The dawn phenomenon in type 2 diabetes: How to assess it in clinical practice?

International audienceAIM : The study was aimed at determining whether the dawn phenomenon in type 2 diabetes (T2D) can be predicted and quantified using simple and easily accessible glucose determinations.METHODS : A total of 210 non-insulin-treated persons with T2D underwent continuous glucose monitoring (CGM). The dawn phenomenon was quantified as the absolute increment from the nocturnal glucose nadir to the pre-breakfast value (Δdawn, mg/dL). Pre-lunch (preL) and pre-dinner (preD) glucose, and their averaged values (preLD), were compared with the nocturnal nadir. These pre-meal values were subtracted from the pre-breakfast values. The differences obtained (Δpre-mealL, Δpre-meal D and Δpre-meal LD) were correlated with Δdawn values. The receiver operating characteristic (ROC) curve was used to select the optimal Δpre-meal value that best predicted a dawn phenomenon, set at a threshold of 20mg/dL.RESULTS : All pre-meal glucose levels and differences from pre-breakfast values (Δpre-meal) significantly correlated (P<0.0001) with the nocturnal nadir and Δdawn values, respectively. The strongest correlations were observed for the parameters averaged at preL and preD time points: r=0.83 for preLD and r=0.58 for Δpre-meal LD. ROC curve analysis indicated that the dawn phenomenon at a threshold of 20mg/dL can be significantly predicted by a Δpre-meal LD cut off value of 10mg/dL. The relationship between Δdawn (Y, mg/dL) and Δpre-meal LD (X, mg/dL) was Y=0.49 X+15.CONCLUSION : The self-monitoring of preprandial glucose values at the three main mealtimes can predict the presence/absence of the dawn phenomenon, and permits reliable assessment of its magnitude without requiring continuous overnight glucose monitoring

Color Screening and the Suppression of the Charmonium State Yield in Nuclear Reactions

We discuss the new data for the production of the $\psi'$ meson in pA collisions at 450 GeV at CERN-SPS (of the NA50-collaboration) [1]. We extract from the CERN data $\sigma(\psi' N)\approx 8$ mb under the assumption that the $\psi'$ is produced as a result of the space-time evolution of a point-like $c\bar c$ pair which expands with time to the full size of the charmonium state. In the analysis we assume the existence of a relationship between the distribution of color in a hadron and the cross section of its interaction with a nucleon. However, our result is rather sensitive to the pattern of the expansion of the wave packet and significantly larger values of $\sigma(\psi' N)$ are not ruled out by the data. We show that recent CERN data confirm the suggestion of [2] that color fluctuations of the strengths in charmonium-nucleon interaction are the major source of suppression of the $J/\psi$ yield as observed at CERN in both pA and AA collisions.Comment: 10 pages, 5 figures (one with color

Flare energetics

In this investigation of flare energetics, researchers sought to establish a comprehensive and self-consistent picture of the sources and transport of energy within a flare. To achieve this goal, they chose five flares in 1980 that were well observed with instruments on the Solar Maximum Mission, and with other space-borne and ground-based instruments. The events were chosen to represent various types of flares. Details of the observations available for them and the corresponding physical parameters derived from these data are presented. The flares were studied from two perspectives, the impulsive and gradual phases, and then the results were compared to obtain the overall picture of the energics of these flares. The role that modeling can play in estimating the total energy of a flare when the observationally determined parameters are used as the input to a numerical model is discussed. Finally, a critique of the current understanding of flare energetics and the methods used to determine various energetics terms is outlined, and possible future directions of research in this area are suggested

Impact of a Community Pharmacist-Delivered Information Program on the Follow-up of Type-2 Diabetic Patients: A Cluster Randomized Controlled Study.

