Digital Health and Shared Decision-Making in Diabetes Care – A Survey Initiative in Patients and Clinicians

ObjectiveTo assess the landscape of digital health resources in the United States, better understand the impact of the digital health on shared decision-making, and identify potential barriers and opportunities for progress in the care of persons with diabetes.MethodsThe study consisted of two phases: A qualitative phase in which one-on-one interviews were conducted virtually with 34 physicians (endocrinologists {Endos}: n = 15; primary care physicians {PCPs}: n = 19) between February 11, 2021 and February 18, 2021, and a quantitative phase in which two online, email-based surveys in the English language were conducted between April 16, 2021 and May 17, 2021: one with healthcare professionals (HCP) (n = 403: n = 200 Endos and n = 203 PCPs), and one with persons with diabetes (n = 517: patients with type 1 diabetes, n = 257; patients with type 2 diabetes, n = 260).ResultsDiabetes digital health tools were found to be helpful in shared decision-making, but leading barriers include cost, coverage, and lack of time by healthcare professionals. Among diabetes digital health tools, continuous glucose monitoring (CGM) systems were used most commonly and viewed as most effective in improving quality of life and facilitating shared decision-making. Strategies for increasing use of diabetes digital health resources included lower cost, integration into electronic health records, and increased simplicity of tools.ConclusionThis study revealed that both Endos and PCPs feel that diabetes digital health tools have an overall positive impact. Integration with telemedicine and simpler, lower cost tools with increased patient access can further facilitate shared decision-making and improved diabetes care and quality of life.     

A multi-satellite framework to rapidly evaluate extreme biosphere cascades: The Western US 2021 drought and heatwave

The increasing frequency and intensity of climate extremes and complex ecosystem responses motivate the need for integrated observational studies at low latency to determine biosphere responses and carbon-climate feedbacks. Here, we develop a satellite-based rapid attribution workflow and demonstrate its use at a 1–2-month latency to attribute drivers of the carbon cycle feedbacks during the 2020–2021 Western US drought and heatwave. In the first half of 2021, concurrent negative photosynthesis anomalies and large positive column CO₂ anomalies were detected with satellites. Using a simple atmospheric mass balance approach, we estimate a surface carbon efflux anomaly of 132 TgC in June 2021, a magnitude corroborated independently with a dynamic global vegetation model. Integrated satellite observations of hydrologic processes, representing the soil–plant–atmosphere continuum (SPAC), show that these surface carbon flux anomalies are largely due to substantial reductions in photosynthesis because of a spatially widespread moisture-deficit propagation through the SPAC between 2020 and 2021. A causal model indicates deep soil moisture stores partially drove photosynthesis, maintaining its values in 2020 and driving its declines throughout 2021. The causal model also suggests legacy effects may have amplified photosynthesis deficits in 2021 beyond the direct effects of environmental forcing. The integrated, observation framework presented here provides a valuable first assessment of a biosphere extreme response and an independent testbed for improving drought propagation and mechanisms in models. The rapid identification of extreme carbon anomalies and hotspots can also aid mitigation and adaptation decisions.     

Human placental GLUT1 glucose transporter expression and the fetal insulin-like growth factor axis in pregnancies complicated by diabetes

We have previously described regulation of syncytial GLUT1 glucose transporters by IGF-I. Despite this, it is not clear what signal regulates transplacental glucose transport. In this report we asked whether changes in GLUT1 expression and glucose transport activity in diabetic pregnancies were associated with alterations in the fetal IGF axis. Cord blood samples and paired syncytial microvillous and basal membranes were isolated from normal term pregnancies and pregnancies characterized by gestational diabetes type A2 (GDM A2) and pre-existing insulin-dependent diabetes mellitus (IDDM). Circulating IGF-I, basal membrane GLUT1 expression and glucose transporter activity were correlated with birth weight, but only in control, not diabetic groups. Basal membrane GLUT1 and transporter activity were correlated with IGF-I concentrations in control, but not diabetic groups. IGF binding protein (IGFBP) binding capacity showed a ≥50% reduction in the diabetic groups compared to control; both showed a higher level of free IGF-I. The absence of a correlation between birth weight and factors such as fetal IGF-I or GLUT1 expression in the diabetic groups suggests that IGF-I-stimulated effects may have reached a limiting threshold, such that further increases in IGF-I (or GLUT1) are without effect. These data support that fetal IGF-I acts as a fetal nutritional signal, modulating placental GLUT1 expression and birth weight via altered levels of fetal circulating IGFBPs. Diabetes appears to exert its effects on fetal and placental factors prior to the third trimester and, despite good glycemic control immediately prior to, and in the third trimester, these effects persist to term.     

