Is all hypoglycaemia treated as equal? An observational study of how the type of diabetes and treatment prescribed prior to admission influences quality of treatment of inpatient hypoglycaemia

Aims: Inpatient hypoglycaemia is common and associated with adverse outcomes. There is often increased vigilance of hypoglycaemia in inpatients with type 1 diabetes (T1DM) compared to type 2 diabetes (T2DM). We aimed to investigate this apparent discrepancy, utilising the time to repeat (TTR) capillary blood glucose (CBG) measurement as a surrogate for engagement with guidelines stating that CBG should be rechecked following intervention within 15 min of an initial CBG of <4 mmol/L. Methods: This is an observational study of inpatient CBG data from 8 hospitals over a 7-year period. A national diabetes registry allowed identification of individual’s diagnosis and diabetes therapy. For each initial (index) CBG, the TTR for individuals with T2DM—on insulin or sulphonylurea—was compared with the TTR for individuals with T1DM, using a t test for significance performed on log(TTR). The median TTR was plotted for each group per index CBG. Results: In total, 1480,335 CBG measurements were obtained. A total of 26,664 were <4 mmol/L. The TTR in T2DM individuals on sulphonylurea was significantly greater than in T1DM individuals where index CBG was ≥2.3 mmol/L (except index CBG 2.6 mmol/L). For T2DM patients receiving insulin significance exists for index CBGs of ≥3.2 mmol/L. Conclusions: This analysis suggests that quality of care of hypoglycaemia varies according to diagnosis and medication. The group with the highest TTR (T2DM sulphonylurea treated) are possibly the clinical group in whom hypoglycaemia is most concerning. These data therefore suggest a need for education and raising awareness within the inpatient nursing staff

Design of a large scale experiment for measuring effects of fishing on the Great Barrier Reef

There is considerable concern about the effects of fishing on the GBR. Two types of fishing may have substantial effects over large areas: (1) "line" fishing (recreational and commercial) for larger species such as coral trout, and (2) commercial "trawl" fishing for prawns and scallops in inter-reef areas and in the GBR lagoon inshore of the midshelf reef complex. Besides directly affecting the abundance of target species, line fishing may have a variety of indirect effects by altering the trophic structure (predator-prey interactions, competition) of reef communities. Trawling may affect benthic communities used by reef species for functions such as feeding, dispersal, and juvenile rearing. There may be important "interaction effects" between line and trawl fishing, particularly if trawling affects dispersal of fish among reefs and hence the immigration component of recruitment to reef populations subject to line fishing (ie, line fishing effects may be larger in areas where trawling is present, due to reduced replenishment of heavily fished reef populations by dispersal from areas where less fishing occurs)

AN INVESTIGATION OF THE ACTIVATION OF THE SUBDIVISIONS OF GLUTEUS MEDIUS DURING ISOMETRIC HIP CONTRACTIONS

Gluteus medius is involved in movement and stability of the hip and gluteus medius dysfunction is commonly implicated in many lower limb pathologies (Fredericson et al 2000). It is proposed that functional subdivisions exist within the gluteus medius muscle (Conneely and O’Sullivan 2008). There is however a lack of empirical evidence examining the role of the subdivisions of gluteus medius. This study compared the muscle activation of these subdivisions (anterior, middle and posterior) during isometric contractions of hip abduction, internal and external rotation in normal subjects

Structural basis of transcription initiation by RNA polymerase II.

Transcription of eukaryotic protein-coding genes commences with the assembly of a conserved initiation complex, which consists of RNA polymerase II (Pol II) and the general transcription factors, at promoter DNA. After two decades of research, the structural basis of transcription initiation is emerging. Crystal structures of many components of the initiation complex have been resolved, and structural information on Pol II complexes with general transcription factors has recently been obtained. Although mechanistic details await elucidation, available data outline how Pol II cooperates with the general transcription factors to bind to and open promoter DNA, and how Pol II directs RNA synthesis and escapes from the promoter

Gluteus Medius Muscle Activation During Isometric Muscle Contractions

Context: Functional subdivisions are proposed to exist in the gluteus medius (GM) muscle. Dysfunction of the GM, in particular its functional subdivisions, is commonly implicated in lower limb pathologies. However, there is a lack of empirical evidence examining the role of the subdivisions of the GM. Objectives: To compare the activation of the functional subdivisions of the GM (anterior, middle, and posterior) during isometric hip contractions. Design: Single-session, repeated-measures observational study. Setting: University research laboratory. Participants: Convenience sample of 15 healthy, pain-free subjects. Intervention: Subjects performed 3 maximal voluntary isometric contractions for hip abduction and internal and external rotation on an isokinetic dynamometer with simultaneous recording of surface electromyography (sEMG) activity of the GM subdivisions. Main Outcome Measures: sEMG muscle activity for each functional subdivision of the GM during each hip movement was analyzed using a 1-way repeated-measures ANOVA (post hoc Bonferroni). Results: The response of GM subdivisions during the 3 different isometric contractions was significantly different (interaction effect; P = .003). The anterior GM displayed significantly higher activation across all 3 isometric contractions than the middle and posterior subdivisions (main effect; both P < .001). The middle GM also demonstrated significantly higher activation than the posterior GM across all 3 isometric contractions (main effect; P = .027). There was also significantly higher activation of all 3 subdivisions during both abduction and internal rotation than during external rotation (main effect; both P < .001). Conclusions: The existence of functional subdivisions in the GM appears to be supported by the findings. Muscle activation was not homogeneous throughout the entire muscle. The highest GM activation was found in the anterior GM subdivision and during abduction and internal rotation. Future studies should examine the role of GM functional subdivisions in subjects with lower limb pathologies

Structural basis of initial RNA polymerase II transcription

Several RNA polymerase II–nucleic acid crystal structures reveal the transition of the initiating polymerase from the open complex (OC) state to the initially transcribing complex (ITC) containing several RNA nucleotides

The influence of risk factors associated with captive rearing on post-release survival in translocated cirl buntings Emberiza cirlus in the UK

Population decline resulting from agricultural intensification led to contraction of the range of the cirl bunting Emberiza cirlus in the UK to a small area of south Devon. As part of the UK Biodiversity Action Plan for the species, a project to re-establish a population in suitable habitat in Cornwall was undertaken during 2006–2011, in which chicks were removed from the nest in Devon, hand-reared and then delayed-released. The survival of the birds to four time points in the year after release was analysed in relation to the effect of rearing factors, using a multivariable logistic regression model. Individuals with higher body weight at capture were more likely to survive to 1 January and 1 May in the year following release, and individuals released in June and July were more likely to survive than those released in August. Individuals released in 2006 and 2011 had a higher survival rate than those released during 2007–2010. Timing of capture, time spent at each stage in captivity, medication and the detection of parasites in the brood had no significant effect. Immunosuppressive disease, weather factors and predator activity may have led to some of the observed differences in survival. This analysis provides evidence with which to plan future translocation projects for cirl buntings and other passerine birds

Refusing to Endorse. A must Explanation for Pejoratives.

In her analysis of pejoratives, Eva Picardi rejects a too sharp separation between descriptive and expressive content. I reconstruct some of her arguments, endorsing Eva’s criticism of Williamson’s analysis of Dummett and developing a suggestion by Manuel Garcia Carpintero on a speech act analysis of pejoratives. Eva’s main concern is accounting for our instinctive refusal to endorse an assertion containing pejoratives because it suggests a picture of reality we do not share. Her stance might be further developed claiming that uses of pejoratives not only suggest, but also promote a wrong picture of reality. Our refusal to endorse implies rejecting not only a wrong picture of reality but also a call for participation to what that picture promotes