Effects of Once-Weekly Exenatide on Cardiovascular Outcomes in Type 2 Diabetes.

Abstract BACKGROUND: The cardiovascular effects of adding once-weekly treatment with exenatide to usual care in patients with type 2 diabetes are unknown. METHODS: We randomly assigned patients with type 2 diabetes, with or without previous cardiovascular disease, to receive subcutaneous injections of extended-release exenatide at a dose of 2 mg or matching placebo once weekly. The primary composite outcome was the first occurrence of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke. The coprimary hypotheses were that exenatide, administered once weekly, would be noninferior to placebo with respect to safety and superior to placebo with respect to efficacy. RESULTS: In all, 14,752 patients (of whom 10,782 [73.1%] had previous cardiovascular disease) were followed for a median of 3.2 years (interquartile range, 2.2 to 4.4). A primary composite outcome event occurred in 839 of 7356 patients (11.4%; 3.7 events per 100 person-years) in the exenatide group and in 905 of 7396 patients (12.2%; 4.0 events per 100 person-years) in the placebo group (hazard ratio, 0.91; 95% confidence interval [CI], 0.83 to 1.00), with the intention-to-treat analysis indicating that exenatide, administered once weekly, was noninferior to placebo with respect to safety (P<0.001 for noninferiority) but was not superior to placebo with respect to efficacy (P=0.06 for superiority). The rates of death from cardiovascular causes, fatal or nonfatal myocardial infarction, fatal or nonfatal stroke, hospitalization for heart failure, and hospitalization for acute coronary syndrome, and the incidence of acute pancreatitis, pancreatic cancer, medullary thyroid carcinoma, and serious adverse events did not differ significantly between the two groups. CONCLUSIONS: Among patients with type 2 diabetes with or without previous cardiovascular disease, the incidence of major adverse cardiovascular events did not differ significantly between patients who received exenatide and those who received placebo. (Funded by Amylin Pharmaceuticals; EXSCEL ClinicalTrials.gov number, NCT01144338 .)

Amorphous/crystalline silicon heterojunction solar cells via remote inductively coupled plasma processing

Low-frequency inductively coupled plasma (ICP) has been widely used to deposit amorphous or microcrystalline Si thin films, but the intrinsic drawback namely ion bombardment effect limits its application in Si heterojunction solar cells. In this letter, we redesigned typical ICP and realized a remote plasma deposition with suppressed ion bombardment effect. This remote ICP system enables the synthesis of high quality amorphous Si layers with a compact network and a high hydrogen content (10.5%). By using this remote ICP system, we achieved amorphous/crystalline silicon heterojunction solar cells with an efficiency of 14.1% without any back surface field or textures.Published versio

A decentralized approach to model national and global food and land use systems

The achievement of several sustainable development goals and the Paris Climate Agreement depends on rapid progress towards sustainable food and land systems in all countries. We have built a flexible, collaborative modeling framework to foster the development of national pathways by local research teams and their integration up to global scale. Local researchers independently customize national models to explore mid-century pathways of the food and land use system transformation in collaboration with stakeholders. An online platform connects the national models, iteratively balances global exports and imports, and aggregates results to the global level. Our results show that actions toward greater sustainability in countries could sum up to 1 Mha net forest gain per year, 950 Mha net gain in the land where natural processes predominate, and an increased CO _2 sink of 3.7 GtCO _2 e yr ^−1 over the period 2020–2050 compared to current trends, while average food consumption per capita remains above the adequate food requirements in all countries. We show examples of how the global linkage impacts national results and how different assumptions in national pathways impact global results. This modeling setup acknowledges the broad heterogeneity of socio-ecological contexts and the fact that people who live in these different contexts should be empowered to design the future they want. But it also demonstrates to local decision-makers the interconnectedness of our food and land use system and the urgent need for more collaboration to converge local and global priorities

How can diverse national food and land-use priorities be reconciled with global sustainability targets? Lessons from the FABLE initiative

There is an urgent need for countries to transition their national food and land-use systems toward food and nutritional security, climate stability, and environmental integrity. How can countries satisfy their demands while jointly delivering the required transformative change to achieve global sustainability targets? Here, we present a collaborative approach developed with the FABLE—Food, Agriculture, Biodiversity, Land, and Energy—Consortium to reconcile both global and national elements for developing national food and land-use system pathways. This approach includes three key features: (1) global targets, (2) country-driven multi-objective pathways, and (3) multiple iterations of pathway refinement informed by both national and international impacts. This approach strengthens policy coherence and highlights where greater national and international ambition is needed to achieve global goals (e.g., the SDGs). We discuss how this could be used to support future climate and biodiversity negotiations and what further developments would be needed