Low-quality communication between patients and care providers and limited patient knowledge of the disease and the therapy are important factors associated with poor glycemic control in patients with type 2 diabetes. We conducted a multicenter study to determine whether structured and tailored information delivered by pharmacists to type 2 diabetic patients could improve patient treatment adherence, hemoglobin A1c (HbA1c) levels and knowledge about diabetes. One hundred seventy-four pharmacies were randomized to deliver an educational program on diet, drug treatment, disease and complications during three 30-min interviews over a 6-month period, or to provide no intervention, to type 2 diabetic patients treated with oral antidiabetic agents. Medication adherence was assessed by measuring the medication possession ratio and diabetes control by collecting HbA1c values. Levels of patient treatment self-management and disease knowledge were assessed using self-questionnaires. Three hundred seventy-seven patients were analyzed. The medication possession ratio, already very high at baseline in the intervention (94.8%) and control (92.3%) groups, did not vary significantly after 6 months with no difference between the two groups. Significant decreases in HbA1c were observed in both groups at 6 months (p &lt; 0.001) and 12 months (p &lt; 0.01), with significantly greater changes from baseline in the intervention group than in the control group at 6 months (- 0.5% vs. - 0.2%, p = 0.0047) and 12 months (- 0.6% vs. - 0.2%, p = 0.0057). Patients in the intervention group showed greater improvement in their ability to self-manage treatment (+ 4.86 vs. + 1.58, p = 0.0014) and in the extent of their knowledge about diabetes (+ 0.6 vs. + 0.2, p &lt; 0.01) at 6 months versus baseline compared with the control group. Tailored information provided by the pharmacist to patients with type 2 diabetes did not significantly improve the already high adherence rates, but was associated with a significant decrease in HbA1c and an improvement of patient knowledge about diabetes. ISRCTN33776525. MSD France

Cluster coherent potential approximation for electronic structure of disordered alloys

We extend the single-site coherent potential approximation (CPA) to include the effects of non-local disorder correlations (alloy short-range order) on the electronic structure of random alloy systems. This is achieved by mapping the original Anderson disorder problem to that of a selfconsistently embedded cluster. This cluster problem is then solved using the equations of motion technique. The CPA is recovered for cluster size $N_{c}=1$, and the disorder averaged density-of-states (DOS) is always positive definite. Various new features, compared to those observed in CPA, and related to repeated scattering on pairs of sites, reflecting the effect of SRO are clearly visible in the DOS. It is explicitly shown that the cluster-CPA method always yields positive-definite DOS. Anderson localization effects have been investigated within this approach. In general, we find that Anderson localization sets in before band splitting occurs, and that increasing partial order drives a continuous transition from an Anderson insulator to an incoherent metal.Comment: 7 pages, 6 figures. submitted to PR

Probing Galaxy Formation with TeV Gamma Ray Absorption

We present here the extragalactic background light (EBL) predicted by semi-analytic models of galaxy formation, and show how measurements of the absorption of gamma rays of $\sim$ TeV energies via pair production on the EBL can probe cosmology and the formation of galaxies. Semi-analytic models permit a physical treatment of the key processes of galaxy formation -- including gravitational collapse and merging of dark matter halos, gas cooling and dissipation, star formation, supernova feedback and metal production -- and have been shown to reproduce key observations at low and high redshift. Using this approach, we investigate the consequences of variations in input assumptions such as the stellar initial mass function and the underlying cosmology. We conclude that observational studies of the absorption of $\sim 10^{-2}-10^{2}$ TeV gamma rays will help to constrain the star formation history of the universe, and the nature and extent of the extinction of starlight due to dust and reradiation of the absorbed energy at infrared wavelengths.Comment: 17 pages, 8 figures, presented at the VERITAS Workshop on TeV Astrophysics of Extragalactic Sources, eds. M. Catanese and T. Weekes, to be published in Astroparticle Physic

Deuteron Photodissociation in Ultraperipheral Relativistic Heavy-Ion on Deuteron Collisions

In ultraperipheral relativistic deuteron on heavy-ion collisions, a photon emitted from the heavy nucleus may dissociate the deuterium ion. We find deuterium breakup cross sections of 1.38 barns for deuterium-gold collisions at a center of mass energy of 200 GeV per nucleon, as studied at the Relativistic Heavy Ion Collider, and 2.49 barns for deuterium-lead collisions at a center of mass energy of 6.2 TeV, as proposed for the Large Hadron Collider. This cross section includes an energy-independent 140 mb contribution from hadronic diffractive dissociation. At the LHC, the cross section is as large as that of hadronic interactions. The estimated error is 5%. Deuteron dissociation could be used as a luminosity monitor and a `tag' for moderate impact parameter collisions.Comment: Final version, to appear in Phys. Rev. C. Diffractive dissociation included 10 pages with 3 figure

Constructing Dirac linear fermions in terms of non-linear Heisenberg spinors

We show that the massive (or massless) neutrinos can be described as special states of Heisenberg nonlinear spinors. As a by-product of this decomposition a particularly attractive consequence appears: the possibility of relating the existence of only three species of mass-less neutrinos to such internal non-linear structure. At the same time it allows the possibility that neutrino oscillation can occurs even for massless neutrinos