Limitations of diabetes pharmacotherapy: results from the Vermont Diabetes Information System study

BACKGROUND: There are a wide variety of medications available for the treatment of hyperglycemia in diabetes, including some categories developed in recent years. The goals of this study were to describe the glycemic medication profiles in a cohort of adult patients enrolled in primary care, to compare the regimens with measures of glycemic control, and to describe potential contraindicated regimens. METHODS: One thousand and six subjects with diabetes cared for in community practices in the Northeast were interviewed at home at the time of enrollment in a trial of a diabetes decision support system. Laboratory data were obtained directly from the clinical laboratory. Current medications were obtained by direct observation of medication containers by a research assistant. RESULTS: The median age of subjects was 63 years; 54% were female. The mean A1C was 7.1%, with 60% of subjects in excellent glycemic control (A1C < 7%). Ninety percent of patients were taking 2 or fewer medications for glycemic control, with a range of 0 to 4 medications. Insulin was used by 18%. As the number of diabetes medications increased from 0 to 4, the A1C increased from 6.5% to 9.2% (p < 0.001). The association between glycemic control and number of glycemic medications was confirmed using logistic regression, controlling for potential confounders. Almost 20% of subjects on metformin or thiazolidenediones had potential contraindications to these medications. CONCLUSION: Patients with diabetes cared for in primary care are on a wide variety of medication combinations for glycemic control, though most are on two or fewer medications. A greater number of diabetes medications is associated with poorer glycemic control, reflecting the limitations of current pharmacotherapy. One quarter of patients are on glycemic medications with potential contraindications

An extreme paucity of second population AGB stars in the normal globular cluster M4

Galactic Globular clusters (GCs) are now known to harbour multiple stellar populations, which are chemically distinct in many light element abundances. It is becoming increasingly clear that asymptotic giant branch (AGB) stars in GCs show different abundance distributions in light elements compared to those in the red giant branch (RGB) and other phases, skewing toward more primordial, field-star-like abundances, which we refer to as subpopulation one (SP1). As part of a larger program targeting giants in GCs, we obtained high-resolution spectra for a sample of 106 RGB and 15 AGB stars in Messier 4 (NGC 6121) using the 2dF+HERMES facility on the Anglo-Australian Telescope. In this Letter we report an extreme paucity of AGB stars with [Na/O] > -0.17 in M4, which contrasts with the RGB that has abundances up to [Na/O] =0.55. The AGB abundance distribution is consistent with all AGB stars being from SP1. This result appears to imply that all subpopulation two stars (SP2; Na-rich, O-poor) avoid the AGB phase. This is an unexpected result given M4's horizontal branch morphology -- it does not have an extended blue horizontal branch. This is the first abundance study to be performed utilising the HERMES spectrograph.Comment: 5 pages, 2 figures, 4 tables (full Table 1 online). Accepted for publication in MNRAS Letter

New proof-of-concept in viral inactivation: virucidal efficacy of 405 nm light against feline calicivirus as a model for norovirus decontamination

The requirement for novel decontamination technologies for use in hospitals is ever present. One such system uses 405 nm visible light to inactivate microorganisms via ROS-generated oxidative damage. Although effective for bacterial and fungal inactivation, little is known about the virucidal effects of 405 nm light. Norovirus (NoV) gastroenteritis outbreaks often occur in the clinical setting, and this study was designed to investigate potential inactivation effects of 405 nm light on the NoV surrogate, feline calicivirus (FCV). FCV was exposed to 405 nm light whilst suspended in minimal and organically-rich media to establish the virucidal efficacy and the effect biologically-relevant material may play in viral susceptibility. Antiviral activity was successfully demonstrated with a 4 Log10 (99.99%) reduction in infectivity when suspended in minimal media evident after a dose of 2.8 kJ cm−2. FCV exposed in artificial faeces, artificial saliva, blood plasma and other organically rich media exhibited an equivalent level of inactivation using between 50–85% less dose of the light, indicating enhanced inactivation when the virus is present in organically-rich biologically-relevant media. Further research in this area could aid in the development of 405 nm light technology for effective NoV decontamination within the hospital environment

A new proof-of-concept in bacterial reduction : antimicrobial action of violet-blue light (405 nm) in ex vivo stored plasma

