Glycemic Variability Is Associated with Frequency of Blood Glucose Testing and Bolus: Post Hoc Analysis Results from the ProAct Study

ntroduction: The ProAct study has shown that a pump switch to the Accu-Chek® Combo system (Roche Diagnostics Deutschland GmbH, Mannheim, Germany) in type 1 diabetes patients results in stable glycemic control with significant improvements in glycated hemoglobin (HbA1c) in patients with unsatisfactory baseline HbA1c and shorter pump usage time. Patients and Methods: In this post hoc analysis of the ProAct database, we investigated the glycemic control and glycemic variability at baseline by determination of several established parameters and scores (HbA1c, hypoglycemia frequency, J-score, Hypoglycemia and Hyperglycemia Indexes, and Index of Glycemic Control) in participants with different daily bolus and blood glucose measurement frequencies (less than four day, four or five per day, and more than five per day, in both cases). The data were derived from up to 299 patients (172 females, 127 males; age [mean±SD], 39.4±15.2 years; pump treatment duration, 7.0±5.2 years). Results: Participants with frequent glucose readings had better glycemic control than those with few readings (more than five readings per day vs. less than four readings per day: HbA1c, 7.2±1.1% vs. 8.0±0.9%; mean daily blood glucose, 151±22 mg/dL vs. 176±30 mg/dL; percentage of readings per month >300 mg/dL, 10±4% vs. 14±5%; percentage of readings in target range [80-180 mg/dL], 59% vs. 48% [P<0.05 in all cases]) and had a lower glycemic variability (J-score, 49±13 vs. 71±25 [P<0.05]; Hyperglycemia Index, 0.9±0.5 vs. 1.9±1.2 [P<0.05]; Index of Glycemic Control, 1.9±0.8 vs. 3.1±1.6 [P<0.05]; Hypoglycemia Index, 0.9±0.8 vs. 1.2±1.3 [not significant]). Frequent self-monitoring of blood glucose was associated with a higher number of bolus applications (6.1±2.2 boluses/day vs. 4.5±2.0 boluses/day [P<0.05]). Therefore, a similar but less pronounced effect on glycemic variability in favor of more daily bolus applications was observed (more than five vs. less than four bolues per day: J-score, 57±17 vs. 63±25 [not significant]; Hypoglycemia Index, 1.0±1.0 vs. 1.5±1.4 [P<0.05]; Hyperglycemia Index, 1.3±0.6 vs. 1.6±1.1 [not significant]; Index of Glycemic Control, 2.3±1.1 vs. 3.1±1.7 [P<0.05]). Conclusions: Pump users who perform frequent daily glucose readings have a better glycemic control with lower glycemic variability.

New insights into the reconstructed temperature in Portugal over the last 400 years

The consistency of an existing reconstructed annual (December–November) temperature series for the Lisbon region (Portugal) from 1600 onwards, based on a European-wide reconstruction, with (1) five local borehole temperature–depth profiles; (2) synthetic temperature– depth profiles, generated from both reconstructed temperatures and two regional paleoclimate simulations in Portugal; (3) instrumental data sources over the twentieth century; and (4) temperature indices from documentary sources during the late Maunder Minimum (1675–1715) is assessed. The low-frequency variability in the reconstructed temperature in Portugal is not entirely consistent with local borehole temperature–depth profiles and with the simulated response of temperature in two regional paleoclimate simulations driven by reconstructions of various climate forcings. Therefore, the existing reconstructed series is calibrated by adjusting its low-frequency variability to the simulations (first-stage adjustment). The annual reconstructed series is then calibrated in its location and scale parameters, using the instrumental series and a linear regression between them (second-stage adjustment). This calibrated series shows clear footprints of the Maunder and Dalton minima, commonly related to changes in solar activity and explosive volcanic eruptions, and a strong recent-past warming, commonly related to human-driven forcing. Lastly, it is also in overall agreement with annual temperature indices over the late Maunder Minimum in Portugal. The series resulting from this post-reconstruction adjustment can be of foremost relevance to improve the current understanding of the driving mechanisms of climate variability in Portugal.

