Reasons given by general practitioners for non-treatment decisions in younger and older patients with newly diagnosed type 2 diabetes mellitus in the United Kingdom: a survey study

<p>Abstract</p> <p>Background</p> <p>Older patients with newly diagnosed type 2 diabetes mellitus are less likely to receive antihyperglycaemic therapy compared to their younger counterparts. The purpose of this study was to assess the reasons of general practitioners (GPs) for not treating younger and older patients with newly diagnosed type 2 diabetes mellitus with antihyperglycaemic agents.</p> <p>Methods</p> <p>In a survey conducted between November 2009 and January 2010, 358 GPs from the United Kingdom selected reasons for not initiating antihyperglycaemic therapy in younger (< 65 years) and older (≥65 years) patients with newly diagnosed type 2 diabetes mellitus and untreated with any antihyperglycaemic agent for at least six months following diagnosis. Thirty-six potential reasons were classified into four major categories: <it>Mild hyperglycaemia</it>, <it>Factors related to antihyperglycaemic agents</it>, <it>Comorbidities and polypharmacy</it>, and <it>Patient-related reasons</it>. Reasons for non-treatment were compared between younger (n = 1, 023) and older (n = 1, 005) patients.</p> <p>Results</p> <p>Non-treatment reasons related to <it>Mild hyperglycaemia </it>were selected more often by GPs for both younger (88%) and older (86%) patients than those in other categories. For older patients, <it>Factors related to antihyperglycaemic agents </it>(46% vs. 38%) and <it>Comorbidities and polypharmacy </it>(33% vs. 19%), both including safety-related issues, were selected significantly (p < 0.001) more often by GPs. No between-group difference was observed for the <it>Patient-related reasons </it>category. The GP-reported HbA_1cthreshold for initiating antihyperglycaemic therapy was significantly (p < 0.001) lower for younger patients (mean ± standard deviation: 7.3% ± 0.7) compared to older patients (7.5% ± 0.9).</p> <p>Conclusions</p> <p>GPs selected reasons related to <it>Mild hyperglycaemia </it>for non-treatment of their untreated patients with newly diagnosed type 2 diabetes mellitus, despite nearly one-third of these patients having their most recent HbA_1cvalue ≥7%. The findings further suggest that safety-related issues may influence the non-treatment of older patients with type 2 diabetes mellitus.</p

The acridonecarboxamide GF120918 potently reverses P-glycoprotein-mediated resistance in human sarcoma MES-Dx5 cells

The doxorubicin-selected, P-glycoprotein (P-gp)-expressing human sarcoma cell line MES-Dx5 showed the following levels of resistance relative to the non-P-gp-expressing parental MES-SA cells in a 72 h exposure to cytotoxic drugs: etoposide twofold, doxorubicin ninefold, vinblastine tenfold, taxotere 19-fold and taxol 94-fold. GF120918 potently reversed resistance completely for all drugs. The EC50s of GF120918 to reverse resistance of MES-Dx5 cells were: etoposide 7 ± 2 nM, vinblastine 19 ± 3 nM, doxorubicin 21 ± 6 nM, taxotere 57 ± 14 nM and taxol 91 ± 23 nM. MES-Dx5 cells exhibited an accumulation deficit relative to the parental MES-SA cells of 35% for [3H]-vinblastine, 20% for [3H]-taxol and [14C]-doxorubicin. The EC50 of GF120918, to reverse the accumulation deficit in MES-Dx5 cells, ranged from 37 to 64 nM for all three radiolabelled cytotoxics. [3H]-vinblastine bound saturably to membranes from MES-Dx5 cells with a KD of 7.8 ± 1.4 nM and a Bmax of 5.2 ± 1.6 pmol mg–1 protein. Binding of [3H]-vinblastine to P-gp in MES-Dx5 membranes was inhibited by GF120918 (Ki = 5 ± 1 nM), verapamil (Ki = 660 ± 350 nM) and doxorubicin (Ki = 6940 ± 2100 nM). Taxol, an allosteric inhibitor of [3H]-vinblastine binding to P-gp, could only displace 40% of [3H]-vinblastine (Ki = 400 ± 140 nM). The novel acridonecarboxamide derivative GF120918 potently overcomes P-gp-mediated multidrug resistance in the human sarcoma cell line MES-Dx5. Detailed analysis revealed that five times higher GF120918 concentrations were needed to reverse drug resistance to taxol in the cytotoxicity assay compared to doxorubicin, vinblastine and etoposide. An explanation for this phenomenon had not been found. © 1999 Cancer Research Campaig