Bacterial contamination of injectable stored biological fluids such as blood plasma and platelet concentrates preserved in plasma at room temperature is a major health-risk. Current pathogen-reduction technologies (PRT) rely on the use of chemicals and/or ultraviolet-light, which affects product quality and can be associated with adverse events in recipients. 405nm violet-blue light is antibacterial without the use of photosensitizers, and can be applied at levels safe for human exposure, making it of potential interest for decontamination of biological fluids such as plasma. As a pilot study to test whether 405nm light is capable of inactivating bacteria in biological fluids, rabbit and human plasma were seeded with bacteria and treated with a 405nm light emitting diode (LED) exposure system (patent pending). Inactivation was achieved in all tested samples, ranging from low volumes to pre-bagged plasma. 99.9% reduction of low density bacterial populations (≤103 CFUml-1), selected to represent typical ‘natural’ contamination levels, were achieved using doses of 144 Jcm-2. The penetrability of 405nm light, permitting decontamination of pre-bagged plasma, and the non-requirement for photosensitizing agents, provides a new proof-of-concept in bacterial reduction in biological fluids, especially injectable fluids relevant to transfusion medicine

Explicit volume-preserving numerical schemes for relativistic trajectories and spin dynamics

A class of explicit numerical schemes is developed to solve for the relativistic dynamics and spin of particles in electromagnetic fields, using the Lorentz-BMT equation formulated in the Clifford algebra representation of Baylis. It is demonstrated that these numerical methods, reminiscent of the leapfrog and Verlet methods, share a number of important properties: they are energy-conserving, volume-conserving and second order convergent. These properties are analysed empirically by benchmarking against known analytical solutions in constant uniform electrodynamic fields. It is demonstrated that the numerical error in a constant magnetic field remains bounded for long time simulations in contrast to the Boris pusher, whose angular error increases linearly with time. Finally, the intricate spin dynamics of a particle is investigated in a plane wave field configuration.Comment: 15 pages, 9 figure

Magnetic Order and Dynamics in an Orbitally Degenerate Ferromagnetic Insulator

Neutron scattering was used to determine the spin structure and the magnon spectrum of the Mott--Hubbard insulator YTiO$_3$. The magnetic structure is complex, comprising substantial G-type and A-type antiferromagnetic components in addition to the predominant ferromagnetic component. The magnon spectrum, on the other hand, is gapless and nearly isotropic. We show that these findings are inconsistent with the orbitally ordered states thus far proposed for YTiO$_3$ and discuss general implications for a theoretical description of exchange interactions in orbitally degenerate systems.Comment: to appear in Phys. Rev. Let

Spectroscopy of 50^{50}Sc and ab initio calculations of B(M3)B(M3) strengths

The GRIFFIN spectrometer at TRIUMF-ISAC has been used to study excited states and transitions in $^{50}$Sc following the $\beta$-decay of $^{50}$Ca. Branching ratios were determined from the measured $\gamma$-ray intensities, and angular correlations of $\gamma$ rays have been used to firmly assign the spins of excited states. The presence of an isomeric state that decays by an $M3$ transition with a $B(M3)$ strength of 13.6(7)\,W.u. has been confirmed. We compare with the first {\it ab initio} calculations of $B(M3$) strengths in light and medium-mass nuclei from the valence-space in-medium similarity renormalization group approach, using consistently derived effective Hamiltonians and $M3$ operator. The experimental data are well reproduced for isoscalar $M3$ transitions when using bare $g$-factors, but the strength of isovector $M3$ transitions are found to be underestimated by an order of magnitude

An economic survey of New Zealand wheatgrowers : survey no. 2

This is survey number 2. No. 1 was know as "National wheatgrowers' survey"This Report is the second in an annual series of economic surveys of New Zealand wheatgrowing farms. These surveys have been undertaken by the Agricultural Economics Research Unit at Lincoln College on behalf of Wheat Growers Sub-Section of Federated Farmers of New Zealand Inc. Specific attention has been focused on the physical characteristics of wheatgrowing farms, the area of wheat and other crops sown, wheat yields, cultural practices and costs and returns for the 1977/78 wheat crop. An attempt has also been made to allocate plant and machinery overhead costs to the wheat enterprise on both an historical and current cost basis. The need for current and detailed information from the Survey involved two visits to the farms in the sample; one in the spring following drilling and the second in the autumn after harvest

Declining drinking among adolescents: are we seeing a denormalisation of drinking and a normalisation of non-drinking?

Background In the early 2000s, alcohol use among young people began to decline in many western countries, especially among adolescents (aged between 12-17 years old). These declines have continued steadily over the past two decades, against the backdrop of much smaller declines among the general population. Argument Hypotheses examining individual factors fail adequately to provide the necessary ‘big picture’ thinking needed to understand declines in adolescent drinking. We use the normalisation thesis to argue that there is strong international evidence for both processes of denormalisation of drinking and normalisation of non-drinking occurring for adolescents in many western countries. Conclusions Research on declining adolescent drinking provides evidence of both denormalisation of alcohol consumption and normalisation of non-drinking. This has implications for enabling policy environments more amenable to regulation and increasing the acceptability of non-drinking in social contexts. Normalisation theory (and its various interpretations) provides a useful multi-dimensional tool for understanding declines in adolescent drinking