The incidence of hypoglycaemia in children with type 1 diabetes and treated asthma

AIMS: To investigate whether treatment of coexisting asthma has any effect on the incidence of hypoglycaemia and on glycaemic control in children with type 1 diabetes. METHODS: An observational study of children attending the paediatric diabetes clinics of five hospitals in the North Trent Region. Information on the frequency of hypoglycaemia in the preceding three months, treatment for asthma, and the individual’s latest HbA1c, was recorded when they attended for review. RESULTS: Data were collected on 226 children, of whom 27 (12%) had treated asthma. Only 11/27 children with asthma were taking their prescribed inhaled steroids. All used ß agonists at least once a week. There was a reduction of 20% in the incidence of hypoglycaemia in the diabetic children with treated asthma. Of the children with diabetes and treated asthma, 52% reported an episode of hypoglycaemia in the previous three months compared to 72% of those with only diabetes. There was no difference in the proportion of children experiencing nocturnal or severe hypoglycaemia. Although not significant, those with asthma and diabetes also had better overall control (HbA1c 8.8%) compared to those with diabetes alone (HbA1c 9.3%). CONCLUSIONS: Diabetic children with treated asthma have significantly fewer episodes of hypoglycaemia and better glycaemic control compared to children with diabetes alone. This observation needs further investigation but raises an interesting question. Do the drugs used to treat asthma, in particular ß agonists, have the therapeutic potential to reduce hypoglycaemia and facilitate an improvement in glycaemic control

Protocol for: The use of intra-gastric balloons as an adjunct to a lifestyle support programme to promote weight loss in severely obese adolescents

Background: Severe childhood and adolescent obesity (BMI>3.5SD) remains a significant public health priority with an increasing incidence [1] and is associated with significant morbidity including immediate and long-term cardiovascular, metabolic and psychological consequences [2]. Current non-invasive treatments including lifestyle modification and pharmaceutical intervention are of limited effectiveness in this population, which leaves permanent bariatric surgery as the only viable option. As an alternative, intra-gastric balloons offer a reversible, potentially safer and less invasive option for severely obese adolescents for whom all other available treatments have been exhausted. Methods/design: - BOB is a non-randomised pilot study. A cohort of 12 obese adolescents (BMI > 3.5SD, puberty stage 4 or more) aged 13 - 16 years, will be recruited to the study, where an intragastric balloon (ORBERA – inflated to 500-700ml) will be inserted into the stomach for 6 months, whilst receiving intense, weekly, behavioural support for the family. Follow-up will continue for 18 months after balloon removal with reduced behavioural support. The primary outcome measure will be the change in body weight and BMI standard deviation score from baseline following six months with the intragastric balloon and lifestyle therapy. Secondary outcome measures include the assessment of weight maintenance at 18 months post balloon removal, biomedical outcomes including blood glucose levels, physical activity and physical fitness, and psychosocial outcomes such as paediatric health-related quality of life

Disturbed Sleep Connects Symptoms of Posttraumatic Stress Disorder and Somatization: A Network Analysis Approach

Posttraumatic stress disorder (PTSD) and physical health problems, particularly somatic symptom disorder, are highly comorbid. Studies have only examined this co‐occurrence at the disorder level rather than assessing the associations between specific symptoms. Using network analysis to identify symptoms that act as bridges between these disorders may allow for the development of interventions to specifically target this comorbidity. We examined the association between somatization and PTSD symptoms via network analysis. This included 349 trauma‐exposed individuals recruited through the National Centre for Mental Health PTSD cohort who completed the Clinician‐Administered PTSD Scale for DSM‐5 and the Patient Health Questionnaire–15. A total of 215 (61.6%) individuals met the DSM‐5 diagnostic criteria for PTSD. An exploratory graph analysis identified four clusters of densely connected symptoms within the overall network: PTSD, chronic pain, gastrointestinal issues, and more general somatic complaints. Sleep difficulties played a key role in bridging PTSD and somatic symptoms. Our network analysis demonstrates the distinct nature of PTSD and somatization symptoms, with this association connected by disturbed sleep

International survey on high- and low-dose synacthen test and assessment of accuracy in preparing low-dose synacthen

