Trends in HbA1c thresholds for initiation of hypoglycemic agents:Impact of changed recommendations for older and frail patients

Aims: Less strict glycated hemoglobin (HbA1c) thresholds have been recommended in older and/or frail type 2 diabetes (T2D) patients than in younger and less frail patients for initiating hypoglycemic agents since 2011. We aimed to assess trends in HbA1c thresholds at initiation of a first hypoglycemic agent(s) in T2D patients and the influence of age and frailty on these trends. Materials and methods: The groningen initiative to analyze type 2 diabetes treatment (GIANTT) database was used, which includes primary care T2D patients from the north of the Netherlands. Patients initiating a first non-insulin hypoglycemic agent(s) between 2008 and 2014 with an HbA1c measurement within 120 days before initiation were included. The influence of calendar year, age, or frailty and the interaction between calendar year and age or frailty were assessed using multilevel regression analyses adjusted for confounders. Results: We included 4588 patients. The mean HbA1c threshold at treatment initiation was 7.4% up to 2010, decreasing to 7.1% in 2011 and increasing to 7.4% in 2014. This quadratic change over the years was significant (P 0.05). Conclusions: HbA1c thresholds at initiation of a first hypoglycemic agent(s) changed significantly over time, showing a decrease after 2010 and an increase after 2012. The HbA1c threshold at initiation was not influenced by age or frailty, which is in contrast with recommendations for more personalized treatment

Associations between early maternal sensitivity and children's sleep throughout early childhood

Despite strong theoretical reasons to believe that the quality of parent-infant interactions should influence child sleep, the empirical evidence for links between maternal behavior and children’s sleep is equivocal. Notably, it is unclear at which ages such influences might be particularly salient. The current study aimed to examine prospective longitudinal associations between early maternal sensitivity and children’s sleep during early childhood. Maternal sensitivity was assessed at 12 months during a home visit. Children’s sleep was measured at 12 and 18 months as well as at 2, 3, and 4 years, using a sleep diary completed by mothers. Results revealed significant or marginal positive associations between maternal sensitivity and children’s sleep consolidation (percentage of nighttime sleep) at 2, 3 and 4 years, but not at the most proximal assessments of 12 and 18 months. These findings suggest that child age could potentially be a key factor in the associations between maternal behavior and children’s sleep

An Osmotic Model of the Growing Pollen Tube

Pollen tube growth is central to the sexual reproduction of plants and is a longstanding model for cellular tip growth. For rapid tip growth, cell wall deposition and hardening must balance the rate of osmotic water uptake, and this involves the control of turgor pressure. Pressure contributes directly to both the driving force for water entry and tip expansion causing thinning of wall material. Understanding tip growth requires an analysis of the coordination of these processes and their regulation. Here we develop a quantitative physiological model which includes water entry by osmosis, the incorporation of cell wall material and the spreading of that material as a film at the tip. Parameters of the model have been determined from the literature and from measurements, by light, confocal and electron microscopy, together with results from experiments made on dye entry and plasmolysis in Lilium longiflorum. The model yields values of variables such as osmotic and turgor pressure, growth rates and wall thickness. The model and its predictive capacity were tested by comparing programmed simulations with experimental observations following perturbations of the growth medium. The model explains the role of turgor pressure and its observed constancy during oscillations; the stability of wall thickness under different conditions, without which the cell would burst; and some surprising properties such as the need for restricting osmotic permeability to a constant area near the tip, which was experimentally confirmed. To achieve both constancy of pressure and wall thickness under the range of conditions observed in steady-state growth the model reveals the need for a sensor that detects the driving potential for water entry and controls the deposition rate of wall material at the tip

Neonates and Infants

From a polyphasic sleep pattern at birth, sleep shifts toward the night and consolidates to one long nocturnal sleep period generally by 6–9 months of age. Sleep architecture matures from the immature active and quite sleep pattern in the first year of life to the mature form of rapid eye movement (REM) and non-REM sleep. The timing and initiation of sleep and wake is governed by the interplay of the circadian rhythm with sleep homeostasis. Both sleep regulatory processes mature in the first few months after birth. The developing interaction of these two processes may be a key determinant for the maturation of sleep–wake behavior in the first year of life

Sleep in Neonates and Infants

From a polyphasic sleep pattern at birth, sleep shifts towards the night and consolidates to one long nocturnal sleep period generally by 6–9months of age. Sleep architecture matures from the immature active and quite sleep pattern in the first year of life to the mature form of rapid eye movement (REM) and non-REM sleep. The timing and initiation of sleep and wake is governed by the interplay of the circadian rhythm with sleep homeostasis. Both sleep regulatory processes mature in the first few months after birth. The developing interaction of these two processes may be a key determinant for the maturation of sleep–wake behavior in the first year of life

A systematic review of prevention and treatment of infant behavioural sleep problems

Aim: The aim of this review was to evaluate the evidence for interventions for behavioural sleep problem in infants. Methods: Systematic review based on a search in MEDLINE, Web of Science and PsychINFO in December 2017 for articles published in English during 2007-2017 about preventive and treatment interventions for sleep problems in infants. The review included controlled trials and meta-analyses with at least 20 infants in study groups assessed according to the Grading of Recommendations Assessment, Development and Evaluation criteria. Results: Out of 476 original articles assessed for eligibility, 12 studies were included in the synthesis. Interventions with behavioural, educational and massage strategies were evaluated. No intervention was evaluated in more than one trial. Five interventions with behavioural methods for establishing consistent routines or controlled crying showed modest short-term effects, while the evidence for elements of education was inconsistent. Studies of massage were of poor quality. Knowledge gaps were identified regarding interventions in cross-cultural context, involving fathers, in children below six months of age, in high-risk populations and consequences of interventions that include extinction. Conclusion: Some support for short-term effects of behavioural treatment strategies was found, but more studies are needed to establish evidence