Low-density lipoprotein cholesterol in adolescents and young adults with type 1 diabetes: Data from the Australasian Diabetes Data Network registry

AIM

To determine low-density lipoprotein cholesterol (LDL-C) screening frequency and levels, and factors associated with elevated LDL-C, in Australasian youth with type 1 diabetes (T1D).

METHODS

Data were extracted from the Australasian Diabetes Data Network (ADDN), a prospective clinical quality registry, on all T1D healthcare visits attended by young people aged 16-25 years (with T1D duration of >1 year) between January 2011 and December 2020. The primary outcomes were elevated LDL-C > 2.6 mmol/L (100 mg/dL) and threshold for treatment: >3.4 mmol/L (130 mg/dL), according to consensus guidelines. Multivariable Generalised Estimated Equations (GEE) were used to examine factors associated with elevated LDL-C across all visits.

RESULTS

A cohort of 6338 young people (52.6% men) were identified, of whom 1603 (25.3%) had ≥1 LDL-C measurement documented. At last measurement, mean age, age at T1D diagnosis and T1D duration were 18.3 ± 2.4, 8.8 ± 4.5 and 8.9 ± 4.8 years, respectively. LDL-C was elevated in 737 (46.0%) and at the treatment threshold in 250 (15.6%). In multivariable GEE elevated LDL-C continuously was associated with older age (OR = 0.07; 0.01-0.13, p = 0.02), female sex (OR = 0.31; 0.18-0.43; p < 0.001), higher HbA1c (OR = 0.04; 0.01-0.08; p = 0.01) and having an elevated BMI (OR = 0.17, 0.06-0.39, p < 0.001).

CONCLUSIONS

LDL-C screening and levels are suboptimal in this cohort, increasing future cardiovascular complication risk. There is an urgent need to understand how healthcare services can support improved screening and management of dyslipidaemia in this population.

Skin autofluorescence in people with type 1 diabetes and people without diabetes: An eight-decade cross-sectional study with evidence of accelerated aging and associations with complications

AIM

To measure skin autofluorescence in youth (<18 y.o.) and adults (≥18 y.o.) and to assess its relationship with type 1 diabetes, chronic complications and smoking.

METHODS

In a cross-sectional study (n = 383) skin autofluorescence was measured in 269 people with type 1 diabetes (67 with vascular complications) and 114 people without diabetes, covering eight decades of age. Associations of skin autofluorescence with demographics and traditional risk factors were assessed.

RESULTS

Skin autofluorescence increased with age in people with diabetes: for those with complications it increased by a mean ± se of 0.029 ± 0.003 arbitrary units per year (r = 0.76) and, for those without complications, it increased by 0.028 ± 0.002 arbitrary units (r = 0.77). These increases were higher than for people without diabetes, whose skin autofluorescence increased by 0.022 ± 0.002 arbitrary units (r = 0.78) per year (p = 0.004). Mean ±se age-adjusted skin autofluorescence was higher in people with diabetes complications vs people without diabetes complications (1.85 ± 0.04 vs 1.66 ± 0.02 arbitrary units) and people without diabetes (1.48 ± 0.03 arbitrary units; all P < 0.0001). Age-adjusted skin autofluorescence was higher in current smokers and recent ex-smokers vs non-smokers and longer-term ex-smokers (1.86 ± 0.06 vs 1.63 ± 0.02 arbitrary units; P = 0.0005). Skin autofluorescence area under the receiver-operating characteristic curve was 0.89 (95% CI 0.85-0.94) for retinopathy and 0.56 (95% CI 0.47-0.65) for nephropathy.

CONCLUSIONS

Skin autofluorescence increases with age, but faster in people with diabetes, particularly in those with complications and in smokers, consistent with accelerated aging. Skin autofluorescence may facilitate complication screening and prediction. Longitudinal studies are merited.

