Metformin, Sulfonylureas, or Other Antidiabetes Drugs and the Risk of Lactic Acidosis or Hypoglycemia

OBJECTIVE: Lactic acidosis has been associated with use of metformin. Hypoglycemia is a major concern using sulfonylureas. The aim of this study was to compare the risk of lactic acidosis and hypoglycemia among patients with type 2 diabetes using oral antidiabetes drugs. RESEARCH DESIGN AND METHODS: This study is a nested case-control analysis using the U.K.-based General Practice Research Database to identify patients with type 2 diabetes who used oral antidiabetes drugs. Within the study population, all incident cases of lactic acidosis and hypoglycemia were identified, and hypoglycemia case subjects were matched to up to four control patients based on age, sex, practice, and calendar time. RESULTS: Among the study population of 50,048 type 2 diabetic subjects, six cases of lactic acidosis during current use of oral antidiabetes drugs were identified, yielding a crude incidence rate of 3.3 cases per 100,000 person-years among metformin users and 4.8 cases per 100,000 person-years among users of sulfonylureas. Relevant comorbidities known as risk factors for lactic acidosis could be identified in all case subjects. A total of 2,025 case subjects with hypoglycemia and 7,278 matched control subjects were identified. Use of sulfonylureas was associated with a materially elevated risk of hypoglycemia. The adjusted odds ratio for current use of sulfonylureas was 2.79 (95% CI 2.23–3.50) compared with current metformin use. CONCLUSIONS: Lactic acidosis during current use of oral antidiabetes drugs was very rare and was associated with concurrent comorbidity. Hypoglycemic episodes were substantially more common among sulfonylurea users than among users of metformin.Merck SA, Lyon, Franc

Political Economists are Neither Selfish Nor Indoctrinated

Most professional economists believe that economists in general are more selfish than other persons and that this greater selfishness is due to economics education. This paper offers empirical evidence against this widely held belief. Using a unique data set about giving behavior in connection with two social funds at the University of Zurich, it is shown that economics education does not make people act more selfishly. Rather, this natural experiment suggests that the particular behavior of economists can be explained by a selection effect.economists, public good, giving behavior, education, selection

Spatially Resolved Chemistry in Nearby Galaxies II. The Nuclear Bar in Maffei 2

We present 2" - 10" imaging of eleven transitions from nine molecular species across the nuclear bar in Maffei 2. The data were obtained with the BIMA and OVRO interferometers. The ten detected transitions are compared with existing CO isotopologues, HCN, CS and millimeter continuum data. Dramatic spatial variations among the mapped species are observed across the nuclear bar. A principle component analysis is performed to characterize correlations between the transitions, star formation and molecular column density. The analysis reveals that HCN, HNC, HCO+ and 3 mm continuum are tightly correlated, indicating a direct connection to massive star formation. We find two main morphologically distinct chemical groups, CH3OH, SiO and HNCO comprising the grain chemistry molecules, versus HCN, HNC, HCO+ and C2H, molecules strong in the presence of star formation. The grain chemistry molecules, HNCO, CH3OH and SiO, trace hydrodynamical bar shocks. The near constancy of the HNCO/CH3OH, SiO/CH3OH and SiO/HNCO ratios argue that shock properties are uniform across the nucleus. HCN/HCO+, HCN/HNC, HCN/CS and HCN/CO ratios are explained primarily by variations in density. High HCO+/N2H+ ratios are correlated with the C2H line, suggesting that this ratio may be a powerful new dense photon-dominated region (PDR) probe in external galaxies. C2H reveals a molecular outflow along the minor axis. The morphology and kinematics of the outflow are consistent with an outflow age of 6-7 Myrs.Comment: 26 pages, 11 figures; Accepted to the Astrophysical Journa

Use of depot medroxyprogesterone acetate and fracture risk

Depot medroxyprogesterone acetate (DMPA), which has a high rate of use among teenagers in Europe and the United States, has been associated with impaired bone mineral acquisition during adolescence and accelerated bone loss in later life. Studies on the association between DMPA use and fracture risk are limited.; We aimed at evaluating the relationship between use of hormonal contraceptives, specifically DMPA, and fracture risk.; We conducted a case-control analysis using the United Kingdom-based General Practice Research Database.; Participants were females aged 20-44 yr with an incident fracture diagnosis between 1995 and 2008.; Odds ratios (OR) with 95% confidence intervals (CI) of incident fracture in relation to exposure to DMPA or combined oral contraceptives were assessed. Adjustments were made for smoking, body mass index, and additional potential confounders.; We identified 17,527 incident fracture cases and 70,130 control patients (DMPA exposure: 11 and 8%, respectively). Compared with nonuse, current use of one to two, three to nine, or 10 or more DMPA prescriptions yielded adjusted OR for fractures of 1.18 (95% CI = 0.93-1.49), 1.36 (95% CI = 1.15-1.60), and 1.54 (95% CI = 1.33-1.78), respectively. Fracture risk was highest after longer treatment duration (<2-3 yr), and there was no difference in patients below and above the age of 30 yr. For users of combined estrogen-containing oral contraceptives, the OR were around 1.; This population-based study suggests that use of DMPA is associated with a slightly increased risk of fractures

