Cardioprotective effects of insulin: how intensive insulin therapy may benefit cardiac surgery patients

Interest in the effects of insulin on the heart came with the recognition that hyperglycemia in the context of myocardial infarction is associated with increased risks of mortality, congestive heart failure, or cardiogenic shock. More recently, instigated by research findings on stress hyperglycemia in critical illness, this interest has been extended to the influence of insulin on clinical outcome after cardiac surgery. Even in nondiabetic individuals, stress hyperglycemia commonly occurs as a key metabolic response to critical illness, eg, after surgical trauma. It is recognized as a major pathophysiological feature of organ dysfunction in the critically ill. The condition stems from insulin resistance brought about by dysregulation of key homeostatic processes, which implicates immune/inflammatory, endocrine, and metabolic pathways. It has been associated with adverse clinical outcomes, including increased mortality, increased duration of mechanical ventilation, increased intensive care unit (ICU) and hospital stay, and increased risk of infection. Hyperglycemia in critical illness is managed with exogenous insulin as standard treatment; however, there is considerable disagreement among experts in the field as to what target blood glucose level is optimal for the critically ill patient. Conventionally, the aim of insulin therapy has been to maintain blood glucose levels below the renal threshold, typically 220 mg/dL (12.2 mmol/L). In recent years, some have advocated tight glycemic control (TGC) with intensive insulin therapy (IIT) to normalize blood glucose levels to within the euglycemic range, typically 80 to 110 mg/dL (4.4–6.1 mmol/L).

Seasonal pattern of regional carbon balance in the central Rocky Mountains from surface and airborne measurements

[1] High-elevation forests represent a large fraction of potential carbon uptake in North America, but this uptake is not well constrained by observations. Additionally, forests in the Rocky Mountains have recently been severely damaged by drought, fire, and insect outbreaks, which have been quantified at local scales but not assessed in terms of carbon uptake at regional scales. The Airborne Carbon in the Mountains Experiment was carried out in 2007 partly to assess carbon uptake in western U.S. mountain ecosystems. The magnitude and seasonal change of carbon uptake were quantified by (1) paired upwind-downwind airborne CO2 observations applied in a boundary layer budget, (2) a spatially explicit ecosystem model constrained using remote sensing and flux tower observations, and (3) a downscaled global tracer transport inversion. Top-down approaches had mean carbon uptake equivalent to flux tower observations at a subalpine forest, while the ecosystem model showed less. The techniques disagreed on temporal evolution. Regional carbon uptake was greatest in the early summer immediately following snowmelt and tended to lessen as the region experienced dry summer conditions. This reduction was more pronounced in the airborne budget and inversion than in flux tower or upscaling, possibly related to lower snow water availability in forests sampled by the aircraft, which were lower in elevation than the tower site. Changes in vegetative greenness associated with insect outbreaks were detected using satellite reflectance observations, but impacts on regional carbon cycling were unclear, highlighting the need to better quantify this emerging disturbance effect on montane forest carbon cycling.

The Prophetic Sound: a day and night of noise cabaret(symposium of talks and live performances)

'The Prophetic Sound: a day and night of noise cabaret' is the first event hosted by Agency of Noise. This all day event brought together artists and academics whose subject of focus is noise (in creative practice). Artists from across the UK were invited to consider a future post-digital era in which everything with a microchip has malfunctioned, as a thought exercise and starting point for response through sound. In response to Jacques Attali’s claim that music is prophecy, The Prophetic Sound asks us to consider if noise can communicate in an unbridled, unfiltered, way that is somehow not culturally coded -before it becomes sound that is recognised, refined, manipulated and exploited for musical or other cultured purpose. Featuring students from Reading, Brighton, LCC and Goldsmiths alongside more established artists and academics from across the UK, this event brings into focus locations where pattern, timbre, pitch, organisation and sequencing of sounds become distinguishable from noise and asks us to consider, through diversion within such locations, new origins for future communication systems. The Prophetic Sound included talks, films, presentations and performances from: Ryo Ikeshiro / Inigo Wilkins / Neal Spowage / Dane Sutherland / Poulomi Desai / Benedict Drew / AAS / Polly Fibre / Steven Dickie As part of The Prophetic Sound, POLLYFIBRE (Ellison, C.) performed LIVE RECORDING with Amplified Scissors. This industrial activity by POLLYFIBRE short-circuits the complicated chain that is music production. The distinctive roles of consumer, producer, composer, and performer collapse in a series of live ‘cuts’ where vinyl discs are produced with amplified scissors. Production happens through action and action becomes production. A limited edition of 9 flexi discs were produced and available for special collectors at the event.