Biological mechanisms may contribute to soil carbon saturation patterns

Increasing soil organic carbon (SOC) storage is a key strategy to mitigate rising atmospheric CO₂ , yet SOC pools often appear to saturate, or increase at a declining rate, as carbon (C) inputs increase. Soil C saturation is commonly hypothesized to result from the finite amount of reactive mineral surface area available for retaining SOC, and is accordingly represented in SOC models as a physicochemically determined SOC upper limit. However, mineral-associated SOC is largely microbially generated. In this perspective, we present the hypothesis that apparent SOC saturation patterns could emerge as a result of ecological constraints on microbial biomass-for example, via competition or predation-leading to reduced C flow through microbes and a reduced rate of mineral-associated SOC formation as soil C inputs increase. Microbially explicit SOC models offer an opportunity to explore this hypothesis, yet most of these models predict linear microbial biomass increases with C inputs and insensitivity of SOC to input rates. Synthesis of 54 C addition studies revealed constraints on microbial biomass as C inputs increase. Different hypotheses limiting microbial density were embedded in a three-pool SOC model without explicit limits on mineral surface area. As inputs increased, the model demonstrated either no change, linear, or apparently saturating increases in mineral-associated and particulate SOC pools. Taken together, our results suggest that microbial constraints are common and could lead to reduced mineral-associated SOC formation as input rates increase. We conclude that SOC responses to altered C inputs-or any environmental change-are influenced by the ecological factors that limit microbial populations, allowing for a wider range of potential SOC responses to stimuli. Understanding how biotic versus abiotic factors contribute to these patterns will better enable us to predict and manage soil C dynamics.

Integrating the evidence for a terrestrial carbon sink caused by increasing atmospheric CO2

Atmospheric carbon dioxide concentration ([CO₂ ]) is increasing, which increases leaf-scale photosynthesis and intrinsic water-use efficiency. These direct responses have the potential to increase plant growth, vegetation biomass, and soil organic matter; transferring carbon from the atmosphere into terrestrial ecosystems (a carbon sink). A substantial global terrestrial carbon sink would slow the rate of [CO₂ ] increase and thus climate change. However, ecosystem CO₂ responses are complex or confounded by concurrent changes in multiple agents of global change and evidence for a [CO₂ ]-driven terrestrial carbon sink can appear contradictory. Here we synthesize theory and broad, multidisciplinary evidence for the effects of increasing [CO₂ ] (iCO₂ ) on the global terrestrial carbon sink. Evidence suggests a substantial increase in global photosynthesis since pre-industrial times. Established theory, supported by experiments, indicates that iCO₂ is likely responsible for about half of the increase. Global carbon budgeting, atmospheric data, and forest inventories indicate a historical carbon sink, and these apparent iCO₂ responses are high in comparison to experiments and predictions from theory. Plant mortality and soil carbon iCO₂ responses are highly uncertain. In conclusion, a range of evidence supports a positive terrestrial carbon sink in response to iCO₂ , albeit with uncertain magnitude and strong suggestion of a role for additional agents of global change.

Nitrogen cycling microbiomes are structured by plant mycorrhizal associations with consequences for nitrogen oxide fluxes in forests

Volatile nitrogen oxides (N2 O, NO, NO2 , HONO, …) can negatively impact climate, air quality, and human health. Using soils collected from temperate forests across the eastern United States, we show microbial communities involved in nitrogen (N) cycling are structured, in large part, by the composition of overstory trees, leading to predictable N-cycling syndromes, with consequences for emissions of volatile nitrogen oxides to air. Trees associating with arbuscular mycorrhizal (AM) fungi promote soil microbial communities with higher N-cycle potential and activity, relative to microbial communities in soils dominated by trees associating with ectomycorrhizal (ECM) fungi. Metagenomic analysis and gene expression studies reveal a 5 and 3.5 times greater estimated N-cycle gene and transcript copy numbers, respectively, in AM relative to ECM soil. Furthermore, we observe a 60% linear decrease in volatile reactive nitrogen gas flux (NOy  ≡ NO, NO2 , HONO) as ECM tree abundance increases. Compared to oxic conditions, gas flux potential of N2 O and NO increase significantly under anoxic conditions for AM soil (30- and 120-fold increase), but not ECM soil-likely owing to small concentrations of available substrate ( NO 3 - ) in ECM soil. Linear mixed effects modeling shows that ECM tree abundance, microbial process rates, and geographic location are primarily responsible for variation in peak potential NOy flux. Given that nearly all tree species associate with either AM or ECM fungi, our results indicate that the consequences of tree species shifts associated with global change may have predictable consequences for soil N cycling.

