We compared the effects of two diets on glycated hemoglobin (HbA1c) and other health-related outcomes in overweight or obese adults with type 2 diabetes or prediabetes (HbA1c>6%). We randomized ...participants to either a medium carbohydrate, low fat, calorie-restricted, carbohydrate counting diet (MCCR) consistent with guidelines from the American Diabetes Association (n = 18) or a very low carbohydrate, high fat, non calorie-restricted diet whose goal was to induce nutritional ketosis (LCK, n = 16). We excluded participants receiving insulin; 74% were taking oral diabetes medications. Groups met for 13 sessions over 3 months and were taught diet information and psychological skills to promote behavior change and maintenance. At 3 months, mean HbA1c level was unchanged from baseline in the MCCR diet group, while it decreased 0.6% in the LCK group; there was a significant between group difference in HbA1c change favoring the LCK group (-0.6%, 95% CI, -1.1% to -0.03%, p = 0.04). Forty-four percent of the LCK group discontinued one or more diabetes medications, compared to 11% of the MCCR group (p = 0.03); 31% discontinued sulfonylureas in the LCK group, compared to 5% in the MCCR group (p = 0.05). The LCK group lost 5.5 kg vs. 2.6 kg lost in MCCR group (p = 0.09). Our results suggest that a very low carbohydrate diet coupled with skills to promote behavior change may improve glycemic control in type 2 diabetes while allowing decreases in diabetes medications. This clinical trial was registered with ClinicalTrials.gov, number NCT01713764.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
BACKGROUNDBeginning at birth, the microbes in the gut perform essential duties related to the digestion and metabolism of food, the development and activation of the immune system, and the production ...of neurotransmitters that affect behavior and cognitive function.
OBJECTIVESThe objectives of this review are to (a) provide a brief overview of the microbiome and the “microbiome–gut–brain axis”; (b) discuss factors known to affect the composition of the infant microbiomemode of delivery, antibiotic exposure, and infant-feeding patterns; and (c) present research priorities for nursing science and clinical implications for infant health and neurocognitive development.
DISCUSSIONThe gut microbiome influences immunological, endocrine, and neural pathways and plays an important role in infant development. Several factors influence colonization of the infant gut microbiome. Different microbial colonization patterns are associated with vaginal versus surgical birth, exposure to antibiotics, and infant-feeding patterns. Because of extensive physiological influence, infant microbial colonization patterns have the potential to impact physical and neurocognitive development and life course disease risk. Understanding these influences will inform newborn care and parental education.
Abstract Amiodarone, an iodinated benzofuran derivative with Class I, II, III, and IV antiarrhythmic properties, is the most commonly used antiarrhythmic drug used to treat supraventricular and ...ventricular arrhythmias. Appropriate use of this drug, with its severe and potentially life-threatening adverse effects, requires an essential understanding of its risk-benefit properties in order to ensure safety. The objective of this review is to afford clinicians who treat patients receiving amiodarone an appropriate management strategy for its safe use. The authors of this consensus management guide have thoroughly reviewed and evaluated the existing literature on amiodarone and apply this information, along with the collective experience of the authors, in its development. Provided are management guides on the intravenous and oral dosing of amiodarone, appropriate outpatient follow-up of patients taking the drug, its recognized adverse effects, and recommendations on when to consult specialists to help in patient management. All clinicians must be cognizant of the appropriate use, follow-up, and adverse reactions of amiodarone. The responsibility incurred by those treating such patients cannot be overemphasized.
Abstract
The coronavirus disease pandemic has created opportunities for innovation in diabetes care that were not possible before. From the lens of this “new normal” state, we have an opportunity to ...rapidly implement, test, and iterate models of diabetes care to achieve the quadruple aim of improving medical outcomes, patient experience, provider satisfaction, and reducing costs. In this perspective, we discuss several innovative diabetes models of care which promote collaborative care models and improve access to high-quality specialty diabetes care. We discuss ongoing threats to diabetes care innovation, and offer practical solutions to foster evolution and sustain current strides made during the pandemic.
eReferral — A New Model for Integrated Care Chen, Alice Hm; Murphy, Elizabeth J; Yee, Hal F
The New England journal of medicine,
06/2013, Letnik:
368, Številka:
26
Journal Article
Recenzirano
In facing the challenge of taking better care of more patients at lower cost, health care organizations can learn from safety-net systems: one innovation prompted by clinical exigencies, eReferral, ...offers a new model for integrating primary and specialty care.