Weather and War – Economic and social vulnerability in Switzerland at the end of the First World War

Neutral Switzerland – not embedded in the fighting forces – yet was involved in the Great War mainly in economical terms. Since Switzerland is a landlocked country especially agriculture became an important topic of war economy in regard to food security. Until 1916 national food supply was limited but could be maintained through barter trade. In 1916 a crisis on both supply and production level occurred and led to a decline in food availability and to immense price risings causing social turmoil. This paper aims to outline the factors of vulnerability in respect of food in Switzerland during the First World War and further it will show different coping strategies that were undertaken during that time. The paper takes the work of Mario Aeby and Christian Pfister (University of Bern) into consideration that pointed out to weather anomalies during the years 1916 and 1917 aggravating the already tense food situation. Arguing for an overlap of supply and production crisis the paper focuses on agricultural and economic history including environmental impacts. Further the paper addresses the question of what makes a food system resilient to such unforeseen impacts.

Southern Hemisphere high-resolution palaeoclimate records of the last 2000 years

This study presents a comprehensive assessment of high-resolution Southern Hemisphere (SH) paleoarchives covering the last 2000 years. We identified 174 monthly to annually resolved climate proxy (tree ring, coral, ice core, documentary, speleothem and sedimentary) records from the Hemisphere. We assess the interannual and decadal sensitivity of each proxy record to large-scale circulation indices from the Pacific, Indian and Southern Ocean regions over the twentieth century. We then analyse the potential of this newly expanded palaeoclimate network to collectively represent predictands (sea surface temperature, sea level pressure, surface air temperature and precipitation) commonly used in climate reconstructions. The key dynamical centres-of-action of the equatorial Indo-Pacific are well captured by the palaeoclimate network, indicating that there is considerable reconstruction potential in this region, particularly in the post AD 1600 period when a number of long coral records are available. Current spatiotemporal gaps in data coverage and regions where significant potential for future proxy collection exists are discussed. We then highlight the need for new and extended records from key dynamical regions of the Southern Hemisphere. Although large-scale climate field reconstructions for the SH are in their infancy, we report that excellent progress in the development of regional proxies now makes plausible estimates of continental- to hemispheric-scale climate variations possible.

Mechanical Thrombectomy for Isolated M2 Occlusions: A Post Hoc Analysis of the STAR, SWIFT, and SWIFT PRIME Studies.

BACKGROUND AND PURPOSE Mechanical thrombectomy is beneficial for patients with acute ischemic stroke and a proximal anterior occlusion, but it is unclear if these results can be extrapolated to patients with an M2 occlusion. The purpose of this study was to examine the technical aspects, safety, and outcomes of mechanical thrombectomy with a stent retriever in patients with an isolated M2 occlusion who were included in 3 large multicenter prospective studies. MATERIALS AND METHODS We included patients from the Solitaire Flow Restoration Thrombectomy for Acute Revascularization (STAR), Solitaire With the Intention For Thrombectomy (SWIFT), and Solitaire With the Intention for Thrombectomy as Primary Endovascular Treatment (SWIFT PRIME) studies, 3 large multicenter prospective studies on thrombectomy for ischemic stroke. We compared outcomes and technical details of patients with an M2 with those with an M1 occlusion. All patients were treated with a stent retriever. Imaging data and outcomes were scored by an independent core laboratory. Successful reperfusion was defined as modified Thrombolysis in Cerebral Infarction score of 2b/3. RESULTS We included 50 patients with an M2 and 249 patients with an M1 occlusion. Patients with an M2 occlusion were older (mean age, 71 versus 67 years; P = .04) and had a lower NIHSS score (median, 13 versus 17; P < .001) compared with those with an M1 occlusion. Procedural time was nonsignificantly shorter in patients with an M2 occlusion (median, 29 versus 35 minutes; P = .41). The average number of passes with a stent retriever was also nonsignificantly lower in patients with an M2 occlusion (mean, 1.4 versus 1.7; P = .07). There were no significant differences in successful reperfusion (85% versus 82%, P = .82), symptomatic intracerebral hemorrhages (2% versus 2%, P = 1.0), device-related serious adverse events (6% versus 4%, P = .46), or modified Rankin Scale score 0-2 at follow-up (60% versus 56%, P = .64). CONCLUSIONS Endovascular reperfusion therapy appears to be feasible in selected patients with ischemic stroke and an M2 occlusion.

High-resolution AMS (super 14) C dating of post-bomb peat archives of atmospheric pollutants.

