Systematic review of SGLT2 receptor inhibitors in dual or triple therapy in type 2 diabetes

Background Despite the number of medications for type 2 diabetes, many people with the condition do not achieve good glycaemic control. Some existing glucose-lowering agents have adverse effects such as weight gain or hypoglycaemia. Type 2 diabetes tends to be a progressive disease, and most patients require treatment with combinations of glucose-lowering agents. The sodium glucose co-transporter 2 (SGLT2) receptor inhibitors are a new class of glucose-lowering agents. Objective To assess the clinical effectiveness and safety of the SGLT2 receptor inhibitors in dual or triple therapy in type 2 diabetes. Data sources MEDLINE, Embase, Cochrane Library (all sections); Science Citation Index; trial registries; conference abstracts; drug regulatory authorities; bibliographies of retrieved papers. Inclusion criteria Randomised controlled trials of SGLT2 receptor inhibitors compared with placebo or active comparator in type 2 diabetes in dual or combination therapy. Methods Systematic review. Quality assessment used the Cochrane risk of bias score. Results Seven trials, published in full, assessed dapagliflozin and one assessed canagliflozin. Trial quality appeared good. Dapagliflozin 10 mg reduced HbA1c by −0.54% (weighted mean differences (WMD), 95% CI −0.67 to −0.40) compared to placebo, but there was no difference compared to glipizide. Canagliflozin reduced HbA1c slightly more than sitagliptin (up to −0.21% vs sitagliptin). Both dapagliflozin and canagliflozin led to weight loss (dapagliflozin WMD −1.81 kg (95% CI −2.04 to −1.57), canagliflozin up to −2.3 kg compared to placebo). Limitations Long-term trial extensions suggested that effects were maintained over time. Data on canagliflozin are currently available from only one paper. Costs of the drugs are not known so cost-effectiveness cannot be assessed. More data on safety are needed, with the Food and Drug Administration having concerns about breast and bladder cancers. Conclusions Dapagliflozin appears effective in reducing HbA1c and weight in type 2 diabetes, although more safety data are needed

Past and future perspectives on mathematical models of tick-borne pathogens

Ticks are vectors of pathogens which are important both with respect to human health and economically. They have a complex lifecycle requiring several blood meals throughout their life. These blood meals take place on different individual hosts and potentially on different host species. Their lifecycle is also dependent on environmental conditions such as the temperature and habitat type. Mathematical models have been used for the more than 30 years to help us understand how tick dynamics are dependent on these environmental factors and host availability. In this paper we review models of tick dynamics and summarise the main results. This summary is split into two parts, one which looks at tick dynamics and one which looks at tick borne-pathogens. In general, the models of tick dynamics are used to determine when the peak in tick densities is likely to occur in the year and how that changes with environmental conditions. The models of tick borne pathogens focus more on the conditions under which the pathogen can persist and how host population densities might be manipulated to control these pathogens. In the final section of the paper we identify gaps in the current knowledge and future modelling approaches

Digital Media Player Controls Supporting Music Education

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Community-Based Efforts Aim to Improve the Food Environment within a Highly Obese Rural Appalachian County

Rural communities in Appalachia are displaying increased obesity prevalence, yet traditional interventions have not provided a broad enough impact to improve dietary consumption patterns. Therefore, expanding efforts that address the food environment and incorporate behavioral nudges through community-developed marketing strategies may be a viable mechanism to improve food and beverage choices within this unique population. This study installed shelf-wobblers across n = 5 gas stations in one rural Appalachian county in Kentucky. Smart Snacks were identified from store inventory lists utilizing the CDC Food Service Guideline for Federal Facilities calculator and were categorized into high-protein snacks, low-fat carbohydrate snacks, meal replacement snacks, and no-calorie beverages. NEMS-CS audits were conducted, and monthly sales data was collected at baseline and for six months thereafter for each store location. A difference-in-difference model was used, adjusting for total sales or total mean sales for each Smart Snack model to assess the percentage change within and between stores. Overall, percent change in mean sales and total sales across all stores resulted in a percentage increase of sales of Smart Snack items following wobbler installment. This study provides unique insight into how a community-driven approach to marketing can influence the sale of healthier food and beverage items

Rural SNAP Participants and Food Insecurity: How Can Communities Leverage Resources to Meet the Growing Food Insecurity Status of Rural and Low-Income Residents?