Exploring the potential of food forestry to assist in ecological restoration in North America and beyond

Food forests—edible, perennial, polyculture systems—are of increasing interest in North America and the United Kingdom, as reflected in projects ranging from urban food initiatives to integrated conservation and restoration planning. To examine emerging food forestry (FF) against the backdrop of ecological restoration (ER), we conducted semi‐structured interviews with eight experts each from the fields of FF and ER in conjunction with observations of food forests in Canada, the United States, and the United Kingdom. Using content analysis, our study builds a FF model that encompasses the underlying goals of emerging FF—forest function; diversity of yields; education and culture sharing; healthy habitats for people and other species; and sustainability. We argue that FF has potential as an urban restoration tool in terms of enhancing the multifunctionality of heterogeneous landscapes undergoing significant changes. This will require meaningful consideration of ethical issues (e.g. commodification of nature), landscape contexts, ecological integrity, integration of historical knowledge, and resilience for interdependent, dynamic social and ecological systems. Moreover, systematic, long‐term monitoring of different types of food forests will be crucial in order to mindfully apply FF in ER. This research provides one of the first in‐depth analyses of how emerging FF might contribute to restoration in the time of the Anthropocene, especially outside traditional tropic regions where most FF has been practiced.     

Hydration State of Goats Transported by Road for 12 Hours During the Hot-Dry Conditions and the Modulating Role of Ascorbic Acid

This study investigated the effects of 12 hr of road transportation during the hot-dry conditions and the modulating role of ascorbic acid (AA) on the hydration state of goats. Twenty goats who served as treatment goats received oral administration of 100 mg/kg body weight of AA, whereas another 20 control goats received sterile water; thereafter, the goats were loaded and transported. The study determined changes in skin thickness; albumin (Alb); total protein (TP); elimination of the gut content; fecal water; urine specific gravity (SG); and pH before, during, and after the transportation. The result obtained in the control goats showed significant (p < .05) increases in the values of TP, Alb, urine SG, and pH; elimination; and drinking behavior, whereas skin thickness decreased over transportation. In the treatment goats who were administered AA, the changes observed in the values were insignificant (p > .05). In conclusion, 12-hr road transportation of goats induced dehydration, which may affect the welfare and health status of the goats. The administration of AA ameliorated the risk of adverse effects of handling, loading, transportation, and hot-dry conditions on hydration state of goats.     

Observations on the diagenesis of the Lower Triassic Sudair Formation,Abu Dhabi,United Arab Emirates

Summary The Lower Triassic Sudair Formation in the United Arab Emirates (U.A.E.) ranges in thickness from 178–297 m and comprises three units consisting of interbedded limestone, argillaceous limestone, dolomite and anhydrite. The Lower Unit contains variable energy shallow marine, slightly argillaceous mudstones and subordinate ooliticpeloidal packstones and grainstones with minor dolomite and anhdrite. The Middle Unit consists of argillaceous and ferroan dolomite deposited in a lagoonal to supratidal setting. The Upper Unit comprises argillaceous mudstones and dolomites at the base grading upward into argillaceous anhydrite deposited in a restricted shallow marine to sabkha setting. These units represent the transition from a carbonate/evaporite shelf with significant terrestrial input to an evaporitic platform defined by an overall shallowing-upward sequence. Diagenesis in the Sudair includes extensive leaching of grain-supported carbonates, partial to complete dolomitization, evaportie formation, clay nucleation, fracturing/pressure solution, late cementation by coarse calcite spar and saddle dolomite, and hematite formation. These processes have had the cumulative effect of reducing the secondary porosity. Dolomitization occurred in two stages: an earlier progression of rhombic-sucrosic-aphanocrystalline dolomite, and a later coarse crystalline and saddle dolomite fracture fill.     

Two New Endozoic Ciliates,Clevelandella lynni sp. n. and Nyctotherus galerus sp. n., Isolated from the Hindgut of the Wood‐feeding Cockroach Panesthia angustipennis (Illiger, 1801)

Two new ciliate species, Clevelandella lynni sp. n. and Nyctotherus galerus sp. n., were discovered in the hindgut of wood‐feeding panesthiine cockroaches. Their morphology was studied using standard methods, and their phylogenetic positions within the order Clevelandellida were determined using the 18S rRNA gene sequences. Clevelandella lynni is characterized by a prominent peristomial projection, a notched left body margin, a tear‐shaped to broadly ovoidal macronucleus, a karyophore attached to the right body margin, and by an adoral zone composed of on average 48 membranelles and extending about 51% of body length. The diagnostic features of N. galerus include a short posterior body projection, a spherical to broadly ellipsoidal macronucleus, a karyophore attached to the right and left body margins, refractile bodies densely packed anterior to the macronucleus, and an adoral zone composed of on average 57 membranelles and extending about 70% body length. The order Clevelandellida was consistently depicted as monophyletic in 18S rRNA gene phylogenies. Nyctotherus galerus was placed in the paraphyletic family Nyctotheridae, as sister taxon to all other Nyctotherus and Clevelandella species isolated from cockroaches. Clevelandella lynni fell in the monophyletic family Clevelandellidae, as sister taxon to C. panesthiae KC139718 but with very poor statistical support.     

The family Schisandraceae: a new record for the flora of Mexico

A population ofSchisandra glabra (Schisandraceae) found in the cloud forest of northeastern Hidaglo state, Mexico, represents a new family for the Mexican flora and the first record for the species outside of the southeastern United States. Morphological comparisons of foliar and floral characteristics of this population with southeastern U.S. specimens reveal the material in both countries to be similar in morphology and apparently conspecific.Schisandra glabra is the only species of the family on the American continent. We speculate that the disjunct distribution of the Mexican population is the result of the gradual contraction of an otherwise wider distribution in connection with climatological changes associated with the Tertiary. The species is described and illustrated to familiarize students interested in the Mexican flora with the species and family.