Peat deposits in Greenland and Denmark were investigated to show that high-resolution dating of these archives of atmospheric deposition can be provided for the last 50 years by radiocarbon dating using the atmospheric bomb pulse. (super 14) C was determined in macrofossils from sequential one cm slices using accelerator mass spectrometry (AMS). Values were calibrated with a general-purpose curve derived from annually averaged atmospheric (super 14) CO (sub 2) values in the northernmost northern hemisphere (NNH, 30 degrees -90 degrees N). We present a through review of (super 14) C bomb-pulse data from the NNH including our own measurements made in tree rings and seeds from Arizona as well as other previously published data. We show that our general-purpose calibration curve is valid for the whole NNH producing accurate dates within 1-2 years. In consequence, (super 14) C AMS can precisely date individual points in recent peat deposits within the range of the bomb-pulse (from the mid-1950s on). Comparing the (super 14) C AMS results with the customary dating method for recent peat profiles by (super 210) Pb, we show that the use of (super 137) Cs to validate and correct (super 210) Pb dates proves to be more problematic than previously supposed. As a unique example of our technique, we show how this chronometer can be applied to identify temporal changes in Hg concentrations from Danish and Greenland peat cores.

Post-operative monitoring of free muscle transfers by Laser Doppler Imaging: A prospective study.

PURPOSE Despite different existing methods, monitoring of free muscle transfer is still challenging. In the current study we evaluated our clinical setting regarding monitoring of such tissues, using a recent microcirculation-imaging camera (EasyLDI) as an additional tool for detection of perfusion incompetency. PATIENTS AND METHODS This study was performed on seven patients with soft tissue defect, who underwent reconstruction with free gracilis muscle. Beside standard monitoring protocol (clinical assessment, temperature strips, and surface Doppler), hourly EasyLDI monitoring was performed for 48 hours. Thereby a baseline value (raised flap but connected to its vascular bundle) and an ischaemia perfusion value (completely resected flap) were measured at the same point. RESULTS The mean age of the patients, mean baseline value, ischaemia value perfusion were 48.00 ± 13.42 years, 49.31 ± 17.33 arbitrary perfusion units (APU), 9.87 ± 4.22 APU, respectively. The LDI measured values in six free muscle transfers were compatible with hourly standard monitoring protocol, and normalized LDI values significantly increased during time (P < 0.001, r = 0.412). One of the flaps required a return to theatre 17 hours after the operation, where an unsalvageable flap loss was detected. All normalized LDI values of this flap were under the ischaemia perfusion level and the trend was significantly descending during time (P < 0.001, r = -0.870). CONCLUSION Due to the capability of early detection of perfusion incompetency, LDI may be recommended as an additional post-operative monitoring device for free muscle flaps, for early detection of suspected failing flaps and for validation of other methods.

Gingival labial recessions and the post-treatment proclination of mandibular incisors

INTRODUCTION A prerequisite for development of gingival recession is the presence of alveolar bone dehiscence. Proclination of mandibular incisors can result in thinning of the alveolus and dehiscence formation. OBJECTIVE To assess an association between proclination of mandibular incisor and development of gingival recession. METHODS One hundred and seventeen subjects who met the following inclusion criteria were selected: 1. age 11-14 years at start of orthodontic treatment (TS), 2. bonded retainer placed immediately after treatment (T0), 3. dental casts and lateral cephalograms available pre-treatment (TS), post-treatment (T0), and 5 years post-treatment (T5), and 4. post-treatment (T0) lower incisor inclination (Inc_Incl) <95° or >100.5°. Two groups were formed: non-proclined (N = 57; mean Inc_Incl = 90.8°) and proclined (N = 60; mean Inc_Incl = 105.2°). Clinical crown heights of mandibular incisors and the presence of gingival recession sites in this region were assessed on plaster models. Fisher's exact tests, t-tests, and regression models were computed for analysis of inter-group differences. RESULTS The mean increase of clinical crown heights (from T0 to T5) of mandibular incisors ranged from 0.75 to 0.83mm in the non-proclined and proclined groups, respectively (P = 0.273). At T5, gingival recession sites were present in 12.3% and 11.7% patients from the non-proclined and proclined groups, respectively. The difference was also not significant (P = 0.851). CONCLUSIONS The proclination of mandibular incisors did not increase a risk of development of gingival recession during five-year observation in comparison non-proclined teeth.

