Hypoglycemia in patient with type 2 diabetes treated with insulin: it can happen

There are many misconceptions about the prevalence and effects of hypoglycemia in people with type 2 diabetes (T2D), including hypoglycemia does not occur or does not have adverse consequences in T2D. This narrative review aims to help dispel these myths. Around 25% of people with T2D taking insulin for >5 years were found to have severe hypoglycemic events, which is comparable to the severe hypoglycemia rate in adults with type 1 diabetes (T1D) diagnosed within 5 years. The total number of hypoglycemic events among insulin-treated T2D, including severe hypoglycemia, is as high or higher than among those with T1D. Recent evidence suggests serious consequences of hypoglycemia may, in some respects, be greater in individuals with T2D, particularly regarding effects on the cardiovascular system. Hypoglycemia is generally patient-reported. Issues with hypoglycemia unawareness, limited glucose testing, limited recall, lack of event logging and fear of failure or shaming limits the number of hypoglycemic episodes reported by people with diabetes. Barriers to healthcare provider inquiry and reporting include lack of knowledge regarding the problem’s magnitude, competing priorities during patient visits, lack of incentives to report and limitations to documentation systems for adequate reporting. All people with diabetes should be encouraged to discuss their experiences with hypoglycemia without judgment or shame. Glucose targets, testing schedules (blood glucose or continuous glucose monitoring) and treatment plans should be reviewed often and individualized to the minimize risk of hypoglycemia. Finally, people with T2D on insulin should always be encouraged to have oral glucose and rescue medication immediately available

Metabolic profiling predicts response to anti-tumor necrosis factor α therapy in patients with rheumatoid arthritis

<p>Objective: Anti–tumor necrosis factor (anti-TNF) therapies are highly effective in rheumatoid arthritis (RA) and psoriatic arthritis (PsA), but a significant number of patients exhibit only a partial or no therapeutic response. Inflammation alters local and systemic metabolism, and TNF plays a role in this. We undertook this study to determine if the patient's metabolic fingerprint prior to therapy could predict responses to anti-TNF agents.</p> <p>Methods: Urine was collected from 16 RA patients and 20 PsA patients before and during therapy with infliximab or etanercept. Urine metabolic profiles were assessed using nuclear magnetic resonance spectroscopy. Discriminating metabolites were identified, and the relationship between metabolic profiles and clinical outcomes was assessed.</p> <p>Results: Baseline urine metabolic profiles discriminated between RA patients who did or did not have a good response to anti-TNF therapy according to European League Against Rheumatism criteria, with a sensitivity of 88.9% and a specificity of 85.7%, with several metabolites contributing (in particular histamine, glutamine, xanthurenic acid, and ethanolamine). There was a correlation between baseline metabolic profiles and the magnitude of change in the Disease Activity Score in 28 joints from baseline to 12 months in RA patients (P = 0.04). In both RA and PsA, urinary metabolic profiles changed between baseline and 12 weeks of anti-TNF therapy. Within the responders, urinary metabolite changes distinguished between etanercept and infliximab treatment.</p> <p>Conclusion: The clear relationship between urine metabolic profiles of RA patients at baseline and their response to anti-TNF therapy may allow development of novel approaches to the optimization of therapy. Differences in metabolic profiles during treatment with infliximab and etanercept in RA and PsA may reflect distinct mechanisms of action.</p&gt

Plasma Turbulence in the Local Bubble

Turbulence in the Local Bubble could play an important role in the thermodynamics of the gas that is there. The best astronomical technique for measuring turbulence in astrophysical plasmas is radio scintillation. Measurements of the level of scattering to the nearby pulsar B0950+08 by Philips and Clegg in 1992 showed a markedly lower value for the line-of-sight averaged turbulent intensity parameter $$than is observed for other pulsars, consistent with radio wave propagation through a highly rarefied plasma. In this paper, we discuss the observational progress that has been made since that time. At present, there are four pulsars (B0950+08, B1133+16, J0437-4715, and B0809+74) whose lines of sight seem to lie mainly within the local bubble. The mean densities and line of sight components of the interstellar magnetic field along these lines of sight are smaller than nominal values for pulsars, but not by as much expected. Three of the four pulsars also have measurements of interstellar scintillation. The value of the parameter$$ is smaller than normal for two of them, but is completely nominal for the third. This inconclusive status of affairs could be improved by measurements and analysis of ``arcs'' in ``secondary spectra'' of pulsars.Comment: Submitted to Space Science Reviews as contribution to Proceedings of ISSI (International Space Science Institute) workshop "From the Heliosphere to the Local Bubble". Refereed version accepted for publicatio

Posthuman Object Pedagogies: Thinking with Things to Think with Theory for Innovative Educational Research

Educational practices and learning processes are entangled with multitudes of objects but these objects are so often disregarded as mundane background and thingified – positioned as dull, inert matter, unnoticed, and made subserviently serviceable in order that the proper business of educating the human can go on. Such an education, with its orientation to reason, logical argument and the mind, silences objects and produces humans as docile bodies. This article develops posthuman object pedagogies to contest the ontological positioning of objects as inert and dead and, instead, attend to the quiet but powerful work they do (Taylor, 2013, 2017). Using Barad’s (2007) and Haraway’s (2016) posthumanist materialist ontology of what Bennett’s (2010) calls thing-power the article proposes a practice of thinking with things as a means of thinking with theory. We illuminate this practice through four object encounters. The insights from these encounters provide the basis for developing posthuman object pedagogies which re-evaluate understanding of the work objects do as intra-active agencies and in recasting educational research. As four educators at different career stages, we develop posthuman object pedagogies to enable us to do educational research otherwise