OBJECTIVE: The short synacthen test (SST) is widely used to assess patients for adrenal insufficiency but the frequency and protocols used across different centres for the low-dose test (LDT) are unknown. This study aimed to survey centres and test the accuracy of ten different synacthen preparation strategies used for the LDT. METHODS: Members of six international endocrine societies were surveyed regarding diagnostic tests used for adrenal insufficiency, and in particular the SST. Synacthen was diluted for the LDT and concentrations measured using a synacthen ELISA. RESULTS: Survey responses were received from 766 individuals across 60 countries (52% adult, 45% paediatric endocrinologists). The SST is used by 98% of centres: 92% using high-dose (250 μg), 43% low-dose, and 37% both. Ten low-dose dilution methods were assessed and variation in synacthen concentration was demonstrated with intra-method coefficients of variation (CV) ranging from 2.1% to 109%. The method using 5% dextrose as a diluent was the least variable (CV of 2.1%). The variation in dilution methods means that the dose of synacthen administered in a LDT may vary between 0.16 μg and 0.81 μg. CONCLUSIONS: The high-dose SST is the most popular diagnostic test of adrenal insufficiency but up to 72% of paediatric endocrinologists use a LDT. There is considerable variation observed both within and between low-dose synacthen dilution methods creating considerable risk of inaccurate dosing and thereby invalid results

Agr quorum sensing influences the Wood-Ljungdahl pathway in Clostridium autoethanogenum

Acetogenic bacteria are capable of fermenting CO2 and carbon monoxide containing waste-gases into a range of platform chemicals and fuels. Despite major advances in genetic engineering and improving these biocatalysts, several important physiological functions remain elusive. Among these is quorum sensing, a bacterial communication mechanism known to coordinate gene expression in response to cell population density. Two putative agr systems have been identified in the genome of Clostridium autoethanogenum suggesting bacterial communication via autoinducing signal molecules. Signal molecule-encoding agrD1 and agrD2 genes were targeted for in-frame deletion. During heterotrophic growth on fructose as a carbon and energy source, single deletions of either gene did not produce an observable phenotype. However, when both genes were simultaneously inactivated, final product concentrations in the double mutant shifted to a 1.5:1 ratio of ethanol:acetate, compared to a 0.2:1 ratio observed in the wild type control, making ethanol the dominant fermentation product. Moreover, CO2 re-assimilation was also notably reduced in both hetero- and autotrophic growth conditions. These findings were supported through comparative proteomics, which showed lower expression of carbon monoxide dehydrogenase, formate dehydrogenase A and hydrogenases in the ∆agrD1∆agrD2 double mutant, but higher levels of putative alcohol and aldehyde dehydrogenases and bacterial micro-compartment proteins. These findings suggest that Agr quorum sensing, and by inference, cell density play a role in carbon resource management and use of the Wood-Ljungdahl pathway as an electron sink

The dynamics of quantum phases in a spinor condensate

We discuss the quantum phases and their diffusion dynamics in a spinor-1 atomic Bose-Einstein condensate. For ferromagnetic interactions, we obtain the exact ground state distribution of the phases associated with the total atom number ($N$), the total magnetization (${\cal M}$), and the alignment (or hypercharge) ($Y$) of the system. The mean field ground state is stable against fluctuations of atom numbers in each of the spin components, and the phases associated with the order parameter for each spin components diffuse while dynamically recover the two broken continuous symmetries [U(1) and SO(2)] when $N$ and ${\cal M}$ are conserved as in current experiments. We discuss the implications to the quantum dynamics due to an external (homogeneous) magnetic field. We also comment on the case of a spinor-1 condensate with anti-ferromagnetic interactions.Comment: 5 figures, an extended version of cond-mat/030117

Measurement of the residual energy of muons in the Gran Sasso underground Laboratories

The MACRO detector was located in the Hall B of the Gran Sasso underground Laboratories under an average rock overburden of 3700 hg/cm^2. A transition radiation detector composed of three identical modules, covering a total horizontal area of 36 m^2, was installed inside the empty upper part of the detector in order to measure the residual energy of muons. This paper presents the measurement of the residual energy of single and double muons crossing the apparatus. Our data show that double muons are more energetic than single ones. This measurement is performed over a standard rock depth range from 3000 to 6500 hg/cm^2.Comment: 28 pages, 9 figure