Representing Afghanistan: The United States and Democracy's Imposition

There is an ongoing mission in Afghanistan; a mission driven by external political forces. At its core this mission hopes to establish peace, to protect the populace, and to install democracy. Each of these goals has remained just that, a goal, for the past eight years as the American and international mission in Afghanistan has enjoyed varied levels of commitment. Currently, the stagnant progress in Afghanistan has led the international community to become increasingly concerned about the viability of a future Afghan state. Most of these questions take root in the question over whether or not an Afghan state can function without the auspices of international terrorism. Inevitably, the normative question of what exactly that government should be arises from this base concern. In formulating a response to this question, the consensus of western society has been to install representative democracy. This answer has been a recurring theme in the post Cold War era as states such as Bosnia and Somalia bear witness to the ill effects of external democratic imposition. I hypothesize that the current mold of externally driven state-building is unlikely to result in what western actors seek it to establish: representative democracy. By primarily examining the current situation in Afghanistan, I claim that external installation of representative democracy is modally flawed in that its process mandates choice. Representative democracy by definition constitutes a government reflective of its people, or electorate. Thus, freedom of choice is necessary for a functional representative democracy. From this, one can deduce that because an essential function of democracy is choice, its implementation lies with the presence of choice. State-building is an imposition that eliminates that necessary ingredient. The two stand as polar opposites that cannot effectively collaborate. Security, governing capacity, and development have all been targeted as measurements of success in Afghanistan. The three factors are generally seen as mutually constitutive; so improved security is seen as improving governing capacity. Thus, the recent resurgence of the Taliban in Afghanistan and a deteriorating security environment moving forward has demonstrated the inability of the Afghan government to govern. The primary reason for the Afghan government’s deficiencies is its lack of legitimacy among its constituency. Even the use of the term ‘constituency’ must be qualified because the Afghan government has often oscillated between serving the people within its territorial borders and the international community. The existence of the Afghan state is so dependent on foreign aid and intervention that it has lost policy-making and enforcing power. This is evident by the inability of Afghanistan to engage in basic sovereign state activities as maintaining a national budget, conducting elections, providing for its own national security, and deterring criminality. The Afghan state is nothing more than a shell of a government, and indicative of the failings that external state-building has with establishing democracy.

William Osler: Original Papers 1907-1919

Part 1: 1907-1908 The Royal Medical Society of Edinburg, 1907 On the Library of a Medical School, 1907 On Telangiectasis Circumscripta Universalis, 1907 A Clinical Lecture on Abdominal Tumours Associated with Disease of the Testicle, 1907 A Clinical Lecture on Erythraemia, 1908 Vienna after Thirty-Four Years, 1908 Endocardites Infectieuses Chroniques, 1908 Part 2: 1909 Chronic Infectious Endocarditis, 1909 What the Public Can Do in the Fight Against Tuberculosis, 1909 Annual Oration on the Occasion of the Opening of the New Building of the Medical and Chirurgical Faculty of the State of Maryland, May 13, 1909 The Medical Library in Post-Graduate Work, 1909 The Treatment of Disease, 1909 Part 3: 1910-1911 The Pupil Symptoms in Thoracic Aneurysm, 1910 The Lumleian Lectures on Angina Pectoris, 1910 Certain Vasomotor, Sensory, and Muscular Phenomena Associated with Cervical Rib, 1910 An Address on the Hospital Unit in University Work, 1911 Sulle Telangiectasie Emorragiche Ereditarie, 1911 Transient Attacks of Aphasia and Paralyses in States of High Blood Pressure and Arterio-Sclerosis, 1911 The Pathological Institute of a General Hospital, 1911 Part 4: 1912-1914 An Address on High Blood Pressure: its Associations, Advantages, and Disadvantages, 1912 Specialism in the General Hospital, 1913 Syphilis of the Liver with the Picture of Banti’s Disease, 1913 An Introductory Address on Examinations, Examiners, and Examinees, 1913 The Medical Clinic: a retrospect and a Forecast, 1914 Part 5: 1915-1919 Remarks on the Diagnosis of Polycystic Kidney, 1915 The War and Typhoid Fever, 1914/15 The Cerebro-Spinal Fever in Camps and Barracks, 1915 Remarks on Arterio-Venous Aneurysm, 1915 Nerve & “Nerves”, 1915 Intensive Work in Science at the Public Schools in Relation to the Curriculum, 1916 Creators, Transmuters, and Transmitters, 1916 Annual Oration on the Campaign Against Syphilis, 1917 The First Printed Documents relating to Modern Surgical Anaesthesia, 1918 Observations on the Severe Anaemias of Pregnancy and the Post-Partum State, 1919 Typhoid Spine, 1919

Tributo en la Argentina post-dictadura : Los "muertos por la subversión"

