Effects of Growth Hormone and Pioglitazone in Viscerally Obese Adults with Impaired Glucose Tolerance: A Factorial Clinical Trial

OBJECTIVE: Recombinant human growth hormone (GH) and pioglitazone (PIO) in abdominally obese adults with impaired glucose tolerance were evaluated under the hypothesis that the combination attenuates GH-induced increases in glucose concentrations, reduces visceral adipose tissue (VAT), and improves insulin sensitivity over time. DESIGN: Randomized, double-blind, placebo-controlled, 2 × 2 factorial design. SETTING: Veterans Affairs Palo Alto Health Care System, Palo Alto, California, United States. PARTICIPANTS: 62 abdominally obese adults aged 40–75 with impaired glucose tolerance. INTERVENTIONS: GH (8 μg/kg/d, or placebo) and pioglitazone (30 mg/d, or placebo) for 40 wk. OUTCOME MEASURES: Baseline and after 40 wk of treatment, VAT content was quantified by CT scan, glucose tolerance was assessed using a 75-g oral glucose tolerance test, and insulin sensitivity was measured using steady-state plasma glucose levels obtained during insulin suppression test. RESULTS: Baseline: body mass index (BMI), plasma glucose, and visceral fat content were similar. 40 wk: visceral fat area declined 23.9 ± 7.4 cm(2) in GH group, mean difference from placebo: −28.1 cm(2) (95% CI −49.9 to −6.3 cm(2); p = 0.02). Insulin resistance declined 52 ± 11.8 mg/dl with PIO, mean difference from placebo of −58.8 mg/dl (95% CI −99.7 to −18.0 mg/dl; p = 0.01). VAT and SSPG declined with GH and PIO combined, mean differences from placebo of −31.4 cm(2) (95% CI −56.5 cm(2) to −6.3 cm(2); p = 0.02) and −55.3 mg/dl (95% CI −103.9 to −6.7 mg/dl; p = 0.02), respectively. Fasting plasma glucose increased transiently in GH group. No significant changes in BMI were observed. CONCLUSIONS: Addition of PIO to GH attenuated the short-term diabetogenic effect of GH; the drug combination reduced VAT and insulin resistance over time. GH plus PIO may have added benefit on body composition and insulin sensitivity in the metabolic syndrome

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

COVID-19 and Gender : A Necessary Connection in Diplomatic Studies

The COVID-19 crisis has fundamentally gendered effects, on intimate partner violence, the division of care labour, healthcare and more. This, and other COVID-19-related changes, may have important consequences for the gendered practice of diplomacy. This essay therefore discusses COVID-19 to highlight the need to pay better attention to gender in the study of diplomacy. For instance, what are the gender dimensions of diplomacy moving online? What are the gendered implications of the increased pressures on consular diplomacy? Turning to longer-term issues, how do gender justice organisations that respond to COVID-19 target diplomats and embassies? How, in turn, do diplomats respond to such advocacy and the underlying problems they address, and does the recent increase in women diplomats make any difference? Gender and diplomacy are intimately interwoven, this essay contends, and understanding the implications of COVID-19 on diplomacy necessitates examining this connection

Gender Equality and Nation Branding in the Nordic Region

This book explores how gender equality, a central part of the Nordic imaginary, is used in the political communication of Nordic states. The analyses presented move beyond conventional images and discourses of Nordic gender- and women-friendliness by critically investigating how and to what extent gender equality serves nation-branding in the Nordic region. Nation-branding is an unescapable part of globalisation, which is a market-oriented process dominated by the West and predicated on the creation of winners and losers. Hence, efforts to strengthen the national brand or reputation of specific Nordic countries with the aid of gender equality as a political and symbolic value inevitably help to reinforce already established global hierarchies where the Nordics play the role of moral superpower. This book comprises scholars from various fields of specialisation, and provides evidence and understanding for the growing interaction between gender-equality policies and nation-branding in all five Nordic countries. It does so by exploring a variety of policy fields and issues including women’s rights, foreign policy, rape and legislation, female quotas and business policies, in addition to the index industry. The rise of the global indexes has reproduced forceful images of the Nordic countries as frontrunners of gender equality, which indeed help the Nordic countries to further position themselves as ‘best at being good’. This book will be of great interest to students and scholars of Nordic gender equality in political science, sociology, law, criminology, political psychology and history, as well as those interested in nation branding, Nordic studies and exceptionalism

The body of the diplomat

Over the past two decades, the body has emerged as an increasingly important focus of study in the social sciences generally, but little work has been done on it in International Relations. Drawing on a disparate yet voluminous literature on gender, as well as on Bourdieu's analysis of class, this article demonstrates the importance of gendered and classed bodies within the Norwegian Ministry of Foreign Affairs (MFA). Part one, which is based on archival work and interviews, details the emergence of women within the diplomatic service. In part two, which is based on interviews and ethnographic data, I postulate the existence of three masculinity scripts and three femininity scripts within MFA discourse. I conclude that the gendering and classing of diplomats' bodies is a constitutive factor of the MFA hierarchic order and so differentiates diplomats' life chances. It follows that the body is of crucial importance to social life in at least one traditional site of IR study