Quantifying stratospheric biases and identifying their potential sources in subseasonal forecast systems

The stratosphere can be a source of predictability for surface weather on timescales of several weeks to months. However, the potential predictive skill gained from stratospheric variability can be limited by biases in the representation of stratospheric processes and the coupling of the stratosphere with surface climate in forecast systems. This study provides a first systematic identification of model biases in the stratosphere across a wide range of subseasonal forecast systems. It is found that many of the forecast systems considered exhibit warm global-mean temperature biases from the lower to middle stratosphere, too strong/cold wintertime polar vortices, and too cold extratropical upper-troposphere/lowerstratosphere regions. Furthermore, tropical stratospheric anomalies associated with the Quasi-Biennial Oscillation tend to decay toward each system¿s climatology with lead time. In the Northern Hemisphere (NH), most systems do not capture the seasonal cycle of extreme-vortex-event probabilities, with an underestimation of sudden stratospheric warming events and an overestimation of strong vortex events in January. In the Southern Hemisphere (SH), springtime interannual variability in the polar vortex is generally underestimated, but the timing of the final breakdown of the polar vortex often happens too early in many of the prediction systems. These stratospheric biases tend to be considerably worse in systems with lower model lid heights. In both hemispheres, most systems with low-top atmospheric models also consistently underestimate the upward wave driving that affects the strength of the stratospheric polar vortex. We expect that the biases identified here will help guide model development for subseasonal-to-seasonal forecast systems and further our understanding of the role of the stratosphere in predictive skill in the troposphere.This work uses S2S Project data. S2S is a joint initiative of the World Weather Research Programme (WWRP) and the World Climate Research Programme (WCRP). This work was initiated by the Stratospheric Network for the Assessment of Predictability (SNAP), a joint activity of SPARC (WCRP) and the S2S Project (WWRP–WCRP). The work of Rachel W.-Y. Wu is funded through ETH grant ETH-05 19-1. Support from the Swiss National Science Foundation through projects PP00P2_170523 and PP00P2_198896 to Daniela I. V. Domeisen is gratefully acknowledged. Chaim I. Garfinkel and Chen Schwartz are supported by the ISF–NSFC joint research program (grant no. 3259/19). The work of Marisol Osman was supported by UBACyT20020170100428BA and PICT-2018-03046 projects. The work of Alvaro de la Cámara is funded by the Spanish Ministry of Science and Innovation through project PID2019-109107GB-I00. Blanca Ayarzagüena and Natalia Calvo acknowledge the support of the Spanish Ministry of Science and Innovation through the JeDiS (RTI2018-096402-B-I00) project. Froila M. Palmeiro and Javier García-Serrano have been partially supported by the Spanish ATLANTE project (PID2019-110234RB-C21) and Ramón y Cajal program (RYC-2016-21181), respectively. Neil P. Hindley and Corwin J. Wright are supported by UK Natural Environment Research Council (NERC), grant number NE/S00985X/1. Corwin J. Wright is also supported by a Royal Society University Research Fellowship UF160545. Seok-Woo Son and Hera Kim are supported by the Basic Science Research Program through the National Research Foundation of Korea (2017R1E1A1A01074889). This material is based upon work supported by the US Department of Energy, Office of Science, Office of Biological and Environmental Research (BER), Regional and Global Model Analysis (RGMA) component of the Earth and Environmental System Modeling program under award no. DE-SC0022070 and National Science Foundation (NSF) IA 1947282. This work was also supported by the National Center for Atmospheric Research (NCAR), which is a major facility sponsored by the NSF under cooperative agreement no. 1852977. Pu Lin is supported by award NA18OAR4320123 from the National Oceanic and Atmospheric Administration (NOAA), U.S. Department of Commerce. Zachary D. Lawrence was partially supported under NOAA award NA20NWS4680051; Zachary D. Lawrence and Judith Perlwitz also acknowledge support from US federally appropriated funds