Treatment approaches for dual diagnosis clients in England

Introduction - Dual diagnosis (DD, co-occurrence of substance use and mental health problems) prevalence data in England are limited to specific regions and reported rates vary widely. Reliable information on actual service provision for dual diagnosis clients has not been collated. Thus a national survey was carried out to estimate dual diagnosis prevalence in treatment populations and describe the service provision available for this client population in drug/alcohol (DAS) and mental health services (MHS). Design - A questionnaire was sent to managers of 706 DAS and 2374 MHS. Overall, 249 (39%) DAS and 493 (23%) MHS participated in the survey. Results - In both DAS and MHS, around 32% of clients were estimated to have dual diagnosis problems. However, fewer than 50% of services reported assessing clients for both problem areas. Regarding specific treatment approaches, most services (DAS: 88%, MHS: 87%) indicated working jointly with other agencies. Significantly fewer services used joint protocols (DAS: 55%, MHS: 48%) or shared care arrangements, including access to external drug/alcohol or mental health teams (DAS: 47%, MHS: 54%). Only 25% of DAS and 17% of MHS employed dual diagnosis specialists. Conclusions - Dual diagnosis clients constitute a substantial proportion of clients in both DAS and MHS in England. Despite recent policy initiatives, joint working approaches tend to remain unstructured

Signatures of dynamically polarized nuclear spins in all-electrical lateral spin transport devices

The effect of nuclear spins in Fe/GaAs all-electrical spin-injection devices is investigated. At temperatures below 50 K, strong modifications of the non-local spin signal are found that are characteristic for hyperfine coupling between conduction electrons and dynamically polarized nuclear spins. The perpendicular component of the nuclear Overhauser field depolarizes electron spins near zero in-plane external magnetic field, and can suppress such dephasing when antialigned with the external field, leading to satellite peaks in a Hanle measurement. The features observed agree well with a Monte Carlo simulation of the spin diffusion equation including hyperfine interaction, and are used to study the nuclear spin dynamics and relate it to the spin polarization of injected electrons.Comment: 6 pages, 4 figure

Gas Bubbles Emerging from a Submerged Granular Bed

This fluid dynamics video was submitted to the Gallery of Fluid Motion for the 2009 APS Division of Fluid Dynamics Meeting in Minneapolis, Minnesota. In this video we show some results from a simple experiment where air was injected by a single nozzle at known constant flow rates in the bottom of a granular bed submerged in water. The injected air propagates through the granular bed in one of two modes. Mode 1 emergence involves small discrete bubbles taking tortuous paths through the interstitial space of the bed. Multiple small bubbles can be emitted from the bed in an array of locations at the same time during Mode 1 emergence. Mode 2 emergence involves large discrete bubbles locally fluidizing the granular bed and exiting the bed approximately above the injection site. Bead diameter, bead density, and air flow rate were varied to investigate the change in bubble release behavior at the top of the granular bed. This system is a useful model for methane seeps in lakes. Methane bubbles are released from the decomposition of organic matter in the lake bed. The initial size of the bubble determines how much of the gas is absorbed into the lake and how much of the gas reaches the surface and is released into the atmosphere. The size and behavior of the emerging bubbles may also affect the amount of vertical mixing occurring in the lake, as well as the mixing from the lake bed into the benthic layer.Comment: 2009 APS DFD Gallery of Fluid Motion Submissio

Precise measurements of electron and hole g-factors of single quantum dots by using nuclear field

We demonstrated the cancellation of the external magnetic field by the nuclear field at one edge of the nuclear polarization bistability in single InAlAs quantum dots. The cancellation for the electron Zeeman splitting gives the precise value of the hole g-factor. By combining with the exciton g-factor that is obtained from the Zeeman splitting for linearly polarized excitation, the magnitude and sign of the electron and hole g-factors in the growth direction are evaluated.Comment: 3 pages, 2 figure