El artículo analiza el lugar de Tributo, órgano de FAMUS (Familiares y Amigos de Muertos por la Subversión), en los años '80, en la reivindicación de la actuación militar en la última dictadura y de la represión en general antes de 1976. El argumento central es que la búsqueda de legitimidad en el espacio público se estructura a partir de formas particulares de matar y morir que permiten, a su vez, establecer una oposición radical entre los muertos propios y los del campo opuesto. Se muestra también la adecuación plástica de Tributo a la cambiante coyuntura de los años de la transición democrática y se rescatan las formas en que se iban construyendo las estrategias de los defensores de la represión, sus intentos en un momento dado de postergar para el futuro la justicia que en el presente no reciben y, vistos desde hoy, las líneas de continuidad con formas actuales de reivindicación, que ya en las páginas de Tributo aparecen claramente esbozadas

Tributo en la Argentina post-dictadura : Los "muertos por la subversión"

El artículo analiza el lugar de Tributo, órgano de FAMUS (Familiares y Amigos de Muertos por la Subversión), en los años '80, en la reivindicación de la actuación militar en la última dictadura y de la represión en general antes de 1976. El argumento central es que la búsqueda de legitimidad en el espacio público se estructura a partir de formas particulares de matar y morir que permiten, a su vez, establecer una oposición radical entre los muertos propios y los del campo opuesto. Se muestra también la adecuación plástica de Tributo a la cambiante coyuntura de los años de la transición democrática y se rescatan las formas en que se iban construyendo las estrategias de los defensores de la represión, sus intentos en un momento dado de postergar para el futuro la justicia que en el presente no reciben y, vistos desde hoy, las líneas de continuidad con formas actuales de reivindicación, que ya en las páginas de Tributo aparecen claramente esbozadas

Tributo en la Argentina post-dictadura : Los "muertos por la subversión"

El artículo analiza el lugar de Tributo, órgano de FAMUS (Familiares y Amigos de Muertos por la Subversión), en los años '80, en la reivindicación de la actuación militar en la última dictadura y de la represión en general antes de 1976. El argumento central es que la búsqueda de legitimidad en el espacio público se estructura a partir de formas particulares de matar y morir que permiten, a su vez, establecer una oposición radical entre los muertos propios y los del campo opuesto. Se muestra también la adecuación plástica de Tributo a la cambiante coyuntura de los años de la transición democrática y se rescatan las formas en que se iban construyendo las estrategias de los defensores de la represión, sus intentos en un momento dado de postergar para el futuro la justicia que en el presente no reciben y, vistos desde hoy, las líneas de continuidad con formas actuales de reivindicación, que ya en las páginas de Tributo aparecen claramente esbozadas

(Table 1) Tree age, post fire stand age, and soil organic matter thickness in the western Quebec black spruce boreal ecosystem

The observed long-term decrease in the regional fire activity of Eastern Canada results in excessive accumulation of organic layer on the forest floor of coniferous forests, which may affect climate-growth relationships in canopy trees. To test this hypothesis, we related tree-ring chronologies of black spruce (Picea mariana (Mill.) B.S.P.) to soil organic layer (SOL) depth at the stand scale in the lowland forests of Quebec's Clay Belt. Late-winter and early-spring temperatures and temperature at the end of the previous year's growing season were the major monthly level environmental controls of spruce growth. The effect of SOL on climate-growth relationships was moderate and reversed the association between tree growth and summer aridity from a negative to a positive relationship: trees growing on thin organic layers were thus negatively affected by drought, whereas it was the opposite for sites with deep (>20-30 cm) organic layers. This indicates the development of wetter conditions on sites with thicker SOL. Deep SOL were also associated with an increased frequency of negative growth anomalies (pointer years) in tree-ring chronologies. Our results emphasize the presence of nonlinear growth responses to SOL accumulation, suggesting 20-30 cm as a provisional threshold with respect to the effects of SOL on the climate-growth relationship. Given the current climatic conditions characterized by generally low-fire activity and a trend toward accumulation of SOL, the importance of SOL effects in the black spruce ecosystem is expected to increase in the future.

(Table 1) Observations of bowhead whales (Balaena mysticetus) in the Svalbard area 1940-2008

Forty-six sightings of bowhead whales have been reported from the Svalbard area between 1940 and 2009. But, only three of these sightings are reported prior to 1980. Most observations involve only one or two whales, but groups of up to seven individuals have been seen recently. Increased ship traffic, particularly cruise-based tourism, in the north undoubtedly provides more opportunities for spotting this species, and the establishment of a structured cetacean sighting programme, as well as increase in effort in documenting sightings from a wider marine user-community, likely all play a role in more records being documented in recent years. The absence of a dedicated monitoring programme for ice-associated cetaceans and the generally low scientific activity level in this field in Svalbard Waters hampers firm conclusions about the trends in abundance of bowhead whales in the Svalbard area.