Tree mycorrhizal type predicts within-site variability in the storage and distribution of soil organic matter

Forest soils store large amounts of carbon (C) and nitrogen (N), yet how predicted shifts in forest composition will impact long-term C and N persistence remains poorly understood. A recent hypothesis predicts that soils under trees associated with arbuscular mycorrhizas (AM) store less C than soils dominated by trees associated with ectomycorrhizas (ECM), due to slower decomposition in ECM-dominated forests. However, an incipient hypothesis predicts that systems with rapid decomposition-e.g. most AM-dominated forests-enhance soil organic matter (SOM) stabilization by accelerating the production of microbial residues. To address these contrasting predictions, we quantified soil C and N to 1 m depth across gradients of ECM-dominance in three temperate forests. By focusing on sites where AM- and ECM-plants co-occur, our analysis controls for climatic factors that covary with mycorrhizal dominance across broad scales. We found that while ECM stands contain more SOM in topsoil, AM stands contain more SOM when subsoil to 1 m depth is included. Biomarkers and soil fractionations reveal that these patterns are driven by an accumulation of microbial residues in AM-dominated soils. Collectively, our results support emerging theory on SOM formation, demonstrate the importance of subsurface soils in mediating plant effects on soil C and N, and indicate that shifts in the mycorrhizal composition of temperate forests may alter the stabilization of SOM.

Early changes of arterial elasticity in Type 1 diabetes with microvascular complications - A cross-sectional study from childhood to adulthood

AIM

To examine the trajectory of small artery elasticity (SAE) and pulse pressure (PP) in people with Type 1 diabetes and non-diabetic controls across the lifespan, and explore associations with microvascular complications (CX+).

METHODS

This cross-sectional study included 477 Type 1 diabetes patients (188 with CX+, 289 without CX-) and 515 controls. Relationships between SAE and PP and age were evaluated using segmented linear regression. Logistic regression was used to assess the associations between microvascular complications (retinopathy and/or nephropathy) and SAE and PP.

RESULTS

SAE peaked significantly later among controls than diabetic patients CX- vs. CX+ (21.2 vs. 20.4 vs. 17.6 years respectively, p < 0.001). In adults, mean SAE was significantly lower in CX+ vs. CX- vs. controls (6.8 vs. 7.8 vs. 8.0 ml/mm Hg × 10; p < 0.0001), and mean PP was significantly higher in CX+ vs CX- and controls (60 vs. 55 vs. 53 mm Hg; p < 0.0001).

CONCLUSION

Type 1 diabetes CX+ subjects have an earlier peak and decline in SAE relative to CX- and controls, who did not differ. Lower SAE and higher PP were associated with increased odds of Type 1 diabetes complications in adults. These clinically applicable techniques demonstrate an association between accelerated vascular aging and vascular complications in diabetes.

Plant-microbial competition for nitrogen increases microbial activities and carbon loss in invaded soils

Many invasive plant species show high rates of nutrient acquisition relative to their competitors. Yet the mechanisms underlying this phenomenon, and its implications for ecosystem functioning, are poorly understood, particularly in nutrient-limited systems. Here, we test the hypothesis that an invasive plant species (Microstegium vimineum) enhances its rate of nitrogen (N) acquisition by outcompeting soil organic matter-degrading microbes for N, which in turn accelerates soil N and carbon (C) cycling. We estimated plant cover as an indicator of plant N acquisition rate and quantified plant tissue N, soil C and N content and transformations, and extracellular enzyme activities in invaded and uninvaded plots. Under low ambient N availability, invaded plots had 77% higher plant cover and lower tissue C:N ratios, suggesting that invasion increased rates of plant N acquisition. Concurrent with this pattern, we observed significantly higher mass-specific enzyme activities in invaded plots as well as 71% higher long-term N availability, 21% lower short-term N availability, and 16% lower particulate organic matter N. A structural equation model showed that these changes were interrelated and associated with 27% lower particulate organic matter C in invaded areas. Our findings suggest that acquisition of N by this plant species enhances microbial N demand, leading to an increased flux of N from organic to inorganic forms and a loss of soil C. We conclude that high N acquisition rates by invasive plants can drive changes in soil N cycling that are linked to effects on soil C.

Higher skin autofluorescence in young people with Type 1 diabetes and microvascular complications

AIM

To test the hypothesis that non-invasive skin autofluorescence, a measure of advanced glycation end products, would provide a surrogate measure of long-term glycaemia and be associated with early markers of microvascular complications in adolescents with Type 1 diabetes.

METHODS

Forearm skin autofluorescence (arbitrary units) was measured in a cross-sectional study of 135 adolescents with Type 1 diabetes [mean ± sd age 15.6 ± 2.1 years, diabetes duration 8.7 ± 3.5 years, HbA_1c 72 ± 16 mmol/mol (8.7 ± 1.5%)]. Retinopathy, assessed using seven-field stereoscopic fundal photography, was defined as ≥1 microaneurysm or haemorrhage. Cardiac autonomic function was measured by standard deviation of consecutive RR intervals on a 10-min continuous electrocardiogram recording, as a measure of heart rate variability.

