Rat anterior cingulate neurons responsive to rule or strategy changes are modulated by the hippocampal theta rhythm and sharp-wave ripples.

To better understand neural processing during adaptive learning of stimulus-response-reward contingencies, we recorded synchrony of neuronal activity in anterior cingulate cortex (ACC) and hippocampal rhythms in male rats acquiring and switching between spatial and visual discrimination tasks in a Y-maze. ACC population activity as well as single unit activity shifted shortly after task rule changes or just before the rats adopted different task strategies. Hippocampal theta oscillations (associated with memory encoding) modulated an elevated proportion of rule-change responsive neurons (70%), but other neurons that were correlated with strategy-change, strategy value and reward-rate were not. However, hippocampal sharp wave-ripples modulated significantly higher proportions of rule-change, strategy-change and reward-rate responsive cells during post-session sleep but not pre-session sleep. This suggests an underestimated mechanism for hippocampal mismatch and contextual signals to facilitate ACC to detect contingency changes for cognitive flexibility, a function that is attenuated after it is damaged.

The transCampus Metabolic Training Programme Explores the Link of SARS-CoV-2 Virus to Metabolic Disease.

Currently, we are experiencing a true pandemic of a communicable disease by the virus SARS-CoV-2 holding the whole world firmly in its grasp. Amazingly and unfortunately, this virus uses a metabolic and endocrine pathway via ACE2 to enter our cells causing damage and disease. Our international research training programme funded by the German Research Foundation has a clear mission to train the best students wherever they may come from to learn to tackle the enormous challenges of diabetes and its complications for our society. A modern training programme in diabetes and metabolism does not only involve a thorough understanding of classical physiology, biology and clinical diabetology but has to bring together an interdisciplinary team. With the arrival of the coronavirus pandemic, this prestigious and unique metabolic training programme is facing new challenges but also new opportunities. The consortium of the training programme has recognized early on the need for a guidance and for practical recommendations to cope with the COVID-19 pandemic for the community of patients with metabolic disease, obesity and diabetes. This involves the optimal management from surgical obesity programmes to medications and insulin replacement. We also established a global registry analyzing the dimension and role of metabolic disease including new onset diabetes potentially triggered by the virus. We have involved experts of infectious disease and virology to our faculty with this metabolic training programme to offer the full breadth and scope of expertise needed to meet these scientific challenges. We have all learned that this pandemic does not respect or heed any national borders and that we have to work together as a global community. We believe that this transCampus metabolic training programme provides a prime example how an international team of established experts in the field of metabolism can work together with students from all over the world to address a new pandemic.

Biological Control of Citrus Huanglongbing with EB92-1, a Benign Strain of Xylella fastidiosa.

Huanglongbing (HLB), caused by Candidatus Liberibacter asiaticus, is currently the most destructive disease of citrus and threatens production in all affected areas. There is no cure. Benign Xylella fastidiosa strain EB92-1 provided good control of Pierce's disease of grapevine by inducing host resistance; therefore, we evaluated the strain for the biological control of HLB in citrus. Treatment was by injection into the trunk of the trees. Strain EB92-1 was shown to colonize citrus and provided control of HLB by reducing both the incidence of symptomatic trees and the percentage of trees with severe symptoms in three separate trials. All trees were positive by quantitative PCR (qPCR) for Candidatus Liberibacter asiaticus at the start of the trials, and treatment did not eliminate the bacterium. In a trial of asymptomatic mature trees, a single treatment with EB92-1 reduced the incidence of trees with symptoms through 18 months after treatment and reduced the incidence of trees with severe symptoms through 3 years. In mature trees that had 60% incidence of mild HLB symptoms at trial initiation, percentage of trees with symptoms and trees with severe symptoms continued to develop in both the untreated and in the EB92-1-treated trees for 12 months. However, retreatment at 9 and 20 months prevented the development of additional severe symptoms in the EB92-1-treated trees throughout the remainder of the 5-year trial. In 2-year-old trees, incidence of trees with HLB symptoms was higher in the untreated trees than in the treated trees throughout the 6 years of the trial, reaching 90% in the untreated versus 50% in the treated. After 6 years, severity of symptoms was much lower in the EB92-1-treated trees, only 3% of the treated trees had become unproductive compared with 18% of the untreated. In 2020, the reduction in HLB severity resulted in approximately twice as much yield in the treated trees as in these untreated 8-year-old trees. X. fastidiosa strain EB92-1 proved to be efficacious for the control of HLB symptoms in both mature trees and newly planted young trees, but trees may need to be retreated yearly for at least the first 2 to 3 years.

Multidisciplinary healthcare teams' challenges and strategies in supporting people with type 1 diabetes to recover from disordered eating.

AIM: To examine the challenges healthcare teams face when treating people with type 1 diabetes and disordered eating and the strategies these teams have developed to facilitate effective treatment. METHODS: Four semi-structured focus groups were conducted including two tertiary diabetes specialist teams and three tertiary eating disorders specialist teams between July and December 2018. Thematic analysis of the transcripts followed a six-phase process. RESULTS: Twenty-nine experienced healthcare professionals (16 diabetes and 13 eating disorder specialists, 16±12 years' professional experience) were interviewed. The challenges identified in treating people with type 1 diabetes and disordered eating included subthemes the 'challenges specific to the healthcare professional' (feeling not competent enough and perceived emotional burden), 'challenges pertaining to patient factors' (e.g. difficulties with engaging in therapy) and 'challenges created by the healthcare system' (time pressure and staff shortage). Healthcare professionals expressed the need for a consensus on diagnosis and the definition of disordered eating in type 1 diabetes, as well as the need for training and educational resources specific to type 1 diabetes and disordered eating. Healthcare professionals gave practical examples of strategies of communication for better patient engagement and felt that multidisciplinary working in joint clinics with the other specialty were facilitators for recovery from disordered eating. CONCLUSIONS: Healthcare professionals require multidisciplinary team support when treating people with type 1 diabetes and to improve their own competencies. The development of effective screening and assessment tools, educational resources and training for healthcare professionals, and developing multidisciplinary treatment pathways will be key to improving outcomes for their service users with type 1 diabetes and disordered eating.

Guidelines for the management of diabetes in care homes during the Covid-19 pandemic.

The National Diabetes Stakeholders Covid-19 Response Group was formed in early April 2020 as a rapid action by the Joint British Diabetes Societies for Inpatient Care, Diabetes UK, the Association of British Clinical Diabetologists, and Diabetes Frail to address and support the special needs of residents with diabetes in UK care homes during Covid-19. It was obvious that the care home sector was becoming a second wave of Covid-19 infection and that those with diabetes residing in care homes were at increased risk not only of susceptibility to infection but also to poorer outcomes. Its key purposes included minimising the morbidity and mortality associated with Covid-19 and assisting care staff to identify those residents with diabetes at highest risk of Covid-19 infection. The guidance was particularly created for care home managers, other care home staff, and specialist and non-specialist community nursing teams. The guidance covers the management of hyperglycaemia by discussion of various clinical scenarios that could arise, the management of hypoglycaemia, foot care and end of life care. In addition, it outlines the conditions where hospital admission is required. The guidance should be regarded as interim and will be updated as further medical and scientific evidence becomes available.

Microbiomics of Namib Desert habitats.

The Namib Desert is one of the world's only truly coastal desert ecosystem. Until the end of the 1st decade of the twenty-first century, very little was known of the microbiology of this southwestern African desert, with the few reported studies being based solely on culture-dependent approaches. However, from 2010, an intense research program was undertaken by researchers from the University of the Western Cape Institute for Microbial Biotechnology and Metagenomics, and subsequently the University of Pretoria Centre for Microbial Ecology and Genomics, and their collaborators, led to a more detailed understanding of the ecology of the indigenous microbial communities in many Namib Desert biotopes. Namib Desert soils and the associated specialized niche communities are inhabited by a wide array of prokaryotic, lower eukaryotic and virus/phage taxa. These communities are highly heterogeneous on both small and large spatial scales, with community composition impacted by a range of macro- and micro-environmental factors, from water regime to soil particle size. Community functionality is also surprisingly non-homogeneous, with some taxa retaining functionality even under hyper-arid soil conditions, and with subtle changes in gene expression and phylotype abundances even on diel timescales. Despite the growing understanding of the structure and function of Namib Desert microbiomes, there remain enormous gaps in our knowledge. We have yet to quantify many of the processes in these soil communities, from regional nutrient cycling to community growth rates. Despite the progress that has been made, we still have little knowledge of either the role of phages in microbial community dynamics or inter-species interactions. Furthermore, the intense research efforts of the past decade have highlighted the immense scope for future microbiological research in this dynamic, enigmatic and charismatic region of Africa.

Increasing omega-3 levels in meat from ruminants under pasture-based systems.

This review discusses the importance of red meat from ruminants as a source of omega-3 (n-3) fatty acids (FAs) for human life in the context of the contribution of animals to human welfare. Red meat is a valuable food commodity for human life because it is naturally rich in key nutrients such as protein, trace elements, vitamins and essential FAs. In developed countries and high socio-economic groups from developing countries, red meat intake is greater than that of oily fish, owing to availability, preference and affordability. Omega-3 FA concentration is higher in red meat (beef, lamb and mutton) than in white meat (pork, poultry and turkey), due to the fibre types present in muscle tissues and the specialised digestive systems of ruminants. There is mounting evidence that regular consumption of n-3 FAs is beneficial for growth and development as well as the health and welfare of humans of all ages. The dietary background of ruminants significantly influences the concentration of n-3 FAs in red meat. Meat from forage- or grassfed ruminants has a greater concentration of n-3 FAs than that from their feedlot or grain-fed counterparts and can also offer a favourable n-6:n-3 ratio in the meat. Scientific literature shows that the advantages of consuming n-3 FAs enriched meat (foods) outweigh the disadvantages.

Dans le cadre de l'analyse de la contribution des animaux au bien-être de l'homme, les auteurs examinent l'importance pour l'alimentation humaine des acides gras oméga-3 présents dans la viande rouge provenant de ruminants. La viande rouge est une denrée alimentaire précieuse pour l'organisme humain, étant naturellement riche en plusieurs nutriments majeurs tels que protéines, oligo-éléments, vitamines et acides gras essentiels. Dans les pays développés et dans les classes aisées au plan socio-économique des pays en développement, la consommation de viande rouge dépasse celle de poissons gras pour des raisons de disponibilité, de préférence et de prix. La teneur en acides gras oméga-3 est plus élevée dans les viandes rouges (boeuf, agneau et mouton) que dans les viandes blanches (porc, volaille et dinde) du fait des caractéristiques des fibres des tissus musculaires des ruminants et de leur système digestif spécialisé. Il y a de plus en plus d'indices démontrant qu'une consommation régulière d'acides gras oméga-3 est bénéfique pour la croissance et le développement ainsi que pour la santé et le bien-être de l'être humain à tous les âges de sa vie. Le contexte de l'alimentation des ruminants influence de manière significative la teneur en acides gras oméga-3 de la viande rouge. La viande issue de ruminants nourris de fourrage ou à l'herbe présente une concentration plus élevée d'acides gras oméga-3 que celle de leurs homologues des parcs d'engraissement ou nourris au grain, ainsi qu'un ratio oméga 6/oméga-3 favorable. La littérature scientifique montre que la consommation de viandes (ou autres aliments) riches en acides gras oméga-3 apporte plus de bénéfices que d'inconvénients.

Considerando la cuestión desde el ángulo de la contribución de los animales al bienestar humano, los autores examinan la importancia que reviste para la vida humana la carne roja de rumiante como fuente de ácidos grasos omega-3 (n-3). Por su elevado contenido natural en nutrientes fundamentales como proteínas, oligoelementos, vitaminas y ácidos grasos esenciales, la carne roja es un artículo alimentario de gran valor para la vida humana. En los países desarrollados, al igual que entre las élites socioeconómicas de los países en desarrollo, la ingesta de carne roja es superior a la de pescado azul, por razones de disponibilidad, preferencia y asequibilidad. Por los tipos de fibra presentes en el tejido muscular de los rumiantes y por el carácter especializado de su sistema digestivo, la concentración de ácidos grasos omega-3 es mayor en la carne roja (bovinos y ovinos) que en la carne blanca (cerdo, pollo y pavo). Cada vez hay más datos demostrativos de que el consumo regular de ácidos grasos n-3 es beneficioso para el crecimiento, el desarrollo, la salud y el bienestar de las personas a cualquier edad. El tipo de alimentación de un rumiante influye sensiblemente en la concentración de ácidos grasos n-3 que presentará su carne: la carne de rumiantes que han forrajeado o pastado en campos de hierba tiene mayor concentración de esos ácidos grasos que la de sus homólogos procedentes de establos de engorde o alimentados con grano, además de presentar en ocasiones una proporción más favorable entre n-6 y n-3. Los estudios científicos publicados ponen de relieve que el consumo de carne (u otros alimentos) enriquecida en ácidos grasos n-3 tiene más ventajas que inconvenientes.

Factors influencing attendance at structured education for Type 1 diabetes in south London.

AIM: To investigate the factors influencing uptake of structured education for people with Type 1 diabetes in our local population in order to understand why such uptake is low. METHODS: We conducted a cross-sectional database study of adults with Type 1 diabetes in two south London boroughs, analysed according to Dose Adjustment For Normal Eating (DAFNE) attendance or non-attendance. Demographics, glycaemic control and service use, with subset analysis by ethnicity, were compared using univariate analysis. An exploratory regression model was used to identify influencing factors. RESULTS: The analysis showed that 73% of adults had not attended the DAFNE programme. For non-attenders vs attenders, male gender (59 vs 48%; P = 0.002), older age (39 vs 35 years; P < 0.001), non-white ethnicity (30 vs 20%; P = 0.001) and coming from an area of social deprivation (index of multiple deprivation score 31 vs 28; P < 0.001) were associated with non-attendance. The difference in gender (88% men vs 70% women; P < 0.001) and age (43 vs 34 years) persisted in the non-white group. Regression analysis showed that higher baseline HbA1c level (odds ratio 1.96; P = 0.004), younger age (odds ratio 0.98; P = 0.001) and lower social deprivation (odds ratio 0.52; P = 0.001) was associated with attendance. CONCLUSION: Socio-economic status and factors perceived as indicating greater severity of disease (HbA1c ) influence attendance at DAFNE. More work is necessary to understand the demography of non-attenders to aid future service design and alternative engagement strategies for these groups.

Pharmacogenomics in type 2 diabetes: oral antidiabetic drugs.

Type 2 diabetes mellitus (T2DM) is a fast progressing disease reaching pandemic proportions. T2DM is specifically harmful because of its severe secondary complications. In the course of the disease, most patients require treatment with oral antidiabetic drugs (OADs), for which a relatively large number of different options are available. The growing number of individuals affected by T2DM as well as marked interindividual differences in the response to treatment call for individualized therapeutic regimens that can maximize treatment efficacy and thus reduce side effects and costs. A large number of genetic polymorphisms have been described affecting the response to treatment with OADs; in this review, we summarize the most recent advances in this area of research. Extensive evidence exists for polymorphisms affecting pharmacokinetics and pharmacodynamics of biguanides and sulfonylureas. Data on incretin-based medications as well as the new class of sodium/glucose cotransporter 2 (SGLT2) inhibitors are just starting to emerge. With diabetes being a known comorbidity of several psychiatric disorders, we also review genetic polymorphisms possibly responsible for a common treatment response in both conditions. For all drug classes reviewed here, large prospective trials are necessary in order to consolidate the existing evidence and derive treatment schemes based on individual genetic traits.

Accelerometer output and its association with energy expenditure during manual wheelchair propulsion.

STUDY DESIGN: This is an experimental design. OBJECTIVES: This study examined the association between rates of energy expenditure (that is, oxygen consumption (VO2)) and accelerometer counts (that is, vector magnitude (VM)) across a range of speeds during manual wheelchair propulsion on a motor-driven treadmill. Such an association allows for the generation of cutoff points for quantifying the time spent in moderate-to-vigorous physical activity (MVPA) during manual wheelchair propulsion. SETTING: The study was conducted in the University Laboratory. METHODS: Twenty-four manual wheelchair users completed a 6-min period of seated rest and three 6-min periods of manual wheelchair propulsion on a motor-driven wheelchair treadmill. The 6-min periods of wheelchair propulsion corresponded with three treadmill speeds (1.5, 3.0 and 4.5 mph) that elicited a range of physical activity intensities. Participants wore a portable metabolic unit and accelerometers on both wrists. Primary outcome measures included steady-state VO2 and VM, and the strength of association between VO2 and VM was based on the multiple correlation and squared multiple correlation coefficients from linear regression analyses. RESULTS: Strong linear associations were established between VO2 and VM for the left (R=0.93±0.44; R2=0.87±0.19), right (R=0.95±0.37; R2=0.90±0.14) and combined (R=0.94±0.38; R2=0.88±0.15) accelerometers. The linear relationship between VO2 and VM for the left, right and combined wrists yielded cutoff points for MVPA of 3659 ±1302, 3630±1403 and 3644±1339 counts min(-1), respectively. CONCLUSION: We provide cutoff points based on the linear association between energy expenditure and accelerometer counts for estimating time spent in MVPA during manual wheelchair propulsion using wrist-worn accelerometry. The similarity across wrist location permits flexibility in selecting a location for wrist accelerometry placement.

Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT RCT study--Corrigendum.

The author regrets to announce that affiliation 8, in the above article (Gardner-Sood et al. 2015), contained an error in the author affiliation address and author surname, which were published in the approved article. The correct surname and affiliation address are given below. J. Eberhard, Clinical Psychiatric Research Center, Lund University, Skåne, Sweden

Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial.

BACKGROUND: The aims of the study were to determine the prevalence of cardiometabolic risk factors and establish the proportion of people with psychosis meeting criteria for the metabolic syndrome (MetS). The study also aimed to identify the key lifestyle behaviours associated with increased risk of the MetS and to investigate whether the MetS is associated with illness severity and degree of functional impairment. METHOD: Baseline data were collected as part of a large randomized controlled trial (IMPaCT RCT). The study took place within community mental health teams in five Mental Health NHS Trusts in urban and rural locations across England. A total of 450 randomly selected out-patients, aged 18-65 years, with an established psychotic illness were recruited. We ascertained the prevalence rates of cardiometabolic risk factors, illness severity and functional impairment and calculated rates of the MetS, using International Diabetes Federation (IDF) and National Cholesterol Education Program Third Adult Treatment Panel criteria. RESULTS: High rates of cardiometabolic risk factors were found. Nearly all women and most men had waist circumference exceeding the IDF threshold for central obesity. Half the sample was obese (body mass index ≥ 30 kg/m2) and a fifth met the criteria for type 2 diabetes mellitus. Females were more likely to be obese than males (61% v. 42%, p < 0.001). Of the 308 patients with complete laboratory measures, 57% (n = 175) met the IDF criteria for the MetS. CONCLUSIONS: In the UK, the prevalence of cardiometabolic risk factors in individuals with psychotic illnesses is much higher than that observed in national general population studies as well as in most international studies of patients with psychosis.

Sustained benefit of continuous subcutaneous insulin infusion on glycaemic control and hypoglycaemia in adults with Type 1 diabetes.

AIM: To evaluate the sustainability of the benefits of continuous subcutaneous insulin infusion therapy in routine practice in a cohort of adults with diabetes. METHODS: The clinical records of all adults starting continuous subcutaneous insulin infusion over 12 years at our centre were included in this study. Baseline and mean annual HbA(1c) levels were recorded. The frequency of mild-to-moderate and severe hypoglycaemia and hypoglycaemia awareness were analysed in a subgroup. RESULTS: Adequate data were available from 327 patients, of whom 71% were female. The patients' mean ± sd age was 41 ± 14 years, the mean ± sd (range) follow-up for continuous subcutaneous insulin infusion was 4.3 ± 2.7 (1-12) years. The mean ± sd HbA(1c) concentration fell by 8 ± 5 mmol/mol (0.7 ± 0.5%) at year 1 [to 63 ± 12 mmol/mol from 70 ± 18 mmol/mol (7.9 ± 1.1% from 8.6 ± 1.6%); P < 0.0005], sustained to year 5. In patients with initial poor control, HbA(1c) dropped by 12 ± 11 mmol/mol (1.1 ± 1.0%; P < 0.0005) at year 1, sustained to year 6. The percentage of patients with ≥ 5 mild to moderate hypoglycaemic episodes per week fell from 29 to 12% (n = 163; P = 0.006). In the subgroup (n = 87; follow-up 2.5 ± mean ± sd 1.1 years), the frequency of severe hypoglycaemia fell from 0.6 ± 1.7 episodes per patient per year to 0.3 ± 0.9 (P = 0.047). Of 24 patients with impaired awareness of hypoglycaemia (Gold score ≥ 4), the mean ± sd Gold score improved from 4.9 ± 0.9 to 3.8 ± 1.7 (P = 0.011). Nine people regained awareness. No deterioration in HbA(1c) was seen in the hypoglycaemia-prone groups. CONCLUSIONS: The benefits of continuous subcutaneous insulin infusion with regard to improving glycaemic control and reducing hypoglycaemia frequency, along with improvement in hypoglycaemia awareness without deterioration in glycaemic control, can be sustained over several years in clinical practice.

Outcomes for adults with type 1 diabetes referred with severe hypoglycaemia and/or referred for islet transplantation to a specialist hypoglycaemia service.

Islet transplantation alone (ITA) is indicated for patients with type 1 diabetes (T1D) with disabling severe hypoglycaemia (SH) despite optimised medical therapy. We examined outcomes for patients referred to an islet transplant unit with recurrent SH. Retrospective case note audit of 45 patients with ≥1 SH per year who were referred to our ITA unit between 2009-2012; 36 patients attended follow-up appointments. The cohort was 52.8% male, mean (± SD) age 43.9 (± 11.4) years, and duration of diabetes 26.5 (± 12.9) years. Baseline HbA1c was 8.3% (± 1.7) (67.2 mmol/mol), median (IQR) frequency of SH was 6.0 (2.0-24.0) per/patient/year and 83.3% had impaired awareness of hypoglycaemia (IAH). 80.6% of patients were referred from other secondary diabetes services, 22.2% had completed structured education, and 30.6% were using continuous subcutaneous insulin infusion (CSII). Seventeen patients were optimised with conventional therapy; SH reduced from 2.0 (1.5-9.0) to 0.0 (0.0-0.5) episodes/patient/year; p<0.001, and there was concurrent improvement in HbA1c (8.1-7.7%; 65.0 vs. 60.7 mmol/mol; p=0.072). Ten patients were listed for transplantation as they were not optimised despite structured education, CSII, and continuous glucose monitoring (CGM). The remaining 9 had a reduction in SH [7.0 (4.8-40.5) to 4.0 (2.5-6.3) episodes/patient/year; p=0.058] and either left the service (n=5) or are still being optimised (n=4). In conclusion, 47.2% of patients presenting with problematic hypoglycaemia resolved with optimal medical therapy, with a further 25% achieving clinically relevant improvement, however 27.8% required transplantation despite access to all therapies. Provision of expertise in hypoglycaemia management is essential to focus limited transplant resources on those who need it most.

Sources of vitamin D and calcium in the diets of preschool children in the UK and the theoretical effect of food fortification.

BACKGROUND: Dietary intakes of vitamin D are very low in the UK. Dietary calcium is also necessary to promote bone health. The fortification of foods with vitamin D could be a safe and effective way of increasing intake. METHODS: Diets of preschool children, 755 at 18 months and 3.5 years, from the Avon Longitudinal Study of Parents and Children were assessed using dietary records completed by parents. Energy, vitamin D and calcium intakes were calculated. Multinomial logistic regression was used to estimate the odds ratio for being in the highest/lowest quartile of intake. Intakes were recalculated to test different fortification regimes. RESULTS: Vitamin D intakes were low; all children were below the UK and US dietary recommendations. Calcium intakes decreased between the two ages as a result of reduced milk consumption. Children in the lowest quartile for vitamin D intake at 18 months were twice as likely to remain in that quartile at 3.5 years (odds ratio = 2.35; 95% confidence interval = 1.56-3.55). The majority of foods provide no vitamin D with fat spreads and milk as the main sources. The contribution from breakfast cereals increased, from 6% to 12%, as a result of the increased consumption of fortified cereals. Dairy foods provided the highest contribution to calcium at 18 months but were less important at 3.5 years. Theoretical intakes from different fortification regimens suggest that milk fortified at 2 µg 100 g(-1) vitamin D would provide most children with adequate but not excessive intakes. CONCLUSIONS: Dietary vitamin D intakes were very low and calcium intakes were mostly adequate. Fortification of milk with vitamin D could be a good way to boost intakes.

Type 1 diabetes structured education: What are the core self-management behaviours?

AIMS: Study aims were to (1) describe and compare the way diabetes structured education courses have evolved in the UK, (2) identify and agree components of course curricula perceived as core across courses and (3) identify and classify self-care behaviours in order to develop a questionnaire assessment tool. METHODS: Structured education courses were selected through the Type 1 diabetes education network. Curricula from five courses were examined and nine educators from those courses were interviewed. Transcripts were analysed using framework analysis. Fourteen key stakeholders attended a consensus meeting, to identify and classify Type 1 diabetes self-care behaviours. RESULTS: Eighty-three courses were identified. Components of course curricula perceived as core by all diabetes educators were: carbohydrate counting and insulin dose adjustment, hypoglycaemia management, group work, goal setting and empowerment, confidence and control. The broad areas of self-management behaviour identified at the consensus meeting were carbohydrate counting and awareness, insulin dose adjustment, self-monitoring of blood glucose, managing hypoglycaemia, managing equipment and injection sites; and accessing health care. Specific self-care behaviours within each area were identified. CONCLUSIONS: Planned future work will develop an updated questionnaire tool to access self-care behaviours. This will enable assessment of the effectiveness of existing structured education programmes at producing desired changes in behaviour. It will also help people with diabetes and their healthcare team identify areas where additional support is needed to initiate or maintain changes in behaviour. Provision of such support may improve glycaemia and reduce diabetes-related complications and severe hypoglycaemia.

E-cigarettes in the Middle East: The known, unknown, and what needs to be known next.

The prevalence of electronic cigarettes (e-cigarettes) is increasing globally. Population-level data from several nations suggest that a higher proportion of youth and young adults are using e-cigarettes compared to the general population. Though significant work has been done in Western countries to better understand various aspects of e-cigarette use among youth and young adults, there is limited evidence about this phenomenon in Middle Eastern countries. This commentary summarizes the known aspects of youth and young adult e-cigarette use and the limitations of the evidence in the Middle East. Specifically, the limitations of the current literature indicate an overreliance on university-based samples, the overuse of non-user samples, a lack of studies on behaviour change, high variance in existing data, and a lack of uniform instruments to measure e-cigarette use. Lending from findings in other regions, we identify how these limitations should be addressed through future research to fill knowledge gaps in the Middle East.

Learning from their experiences: Strategies used by youth and young adult ex-vapers.

INTRODUCTION: The prevalence of vaping among youth and young adults (YYAs; 16-18 and 19-24 years old, respectively) is moderate worldwide. Existing vaping cessation evidence lacks input from ex-vapers with a history of regular use and substantial maintenance periods. This study noted cessation strategies, relapse triggers, and recommendations for quitting identified by ex-vapers and assessed differences in outcomes across age and gender groups. METHODS: We recruited ex-vapers (N = 290; mean use = 6.5 days/week, SD = 1.05) with a minimum maintenance period of 30 days and a history of three months of consecutive use of nicotine-based devices from Nova Scotia, Canada. The ex-vapers responded to open-ended questions regarding vaping cessation strategies, triggers, and recommendations for quit strategies in an online survey. We coded responses to each topic (e.g., triggers) and grouped them into categories (e.g., social influences). We used chi-square tests and Bonferroni correction tests to determine group differences by topic and within each category. RESULTS: YYA ex-vapers identified cold turkey (28.9 %), self-restriction (27.5 %), and alternative coping mechanisms (19.0 %) as the most common cessation strategies; social influences (35.5 %,), mental state (18.3 %), and substance use (15.7 %) as the top triggers; and support systems (29.5 %), apps (17.3 %), and education (11.8 %) as the most useful recommendations for others. A higher proportion of female youth (51.3 %) identified social influences as a relapse trigger than male YAs (21.2 %) and female YAs (30.3 %). Further, male YAs (36.5 %) reported higher proportions of substance use as a relapse trigger than male youth (3.0 %) and female youth (2.6 %). Female youth (23.7 %) and YAs (22.6 %) recommended apps as a useful cessation strategy more often than male YAs (3.8 %). CONCLUSIONS: Input from ex-vapers can help to inform cessation practices, and gender and age differences shed light onto the need to tailor treatments, such as using social-centric behavioral therapy, for female youth and adopting a polysubstance substance use treatment approach for YAs.