Circadian regulation of hormone signaling and plant physiology

The survival and reproduction of plants depend on their ability to cope with a wide range of daily and seasonal environmental fluctuations during their life cycle. Phytohormones are plant growth regulators that are involved in almost every aspect of growth and development as well as plant adaptation to myriad abiotic and biotic conditions. The circadian clock, an endogenous and cell-autonomous biological timekeeper that produces rhythmic outputs with close to 24-h rhythms, provides an adaptive advantage by synchronizing plant physiological and metabolic processes to the external environment. The circadian clock regulates phytohormone biosynthesis and signaling pathways to generate daily rhythms in hormone activity that fine-tune a range of plant processes, enhancing adaptation to local conditions. This review explores our current understanding of the interplay between the circadian clock and hormone signaling pathways

Morphology and rheological properties of silica-​filled poly(carbonate)​/poly(methyl methacrylate) blends

The effect of silica nanoparticles on the morphol. and the rheol. properties was investigated in the immiscible polymer blend poly(carbonate)¿/poly(Me methacrylate) (PC¿/PMMA)¿. In the melt state, the linear viscoelastic properties of the nanocomposite showed a redn. effect of the silica nanoparticles on the mobility of one of the polymer which is related to the state of distribution of the silica nanoparticles. Hydrophilic and hydrophobic silica particles were used to study particle migration and their effects on the morphol. and it was shown that the distribution of the nanoparticles depends on the balance of interactions between the surface of the particles and the polymer components. The effect on the coarsening kinetics was investigated in both hydrophilic and hydrophobic silica-¿filled blends. Compared to the hydrophilic silica, a better compatibilization can be obtained by introducing the hydrophobic silica particles at the PC¿/PMMA interface as the solid barrier

Curing kinetics and morphology of a nanovesicular epoxy/stearyl-block-poly(ethylene oxide) surfactant system

Brittle epoxy based thermosets can be made tougher by introducing structural inhomogeneities at the micro- or nanoscale. In that respect, nano vesicles and worm-like micelles from self-assembling blockcopolymers have been shown to be very effective. This paper describes the curing kinetics and morphology of an epoxy composed of diglycidyl ether of bisphenol A (DGEBA) and 4,4'-methylenedianiline (MDA), modified by 20% of the surfactant stearyl-block-poly(ethylene oxide). Time resolved, synchrotron small-angle X-ray scattering demonstrates that at any time during the epoxy curing process, the surfactant predominantly adopts a bilayer vesicular nano-morphology. Transmission electron microscopy on fully cured systems reveals the coexistence of spherical and worm-like micelles. Differential scanning calorimetry experiments prove that the presence of surfactant reduces the epoxy curing rate but that ultimately full curing is accomplished. The material glass transition temperature falls below that of the pure resin due to plasticization. It is suggested that favorable secondary interactions between the PEO segments and the epoxy resin are responsible for the observed phenomena.crosscheck: This document is CrossCheck deposited copyright_licence: The Royal Society of Chemistry has an exclusive publication licence for this journal copyright_licence: This article is freely available. This article is licensed under a Creative Commons Attribution Non Commercial 3.0 Unported Licence (CC BY-NC 3.0) history: Received 3 May 2015; Accepted 29 June 2015; Accepted Manuscript published 29 June 2015; Advance Article published 6 July 2015; Version of Record published 29 July 2015status: publishe

Curing kinetics and morphology of a nanovesicular epoxy/stearyl-block-poly(ethylene oxide) surfactant system

\u3cp\u3eBrittle epoxy based thermosets can be made tougher by introducing structural inhomogeneities at the micro- or nanoscale. In that respect, nano vesicles and worm-like micelles from self-assembling blockcopolymers have been shown to be very effective. This paper describes the curing kinetics and morphology of an epoxy composed of diglycidyl ether of bisphenol A (DGEBA) and 4,4′-methylenedianiline (MDA), modified by 20% of the surfactant stearyl-block-poly(ethylene oxide). Time resolved, synchrotron small-angle X-ray scattering demonstrates that at any time during the epoxy curing process, the surfactant predominantly adopts a bilayer vesicular nano-morphology. Transmission electron microscopy on fully cured systems reveals the coexistence of spherical and worm-like micelles. Differential scanning calorimetry experiments prove that the presence of surfactant reduces the epoxy curing rate but that ultimately full curing is accomplished. The material glass transition temperature falls below that of the pure resin due to plasticization. It is suggested that favorable secondary interactions between the PEO segments and the epoxy resin are responsible for the observed phenomena.\u3c/p\u3