Isotope sourcing of prehistoric willow and tule textiles recovered from western Great Basin rock shelters and caves e proof of concept

Isotope and trace-metal analyses were used to determine the origin of plants used to manufacture prehistoric textiles (basketry and matting) from archaeological sites in the western Great Basin. Research focused on strontium (87Sr/86Sr) and oxygen (18O/16O) isotope ratios of willow (Salix sp.) and tule (Schoenoplectus sp.), the dominant raw materials in Great Basin textiles. The oxygen-isotope data indicated that the willow and tule used to produce the textiles were harvested from the banks of rivers or in marshes characterized by flowing water and not from lakes or sinks. The strontium-isotope data were useful in showing which plants came from the Humboldt River and which came from rivers headed in the Sierra Nevada

Determination of spin and orbital magnetization in the ferromagnetic superconductor UCoGe

International audienceThe magnetism in the ferromagnetic superconductor UCoGe has been studied using a combination of magnetic Compton scattering, bulk magnetization, X-ray magnetic circular dichroism and electronic structure calculations, in order to determine the spin and orbital moments. The experimentally observed total spin moment, Ms, was found to be-0.24 ± 0.05 µB at 5 T. By comparison with the total moment of 0.16 ± 0.01 µB, the orbital moment, M l , was determined to be 0.40 ± 0.05 µB. The U and Co spin moments were determined to be antiparallel. We find that the U 5f electrons carry a spin moment of Us ≈-0.30 µB and that there is a Co spin moment of Cos ≈ 0.06 µB induced via hybridization. The ratio U l /Us, of −1.3 ± 0.3, shows the U moment to be itinerant. In order to ensure an accurate description of the properties of 5f systems, and to provide a critical test of the theoretical approaches, it is clearly necessary to obtain experimental data for both the spin and orbital moments, rather than just the total magnetic moment. This can be achieved simply by measuring the spin moment with magnetic Compton scattering and comparing this to the total moment from bulk magnetizatio

The toxbox: specific DNA sequence requirements for activation of Vibrio cholerae virulence genes by ToxT

The Gram-negative, curved rod Vibrio cholerae causes the severe diarrhoeal disease cholera. The two major virulence factors produced by V. cholerae during infection are the cholera toxin (CT) and the toxin-coregulated pilus (TCP). Transcription of the genes encoding both CT and the components of the TCP is directly activated by ToxT, a transcription factor in the AraC/XylS family. ToxT binds upstream of the ctxAB genes, encoding CT, and upstream of tcpA , the first gene in a large operon encoding the components of the TCP. The DNA sequences upstream of ctxAB and tcpA that contain ToxT binding sites do not have any significant similarity other than being AT-rich. Extensive site-directed mutagenesis was performed on the region upstream of tcpA previously shown to be protected by ToxT, and we identified specific base pairs important for activation of tcpA transcription by ToxT. This genetic approach was complemented by copper-phenanthroline footprinting experiments that showed protection by ToxT of the base pairs identified as most important for transcription activation in the mutagenesis experiments. Based on this new information and on previous work, we propose the presence of a ToxT-binding motif – the ‘toxbox’– in promoters regulated by ToxT. At tcpA , two toxbox elements are present in a direct repeat configuration and both are required for activation of transcription by ToxT. The identity of only a few of the base pairs within the toxbox is important for activation by ToxT, and we term these the core toxbox elements. Lastly, we examined ToxT binding to a mutant having 5 bp inserted between the two toxboxes at tcpA and found that occupancy of both binding sites is retained regardless of the positions of the binding sites relative to each other on the face of the DNA. This suggests that ToxT binds independently as a monomer to each toxbox in the tcpA direct repeat, in accordance with what we observed previously with the inverted repeat ToxT sites between acfA and acfD .Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75755/1/j.1365-2958.2006.05053.x.pd

QED and String Theory

We analyze the D9-D9bar system in type IIB string theory using Dp-brane probes. It is shown that the world-volume theory of the probe Dp-brane contains two-dimensional and four-dimensional QED in the cases with p=1 and p=3, respectively, and some applications of the realization of these well-studied quantum field theories are discussed. In particular, the two-dimensional QED (the Schwinger model) is known to be a solvable theory and we can apply the powerful field theoretical techniques, such as bosonization, to study the D-brane dynamics. The tachyon field created by the D9-D9bar strings appears as the fermion mass term in the Schwinger model and the tachyon condensation is analyzed by using the bosonized description. In the T-dualized picture, we obtain the potential between a D0-brane and a D8-D8bar pair using the Schwinger model and we observe that it consists of the energy carried by fundamental strings created by the Hanany-Witten effect and the vacuum energy due to a cylinder diagram. The D0-brane is treated quantum mechanically as a particle trapped in the potential, which turns out to be a system of a harmonic oscillator. As another application, we obtain a matrix theory description of QED using Taylor's T-duality prescription, which is actually applicable to a wide variety of field theories including the realistic QCD. We show that the lattice gauge theory is naturally obtained by regularizing the matrix size to be finite.Comment: 33 pages, Latex, 4 figures, a reference adde