RESULTS

Skin autofluorescence was significantly associated with age (R² = 0.15; P < 0.001). Age- and gender-adjusted skin autofluorescence was associated with concurrent HbA_1c (R² = 0.32; P < 0.001) and HbA_1c over the previous 2.5-10 years (R² = 0.34-0.43; P < 0.002). Age- and gender-adjusted mean skin autofluorescence was higher in adolescents with retinopathy vs those without retinopathy [mean 1.38 (95% CI 1.29, 1.48) vs 1.22 (95% CI 1.17, 1.26) arbitrary units; P = 0.002]. In multivariable analysis, retinopathy was significantly associated with skin autofluorescence, adjusted for duration (R² = 0.19; P = 0.03). Cardiac autonomic dysfunction was also independently associated with skin autofluorescence (R² = 0.11; P = 0.006).

CONCLUSIONS

Higher skin autofluorescence is associated with retinopathy and cardiac autonomic dysfunction in adolescents with Type 1 diabetes. The relationship between skin autofluorescence and previous glycaemia may provide insight into metabolic memory. Longitudinal studies will determine the utility of skin autofluorescence as a non-invasive screening tool to predict future microvascular complications.

First report on the nationwide incidence and prevalence of Type 1 diabetes among children in Turkey

AIM

To report, for the first time, the incidence and prevalence of childhood Type 1 diabetes in Turkey using a nationwide registry.

METHODS

Information on birth date, city of birth, diagnosis date and gender of all patients with Type 1 diabetes aged < 18 years were obtained from the Turkish Social Security Institute for the period from January 2011 to December 2013.

RESULTS

There were 17 175 prevalent cases of Type 1 diabetes over the 3-year period. The prevalence of Type 1 diabetes was 0.75/1 000 (95% CI 0.74-0.76) and was higher in girls than in boys (0.79 vs 0.72 /1 000; P < 0.01). There were 2465 incident cases in 2013. The incidence was slightly higher among girls (50.6%) than boys (49.4%); the girl:boy case ratio was 1.02. The incidence was 10.4/100 000 for boys and 11.3/100 000 for girls. The age-standardized incidence rate was 10.8 per 100 000 (95% CI 10.1-11.5) according to the WHO standard population, estimated using the direct method. The mean patient age at diagnosis was 10.6 ± 4.6 years. The highest proportion of cases (40.6%) was diagnosed in children aged 10-14 years.

CONCLUSIONS

This is the first study to report the incidence and prevalence of Type 1 diabetes in children in Turkey. The incidence of Type 1 diabetes reflects the geographical location of Turkey, bridging Asia and Europe, with the incidence being higher than in Asia but lower than in Europe.

Grass invasion effects on forest soil carbon depend on landscape-level land use patterns

Plant invasions can alter the quality and quantity of detrital and root-derived inputs entering a system, thereby influencing the activities of microbial decomposers and affecting the soil carbon cycle. The effect of these inputs on soil carbon storage is often conflicting, suggesting strong context dependency in the plant-decomposer relationship. Whether there is a generalizable pattern that explains this dependency remains relatively unexplored. Here, we (1) examine how invasion by the exotic grass Microstegium vimineum affects carbon cycling across a land use gradient, and (2) evaluate the importance of inorganic nitrogen availability and other environmental variables for explaining patterns in soil carbon. Using paired invaded and uninvaded plots, we quantified invasion effects on belowground carbon pools, extracellular enzyme activities, and native leaf litter decomposition in forests embedded in an urban, agricultural, or forested landscape matrix. Compared to the urban matrix, invasion-associated declines in total soil organic carbon in the forested and agricultural landscapes were 3.5 and 2.5 times greater, respectively. Inorganic nitrogen availability and M. vimineum biomass interacted to explain these patterns: when both nitrogen availability and M. vimineum biomass were high, invaded soils exhibited higher total organic carbon, unchanged particulate organic matter carbon, and higher mineral-associated organic matter carbon compared to adjacent uninvaded soils. Consistent with these patterns, activities of carbon-mineralizing enzymes were lower in invaded than in uninvaded soils when both nitrogen availability and M. vimineum biomass were high. By contrast,. decomposition of native leaf litter was faster when inorganic nitrogen availability and M. vimineum biomass were high. Our findings suggest that, although this invader may accelerate carbon cycling in forest soils, its effects on soil carbon storage largely depend on nitrogen availability and invader biomass, which can be altered by landscape-level patterns of land use. Additional research is needed to determine whether land use or other broad-scale processes such as atmospheric nitrogen deposition can explain context dependence in plant invasion effects on other ecosystem processes.