Solid-state drawing of post-consumer isotactic poly(propylene): effect of melt filtration and carbon black on structural and mechanical properties

\u3cp\u3ePost-consumer plastic waste obtained via mechanical recycling is usually applied in thick-walled products, because of the low mechanical strength due to the presence of contaminants. In fact, sorted post-consumer isotactic poly(propylene) (i-PP) can be considered as a blend of 95% i-PP and 5% poly(ethylene), with traces of poly(ethylene terephthalate) (PET). By applying a treatment such as solid-state drawing (SSD) after melt extrusion, the polymer chains can be oriented in one direction, thereby improving the stiffness and tensile strength. In this research, molecular processes such as crystal break-up and chain orientation of these complex blends were monitored as a function of draw ratio. The melt filter mesh size - used to exclude rigid PET particles - and the addition of carbon black (CB) - often added for coloration in the recycling industry - were varied to investigate their influence on the SSD process. This research shows that despite the blend complexity, the molecular processes during SSD compare to virgin i-PP and that similar draw ratios can be obtained (λ\u3csub\u3emax\u3c/sub\u3e = 20), albeit at reduced stiffness and strength as a result of the foreign polymers present in post-consumer i-PP. It is observed that the process stability improves with decreasing mesh size and that higher draw ratios can be obtained. The addition of carbon black, which resides in the dispersed PE phase, also stabilizes the SSD process. Compared to isotropic post-consumer i-PP, the stiffness can be improved by a factor 10 to over 11 GPa, while the tensile strength can be improved by a factor 15-385 MPa, which is approx. 70% of the maximum tensile strength achieved for virgin i-PP.\u3c/p\u3

Design and preparation of highly filled water-borne polymer–Gibbsite nanocomposites

\u3cp\u3eHighly filled, high solids content, water-borne polymer–Gibbsite nanocomposites are prepared with Gibbsite contents as high as 35 wt%. The polymer–Gibbsite nanocomposites are synthesised via conventional starved feed emulsion polymerization using negatively charged butyl acrylate-co-acrylic acid oligomers, which functioned as electrosteric stabilizers for the initial platelets and the subsequently formed latex particles. A simple mathematical model describing the amount of cooligomer required for the colloidal stability of the initial Gibbsite platelets and the subsequently formed particles was derived. This model was used to determine the reaction conditions required for obtaining colloidally stable nanocomposites with a targeted filler content. Cryogenic transmission electron microscopy characterization of the resulting nanocomposites with filler contents up to 20 wt% revealed fully encapsulated Gibbsite platelets and a mixed morphology of “muffin-like” and encapsulated particles was obtained at higher filler contents.\u3c/p\u3

Improving stiffness, strength, and toughness of poly(ω-pentadecalactone) fibers through in situ reinforcement with a vanillic acid-based thermotropic liquid crystalline polyester

\u3cp\u3eWe report on the morphology and performance of melt-drawn poly(ω-pentadecalactone) (PPDL) fibers reinforced with a vanillic acid-based thermotropic liquid crystalline polyester (LCP). The in situ reinforced PPDL/LCP fibers developed in this work are considered to be renewable in nature, given the fact that the feedstock for both polymers can be obtained from natural resources. To prepare these fibers, the polymers were mixed in a small scale twin-screw extruder, followed by melt-drawing of the extrudate. It is demonstrated that the tensile modulus and tensile strength of the fibers increase with increasing LCP orientation and concentration. Despite the brittle nature of the pure LCP component, melt-spun PPDL/LCP fibers maintain their ductile deformation for fibers containing up to 30 wt % LCP. The improved stiffness and strength of these PPDL/LCP fibers in combination with their ductile nature ensure improved energy absorption during deformation and effectively increases their toughness compared to the pure PPDL material. A further increase of the LCP content to 40 wt % and higher results in a poor control over the blend morphology, and brittle failure of the fibers is observed after the application of 2-3% strain. Small-angle X-ray scattering data indicate that after processing transcrystallization of PPDL occurs on the surface of the oriented LCP phase. According to DSC analysis, this transcrystallization on the oriented LCP fibrils is accompanied by an increase in the crystallization temperature. These findings have been confirmed through morphological analysis using transmission electron microscopy. It is anticipated that this interfacial crystallization strengthens the PPDL/LCP interface and allows delocalization of stress during deformation.\u3c/p\u3