrence risk and chemotherapy benefit in hormone-receptor-positive (HR+) invasive breast cancer. To determine prospective breast-cancer-specific mortality (BCSM) outcomes by baseline Recurrence Score results and clinical covariates, the National Cancer Institute collaborated with Genomic Health and 14 population-based registries in the the Surveillance, Epidemiology, and End Results (SEER) Program to electronically supplement cancer surveillance data with Recurrence Score results. The prespecified primary analysis cohort was 40–84 years of age, and had node-negative, HR+, HER2-negative, nonmetastatic disease diagnosed between January 2004 and December 2011 in the entire SEER population, and Recurrence Score results (N = 38,568). Unadjusted 5-year BCSM were 0.4% (n = 21,023; 95% confidence interval (CI), 0.3–0.6%), 1.4% (n = 14,494; 95% CI, 1.1–1.7%), and 4.4% (n = 3,051; 95% CI, 3.4–5.6%) for Recurrence Score \u3c 18, 18–30, and ≥ 31 groups, respectively (P \u3c 0.001). In multivariable analysis adjusted for age, tumor size, grade, and race, the Recurrence Score result predicted BCSM (P \u3c 0.001). Among patients with node-positive disease (micrometastases and up to three positive nodes; N = 4,691), 5-year BCSM (unadjusted) was 1.0% (n = 2,694; 95% CI, 0.5–2.0%), 2.3% (n = 1,669; 95% CI, 1.3–4.1%), and 14.3% (n = 328; 95% CI, 8.4–23.8%) for Recurrence Score \u3c 18, 18–30, ≥ 31 groups, respectively (P \u3c 0.001). Five-year BCSM by Recurrence Score group are reported for important patient subgroups, including age, race, tumor size, grade, and socioeconomic status. This SEER study represents the largest report of prospective BCSM outcomes based on Recurrence Score results for patients with HR+, HER2-negative, node-negative, or node-positive breast cancer, including subgroups often under-represented in clinical trials

Towards BioDBcore: a community-defined information specification for biological databases

The present article proposes the adoption of a community-defined, uniform, generic description of the core attributes of biological databases, BioDBCore. The goals of these attributes are to provide a general overview of the database landscape, to encourage consistency and interoperability between resources and to promote the use of semantic and syntactic standards. BioDBCore will make it easier for users to evaluate the scope and relevance of available resources. This new resource will increase the collective impact of the information present in biological database

Researchers' experience with project management in health and medical research: Results from a post-project review

<p>Abstract</p> <p>Background</p> <p>Project management is widely used to deliver projects on time, within budget and of defined quality. However, there is little published information describing its use in managing health and medical research projects. We used project management in the <it>Alcohol and Pregnancy Project </it>(2006-2008) <url>http://www.ichr.uwa.edu.au/alcoholandpregnancy</url> and in this paper report researchers' opinions on project management and whether it made a difference to the project.</p> <p>Methods</p> <p>A national interdisciplinary group of 20 researchers, one of whom was the project manager, formed the Steering Committee for the project. We used project management to ensure project outputs and outcomes were achieved and all aspects of the project were planned, implemented, monitored and controlled. Sixteen of the researchers were asked to complete a self administered questionnaire for a post-project review.</p> <p>Results</p> <p>The project was delivered according to the project protocol within the allocated budget and time frame. Fifteen researchers (93.8%) completed a questionnaire. They reported that project management increased the effectiveness of the project, communication, teamwork, and application of the interdisciplinary group of researchers' expertise. They would recommend this type of project management for future projects.</p> <p>Conclusions</p> <p>Our post-project review showed that researchers comprehensively endorsed project management in the <it>Alcohol and Pregnancy Project </it>and agreed that project management had contributed substantially to the research. In future, we will project manage new projects and conduct post-project reviews. The results will be used to encourage continuous learning and continuous improvement of project management, and provide greater transparency and accountability of health and medical research. The use of project management can benefit both management and scientific outcomes of health and medical research projects.</p

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy