Tailoring treatment to the individual in type 2 diabetes practical guidance from the Global Partnership for Effective Diabetes Management

Good glycaemic control continues to be the most effective therapeutic manoeuvre to reduce the risk of development and/or progression of microvascular disease, and therefore remains the cornerstone of diabetes management despite recent scepticism about tight glucose control strategies. The impact on macrovascular complications is still a matter of debate, and so glycaemic control strategies should be placed in the context of multifactorial intervention to address all cardiovascular risk factors. Approaches to achieve glycaemic targets should always ensure patient safety, and results from recent landmark outcome studies support the need for appropriate individualisation of glycaemic targets and of the means to achieve these targets, with the ultimate aim to optimise outcomes and minimise adverse events, such as hypoglycaemia and marked weight gain. The primary goal of the Global Partnership for Effective Diabetes Management is the provision of practical guidance to improve patient outcomes and, in this article, we aim to support healthcare professionals in appropriately tailoring type 2 diabetes treatment to the individual. Patient groups requiring special consideration are identified, including newly diagnosed individuals with type 2 diabetes but no complications, individuals with a history of inadequate glycaemic control, those with a history of cardiovascular disease, children and individuals at risk of hypoglycaemia. Practical guidance specific to each group is provided.

Uncertified absence from work and the Big Five:an examination of absence records and future absence intentions

Uncertified absence from work has traditionally been difficult to link to personality. The present paper argues that personality is best conceptualized as influencing an individual’s intention to be absent from work because of reasons that are within their control. This was investigated in an employed community sample of 128 individuals. These individuals used a self-report measure to express their future intentions to be absent from work as a result of several reasons. These reasons for absence were categorized as “being absent because of external pressure or commitment” (ABCo) and “being absence by choice” (ABCh). The Big Five personality factors were found to be unrelated to objective uncertified absence records and unrelated to ABCo. Three of the Big Five were related to ABCh. Agreeableness was negatively related to ABCh whereas Extraversion and Openness demonstrated a positive correlation. It was concluded that the results should be viewed tentatively, but that this study may provide a useful framework for conceptualizing the association of personality with uncertified absence.

Spatial patterns of the tau pathology in progressive supranuclear palsy

Progressive supranuclear palsy (PSP) is characterized neuropathologically by neuronal loss, gliosis, and the presence of tau-immunoreactive neuronal and glial cell inclusions affecting subcortical and some cortical regions. The objectives of this study were to determine (1) the spatial patterns of the tau-immunoreactive pathology, viz., neurofibrillary tangles (NFT), oligodendroglial inclusions (GI), tufted astrocytes (TA), and Alzheimer's disease-type neuritic plaques (NP) in PSP and (2) to investigate the spatial correlations between the histological features. Post-mortem material of cortical and subcortical regions of eight PSP cases was studied. Spatial pattern analysis was applied to the NFT, GI, TA, NP, abnormally enlarged neurons (EN), surviving neurons, and glial cells. NFT, GI, and TA were distributed either at random or in regularly distributed clusters. The EN and NP were mainly randomly distributed. Clustering of NFT and EN was more frequent in the cortex and subcortical regions, respectively. Variations in NFT density were not spatially correlated with the densities of either GI or TA, but were positively correlated with the densities of EN and surviving neurons in some regions. (1) NFT were the most widespread tau-immunoreactive pathology in PSP being distributed randomly in subcortical regions and in regular clusters in cortical regions, (2) GI and TA were more localized and exhibited a regular pattern of clustering in subcortical regions, and (3) neuronal and glial cell pathologies were not spatially correlated. © 2012 Springer-Verlag.

Soredial dispersal from individual soralia in the lichen Hypogymnia physodes (L.) Nyl.

Soredial dispersal from individual soralia of Hypogymnia physodes (L.) Nyl. was studied in the field under natural conditions and by exposing the soralia to an electric fan. Individual soralia were placed on the adhesive surface of dust particle collectors which were pinned to vertical boards in the field. The majority of soredia that were deposited on the adhesive strips during the experiments were found within 1 cm of the source soralium. Deposition was studied over 6 successive days under natural conditions. Significantly fewer soredia were deposited from soralia after removal of mature accumulations and from soralia taken from moist thalli compared with soralia from air dry thalli. In addition, there was a decline in soredial deposition over the 6 days. The influence of wind speed and initial thallus moisture content on soredial deposition over short intervals of time was studied using an electric fan. More soredia and larger soredial clusters were deposited from air dry than moist soralia at all wind speeds. Variation in wind speed between 4 and 9 m/sec had little effect on soredial deposition. Deposition of soredia was also studied using the fan over successive 5-min intervals. Large numbers of soredia were deposited during the first 5-min period. Deposition then declined but recovered after about four 5-min periods. In all experiments there were differences between individual soralia in total numbers of soredia deposited and in the pattern of deposition over time. These results suggest (1) soredia accumulate on soralia and these deposits may be gradually or rapidly depleted in the field, (2) that after the release of soredial accumulations some newly exposed soredia may be rapidly dispersed, (3) a high initial thallus moisture content inhibits soredial release and (4) variation in wind speed is less important than moisture in influencing soredial deposition. The results may help to explain the intermittent pattern of soredial deposition and the poor correlations between deposition and climatic factors observed previously in the field. © 1992.

Dispersal of soredia from individual soralia of the lichen Hypogymnia physodes (L.) Nyl. in a simple wind tunnel

Dispersal of soredia from individual soralia of the lichen Hypogymnia physodes (L.) Nyl. was studied using a simple wind tunnel constructed in the field. Individual lobes with terminal soralia were placed in the wind tunnel on the adhesive surface of dust particle collectors. Air currents produced by a fan were directed over the surface of the lobes. The majority of soredia were deposited within 5 cm of the source soralium but some soredia were dispersed to at least 80 cm at a wind speed of 6 m s-1. Variation in wind speed had no statistically significant effect on the total number of soredial clusters deposited averaged over soralia but the mean size of cluster and the distance dispersed were greater at higher wind speeds. The number of soredia deposited was dependent on the orientation of the soralium to the air currents. More soredia were deposited with the soralium facing the fan at a wind speed of 9 m s-1. Moisture in the form of a fine mist reduced substantially the number of soredia deposited at a wind speed of 6 m s-1 but had no effect on the mean number of soredia per cluster or on the mean distance dispersed. The data suggest: (1) that wind dispersal from an individual soralium is influenced by wind speed, the location of the soralium on the thallus and the level of moisture and (2) that air currents directed over the surfaces of thalli located on the upper branches of trees would effectively disperse soredia of H. physodes vertically and horizontally within a tree canopy. © 1994.