Health care reform has generated new pressures for the U.S. health care system to take better care of more patients at lower cost. Whereas these challenges are relatively new in the fee-for-service private sector, safety-net systems have perennially had to “do more with less”; innovations in this arena have generally been prompted by clinical exigencies rather than the need to gain market share or maximize revenues.
1
We believe that one such innovation — eReferral — can serve as a new model for integrating primary and specialty care.
In 2005, San Francisco General Hospital (SFGH) was grappling with a challenge familiar . . .
Abstract
Polycyclic aromatic hydrocarbons (PAHs) play a critical role in the reprocessing of stellar radiation and balancing the heating and cooling processes in the interstellar medium but appear to ...be destroyed in H
ii
regions. However, the mechanisms driving their destruction are still not completely understood. Using PHANGS–JWST and PHANGS–MUSE observations, we investigate how the PAH fraction changes in about 1500 H
ii
regions across four nearby star-forming galaxies (NGC 628, NGC 1365, NGC 7496, and IC 5332). We find a strong anticorrelation between the PAH fraction and the ionization parameter (the ratio between the ionizing photon flux and the hydrogen density) of H
ii
regions. This relation becomes steeper for more luminous H
ii
regions. The metallicity of H
ii
regions has only a minor impact on these results in our galaxy sample. We find that the PAH fraction decreases with the H
α
equivalent width—a proxy for the age of the H
ii
regions—although this trend is much weaker than the one identified using the ionization parameter. Our results are consistent with a scenario where hydrogen-ionizing UV radiation is the dominant source of PAH destruction in star-forming regions.
Idiopathic pulmonary fibrosis (IPF) is an untreatable and often fatal lung disease that is increasing in prevalence and is caused by complex interactions between genetic and environmental factors. ...Epigenetic mechanisms control gene expression and are likely to regulate the IPF transcriptome.
To identify methylation marks that modify gene expression in IPF lung.
We assessed DNA methylation (comprehensive high-throughput arrays for relative methylation arrays CHARM) and gene expression (Agilent gene expression arrays) in 94 patients with IPF and 67 control subjects, and performed integrative genomic analyses to define methylation-gene expression relationships in IPF lung. We validated methylation changes by a targeted analysis (Epityper), and performed functional validation of one of the genes identified by our analysis.
We identified 2,130 differentially methylated regions (DMRs; <5% false discovery rate), of which 738 are associated with significant changes in gene expression and enriched for expected inverse relationship between methylation and expression (P < 2.2 × 10(-16)). We validated 13/15 DMRs by targeted analysis of methylation. Methylation-expression quantitative trait loci (methyl-eQTL) identified methylation marks that control cis and trans gene expression, with an enrichment for cis relationships (P < 2.2 × 10(-16)). We found five trans methyl-eQTLs where a methylation change at a single DMR is associated with transcriptional changes in a substantial number of genes; four of these DMRs are near transcription factors (castor zinc finger 1 CASZ1, FOXC1, MXD4, and ZDHHC4). We studied the in vitro effects of change in CASZ1 expression and validated its role in regulation of target genes in the methyl-eQTL.
These results suggest that DNA methylation may be involved in the pathogenesis of IPF.