The burden of obesity disproportionately influences poor health outcomes in rural communities in the United States. Various social and environmental factors contribute to inadequate food access and availability in rural areas, influencing dietary intakes and food insecurity rates. This study aims to identify patterns related to food insecurity and fruit and vegetable consumption within a SNAP-eligible and low-income, highly obese rural Appalachian community. A prospective cohort was implemented to identify gaps in resources addressing obesity and food insecurity challenges. SAS 9.4 software was used to examine differences in dietary intakes and shopping practices among SNAP participants. Among participants (n = 152), most reported an annual household income less than USD 20,000 (n = 90, 60.4%), 29.1% reported food insecurity, and 39.5% reported receiving SNAP benefits within the last month. The overall mean FV intake was 3.46 daily servings (95% CI: 3.06–3.91) among all participants. SNAP participation was associated with food insecurity (p = 0.007) and those participating in SNAP were two times more likely to report being food insecure (OR = 2.707, 95% CI: 1.317, 5.563), relative to non-participants. These findings further depict the need for intervention, as the burden of food insecurity persists. Tailoring health-promoting initiatives to consider rurality and SNAP participation is vital for sustainable success among these populations

From Farm to Fork: growing a Scottish Food System that doesn't cost the Planet

Our global food system is under immense pressure. Feeding a growing human population well while simultaneously delivering required climate, biodiversity and other key outcomes arguably represents the biggest challenge of our civilization in the twenty-first century. Here we discuss this growing challenge in the context of Scotland, its progress to date, its new target of “net zero” greenhouse gas emissions by 2045, and its potential to be an exemplar for well-integrated land use policy that delivers on multiple aims. We highlight the role of research in informing rural policy and landowner actions and stress the importance of social science in helping to ensure a sustainable net zero transition that takes full account of socioeconomic contexts and avoids the big potential pitfalls of ignoring local contexts

Sugar-Sweetened Beverage Consumption among Adults in Rural Appalachia

Sugar-sweetened beverage (SSB) consumption is decreasing nationally, yet intakes remain high in certain sub-populations as new varieties of SSBs are introduced. This study aims to expand on SSB intake patterns among adults living in Appalachia to develop policy, systems, and environmental (PSE) interventions to reduce consumption. Baseline cohort surveys were conducted to examine beverage consumption patterns of adults in one rural Appalachian county in Kentucky using a validated BEVQ-15 instrument. Ages were collapsed into three generational groups – Millennials (22–38 years), Generation X (39–54 years), and Boomers/Silents (≥55 years). Over half (n = 81; 54%) of the sample (n = 150) were Boomers/Silents. Age was a significant predictor of SSB consumption, with Millennials drinking more daily calories of SSB compared to older adults (329.2 kcal v 157.0 kcal v 134.6 kcal, p = 0.05); a significant amount of those calories coming from non-soda SSBs. Millennials were twice as likely to drink sweetened fruit juice drinks (p = 0.0002) and energy drinks (p = 0.01) daily and consumed six times more daily calories from sweetened fruit juice drinks than the other groups (73.5 kcal v 11.1 kcal v 8.0 kcal, p \u3c 0.01). To our knowledge, this is the first study to show beverage choices and consumption patterns in Appalachian adults vary by age and non-soda SSBs are significant sources of added sugar. These findings inform PSE interventions for reducing SSB consumption, such as tailored marketing approaches and technology-based strategies, within a unique setting, and offer insight for nutrition educators and public health professionals working within rural, remote communities

The potential for aquaculture to reduce poverty and control schistosomiasis in Côte d’Ivoire (Ivory Coast) during an era of climate change : a systematic review