Operational changes to the lupus intervention fatigue trial as a result of COVID-19: An update to the study protocol.

Background: The coronavirus disease 2019 (COVID-19) global pandemic drastically impacted the health system and the research community. As a result, research institutions and funding agencies recommended a moratorium on conducting in-person research and study enrollment until protocol changes to protect participant safety were approved and implemented. We detail the operational modifications made to the Lupus Intervention Fatigue Trial (LIFT) protocol and summarize how we met the varied challenges created by COVID-19. Methods: We evaluated study protocols and determined that scheduling, acquiring consent, in-person assessments and intervention baseline visits, patient reported outcomes, and data processing procedures needed modification. Results: Operational modifications were made to ensure study progress while adhering to COVID-19 restrictions. Major changes included electronic consent, remote baseline visits for those in the intervention, self-report outcome measures at home via emailed weblinks, and telemedicine physician assessment visits. The collection of safety labs presented the largest challenge since this required an in-person visit to a laboratory. The study team elected to delay this up to one month after the physician assessment. All follow-up visits were completed, and no participants withdrew from the study. Conclusion: LIFT was severely impacted by COVID-19. We provide insight into how our study protocol was modified without compromising the integrity of the primary and secondary outcomes of the study. The modifications utilized by the LIFT study resulted in efficiencies that will be included in a revised protocol and may serve as a useful example for other behavioral interventions to adapt their research studies.

High levels of IgM against methylglyoxal-modified apolipoprotein B100 are associated with less coronary artery calcification in patients with type 2 diabetes.

OBJECTIVE: Advanced glycation end products (AGE) have been implicated in diabetic vascular complications through activation of pro-inflammatory genes. AGE-modified proteins are also targeted by the immune system resulting in the generation of AGE-specific autoantibodies, but the association of these immune responses with diabetic vasculopathy remains to be fully elucidated. The aim of this study was to determine whether antibodies against apolipoprotein B100 modified by methylglyoxal (MGO-apoB100) are associated with coronary atherosclerosis in patients with type 2 diabetes. METHODS: We measured antibodies against MGO-apoB100 in plasma from 497 type 2 diabetic patients without clinical signs of cardiovascular disease. Severity of coronary disease was assessed as coronary artery calcium (CAC) imaging. Immunoglobulin (Ig)M and IgG levels recognizing MGO-apoB100 were determined by enzyme-linked immunosorbent assay. RESULTS: Anti-MGO-apoB100 IgM antibody levels were higher in subjects with a low to moderate CAC score (≤400 Agatston units) than in subjects with a high score (>400 Agatston units; 136.8±4.4 vs. 101.6± 7.4 arbitrary units (AU), P<0.0001) and in subjects demonstrating no progression of CAC during 30 months of follow-up (136.4±5.7 vs. 113.9 ± 6.2 AU in subjects with progression, P<0.0001). Subjects with a family history of premature myocardial infarction had lower levels of anti-MGO-apoB100 IgM. Female subjects had higher levels of anti-MGO-apoB100 antibodies and lower CAC than men. Accordingly, high levels of IgM against MGO-apoB100 are associated with less severe and a lower risk of progression of coronary disease in subjects with type 2 diabetes. CONCLUSIONS: Although conclusions regarding causal relationships based on epidemiological observations need to be made with caution, our findings suggest the possibility that anti-MGO-apoB100 IgM may be protective in diabetic vasculopathy.