Correspondence to Dr Delphine S Tuot, Division of Nephrology at Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA 94110, USA; delphine.tuot@ucsf.edu ...Ensuring delivery of timely, coordinated, safe and cost-effective specialty care is one of the most pressing issues facing our healthcare systems worldwide.1 Poor access to specialty care is common across health delivery organisations, with wait times as high as 6–12 months in some communities.2–4 For many specialties this is rooted in a shortage of specialist physicians.5 A key question, therefore, is how to maximise the efficiency and effectiveness of specialist use and access. Studies of early adopters of eConsult programmes in North America, for instance, have demonstrated benefits consistent with the overarching goal of achieving the quadruple aim: high-quality care delivery that improves population health and achieves high satisfaction among providers, care team members and patients, while introducing cost-savings from new efficiencies.1 9 Some early adopters have sought to continue to improve the efficiency of eConsults, leveraging advanced practice providers (APP) or registered nurses (RN) to participate in the triage and/or electronic consultation aspects of eConsult programmes under supervision of specialty physicians. With longitudinal oversight and feedback by specialists, it is plausible that non-physicians could achieve greater confidence in correctly triaging more complex cases. ...for programmes such as this to succeed, adequate training is paramount, including comprehensive onboarding for new RNs as well as ongoing easy access to specialist advice and oversight. ...among the cases triaged to specialists by the RNs, 32% met at least one of the criteria for specialist oversight; close to 70% did not meet official criteria for specialist oversight, suggesting that the guidelines might not have adequately captured areas that would be of concern to RNs.
We evaluate a 12-member perturbed parameter ensemble of regional climate simulations over Europe at 12 km resolution, carried out as part of the UK Climate Projections (UKCP) project. This ensemble ...is formed by varying uncertain parameters within the model physics, allowing uncertainty in future projections due to climate modelling uncertainty to be explored in a systematic way. We focus on present day performance both compared to observations, and consistency with the driving global ensemble. Daily and seasonal temperature and precipitation are evaluated as two variables commonly used in impacts assessments. For precipitation we find that downscaling, even whilst within the convection-parameterised regime, generally improves daily precipitation, but not everywhere. In summer, the underestimation of dry day frequency is worse in the regional ensemble than in the driving simulations. For temperature we find that the regional ensemble inherits a large wintertime cold bias from the global model, however downscaling reduces this bias. The largest bias reduction is in daily winter cold temperature extremes. In summer the regional ensemble is cooler and wetter than the driving global models, and we examine cloud and radiation diagnostics to understand the causes of the differences. We also use a low-resolution regional simulation to determine whether the differences are a consequence of resolution, or due to other configuration differences, with the predominant configuration difference being the treatment of aerosols. We find that use of the EasyAerosol scheme in the regional model, which aims to approximate the aerosol effects in the driving model, causes reduced temperatures by around 0.5 K over Eastern Europe in Summer, and warming of a similar magnitude over France and Germany in Winter, relative to the impact of interactive aerosol in the global runs. Precipitation is also increased in these regions. Overall, we find that the regional model is consistent with the global model, but with a typically better representation of daily extremes and consequently we have higher confidence in its projections of their future change.
Bile acids (BAs) are essential for fat absorption and appear to modulate glucose and energy metabolism. Colesevelam, a BA sequestrant, improves glycemic control in type 2 diabetes mellitus (T2DM). We ...aimed to characterize the alterations in BA metabolism associated with T2DM and colesevelam treatment and to establish whether metabolic consequences of T2DM and colesevelam are related to changes in BA metabolism. Male subjects with T2DM (n = 16) and controls (n = 12) were matched for age and body mass index. BA pool sizes and synthesis/input rates were determined before and after 2 and 8 weeks of colesevelam treatment. T2DM subjects had higher cholic acid (CA) synthesis rate, higher deoxycholic acid (DCA) input rate, and enlarged DCA pool size. Colesevelam resulted in a preferential increase in CA synthesis in both groups. CA pool size was increased whereas chenodeoxycholic acid and DCA pool sizes were decreased upon treatment. Fasting and postprandial fibroblast growth factor 19 (FGF19) levels did not differ between controls and diabetics, but were decreased by treatment in both groups. Colesevelam treatment reduced hemoglobin A1C by 0.7% (P < 0.01) in diabetics. Yet, no relationships between BA kinetic parameters and changes in glucose metabolism were found in T2DM or with colesevelam treatment. Conclusion: Our results reveal significant changes in BA metabolism in T2DM, particularly affecting CA and DCA. Colesevelam treatment reduced FGF19 signaling associated with increased BA synthesis, particularly of CA, and resulted in a more hydrophilic BA pool without altering total BA pool size. However, these changes could not be related to the improved glycemic control in T2DM. (HEPATOLOGY 2010;)
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