This work was supported by the Natural Environment Research Council (NERC) via the Belmont Forum: Climate and Health under grant # NE/T013710/1. CLW and GADL were partially supported by US National Science Foundation (NSF) project ICER-2024383. GADL was also partially supported by NSF DEB—2011179.The development of water management infrastructures, such as dams and canals, are important components of society’s response to feed a growing human population and to fight climate change. Yet, these changes in land use can also increase the transmission risk for waterborne diseases. Transmission risk associated with artificial reservoirs has been extensively documented for schistosomiasis, a parasitic disease of poverty that infects more than 240 million people worldwide. Over 90% of these cases are in sub-Saharan Africa, a region that is being steadily reshaped by climate change. Controlling the parasite’s obligate intermediate host snail is key to reducing transmission of this disease. Using commercial aquaculture to farm marketable species which predate upon these snails in vulnerable regions can have multiple positive effects, including the improved socioeconomic and nutritional health of surrounding communities. Here the authors assessed the viability of using the aquaculture of snail predators to simultaneously control schistosomiasis infection rates while alleviating economic and/or nutritional poverty in endemic regions of sub-Saharan Africa. A PRISMA-based 6-step systematic methodology was used to explore the primary literature using the case study of Côte d’Ivoire and two native species of snail predator to make evidence-based conclusions on the viability of this method for controlling schistosomiasis. This detailed thematic examination of the literature concluded that using specific approaches and species, aquaculture could be effective in reducing economic poverty and chronic malnourishment along with high levels of schistosomiasis infection. More current species-specific aquaculture data and consumer survey data are, however, needed to determine the economic and logistical effectiveness of farming native snail predators in-country. These and other opportunities for future research are highlighted.Publisher PDFPeer reviewe

Morphologies and Spectral Energy Distributions of Extremely Red Galaxies in the GOODS-South Field

Using U'- through Ks-band imaging data in the GOODS-South field, we construct a large, complete sample of 275 ``extremely red objects'' (EROs; K_s<22.0, R-K_s>3.35; AB), all with deep HST/ACS imaging in B_435, V_606, i_775, and z_850, and well-calibrated photometric redshifts. Quantitative concentration and asymmetry measurements fail to separate EROs into distinct morphological classes. We therefore visually classify the morphologies of all EROs into four broad types: ``Early'' (elliptical-like), ``Late'' (disk galaxies), ``Irregular'' and ``Other'' (chain galaxies and low surface brightness galaxies), and calculate their relative fractions and comoving space densities. For a broad range of limiting magnitudes and color thresholds, the relative number of early-type EROs is approximately constant at 33-44%, and the comoving space densities of Early- and Late-type EROs are comparable. Mean rest-frame spectral energy distributions (SEDs) at wavelengths between 0.1 and 1.2 um are constructed for all EROs. The SEDs are extremely similar in their range of shapes, independent of morphological type. The implication is that any differences between the broad-band SEDs of Early-type EROs and the other types are relatively subtle, and there is no robust way of photometrically distinguishing between different morphological types with usual optical/near-infrared photometry.Comment: Submitted to the ApJL. A version with full-resolution figures, all GOODS data and all GOODS collaboration papers may be found at http://www.stsci.edu/science/goods

Decoupling of net community and export production on submesoscales in the Sargasso Sea

Author Posting. © American Geophysical Union, 2015. This article is posted here by permission of American Geophysical Union for personal use, not for redistribution. The definitive version was published in Global Biogeochemical Cycles 29 (2015): 1266–1282, doi:10.1002/2014GB004913.Determinations of the net community production (NCP) in the upper ocean and the particle export production (EP) should balance over long time and large spatial scales. However, recent modeling studies suggest that a horizontal decoupling of flux-regulating processes on submesoscales (≤10 km) could lead to imbalances between individual determinations of NCP and EP. Here we sampled mixed-layer biogeochemical parameters and proxies for NCP and EP during 10, high-spatial resolution (~2 km) surface transects across strong physical gradients in the Sargasso Sea. We observed strong biogeochemical and carbon flux variability in nearly all transects. Spatial coherence among measured biogeochemical parameters within transects was common but rarely did the same parameters covary consistently across transects. Spatial variability was greater in parameters associated with higher trophic levels, such as chlorophyll in >5.0 µm particles, and variability in EP exceeded that of NCP in nearly all cases. Within sampling transects, coincident EP and NCP determinations were uncorrelated. However, when averaged over each transect (30 to 40 km in length), we found NCP and EP to be significantly and positively correlated (R = 0.72, p = 0.04). Transect-averaged EP determinations were slightly smaller than similar NCP values (Type-II regression slope of 0.93, standard deviation = 0.32) but not significantly different from a 1:1 relationship. The results show the importance of appropriate sampling scales when deriving carbon flux budgets from upper ocean observations.NASA Ocean Carbon and Biogeochemistry program Grant Number: NNX11AL94G; WHOI Postdoctoral Scholar fellowship; NASA ACE Grant Number: NNX12AJ25G; NSF Grant Number: OCE-07523662016-02-2