Healthcare professional requirements for the care of adult diabetes patients managed with insulin pumps in Australia

BACKGROUND

Healthcare professional (HCP) time supporting insulin pump therapy (IPT) has not been documented, yet it is important in planning and allocating resources for effective care.

AIM

This study aims to determine HCP time spent in IPT patient care to inform resource planning for optimal IPT delivery.

METHODS

Twenty-four Australian adult IPT-experienced institutions (14 government funded, seven private, three both) collected data between April 2012 and January 2013 prospectively, including: patient demographics, HCP classification, purpose of HCP-patient interaction, interaction mode and HCP time with the patient. A subset of patients was tracked from pre-pump education until stable on IPT.

RESULTS

Data on 2577 HCP-adult patient interactions (62% face-to-face, 29% remote, 9% administrative) were collected over 12.2 ± 6.4 weeks for 895 patients; age 35.4 ± 14.2 years; 67% female; 99% type 1 diabetes, representing 25% of all IPT patients of the institutions. Time (hours) spent on IPT interactions per centre per week were: nurses 5.4 ± 2.8, dietitians 0.4 ± 0.2 and doctors 1.0 ± 0.5. IPT starts accounted for 48% of IPT interaction time. The percentage of available diabetes clinic time spent on outpatient IPT interactions was 20.4%, 4.6% and 2.7% for nurses, dietitians and doctors respectively. Fifteen patients tracked from pre-pump to stabilisation over 11.8 ± 4.5 weeks, required a median (range) of 9.2 (3.0-20.9), 2.4 (0.5-6.0) and 1.8 (0.5-5.4) hours per patient from nurses, dietitians and doctors respectively.

CONCLUSIONS

IPT patient care represents a substantial investment in HCP time, particularly for nurses. Funding models for IPT care need urgent review to ensure this now mainstream therapy integrates well into healthcare resources.

Bird-window collisions in the summer breeding season

Birds that reside in urban settings face numerous human-related threats to survival, including mortality from bird-window collisions (BWCs). Our current understanding of this issue has largely been driven by data collected during spring and fall migration, and patterns of collision mortality during the summer breeding season remain relatively unexplored. We assessed BWCs during four breeding seasons (2009-2012) at a site in northwestern Illinois, USA, by comparing the abundance, richness, migratory class, and age of the species living around buildings to species mortally wounded by window collisions. We also systematically assessed the daily timing of BWCs throughout the breeding season. We documented BWCs in 4 of 25 (16%) species and 7 of 21 (33%) species in 2009 and 2010, respectively. The relationship between BWCs and abundance depended on age. For adults, BWCs were highest in the least abundant species, e.g., Red-eyed Vireo (Vireo olivaceus), and lowest in species with high abundance values, e.g., Chipping Sparrow (Spizella passerina). For juveniles, mortality was greatest for the most abundant species, and the American Robin (Turdus migratorius) accounted for 62% of all juvenile carcasses. Early in the breeding season, collision mortality was restricted to adults of Long-distance Migrants, whereas juveniles of all three migratory guilds (Long-distance and Short-distance Migrants and Permanent Residents) died at windows from late June through early August. Daily mortality for all species was highest between sunrise-1600 h and lowest from 1600 h-sunrise the next day. Generally, the species observed as carcasses matched birds considered a 'high risk' for BWCs, e.g., Ruby-throated Hummingbird (Archilochus colubris), and those considered 'low risk' were not observed as carcasses, e.g., Blue-gray Gnatcatcher (Polioptila caerulea). Our results suggest that the number of BWCs during the breeding season does not necessarily increase with abundance, but rather appears related to variation among species and age classes, which may have important implications on the population health of affected species. The mechanisms driving these differences are unknown, but may be related reproductive behavior, flight speed, distance movements, and dispersal patterns.

Plateau of adiposity in Australian children diagnosed with Type 1 diabetes: a 20-year study

AIMS

To examine temporal trends in anthropometry in children with Type 1 diabetes from Sydney, Australia.

METHODS

We conducted a retrospective study in a total of 1975 children with Type 1 diabetes, aged <16 years, between 1990 and 2009. Trends in height, weight and BMI standard deviation score after initial stabilization were examined by age group (<5 years, 5 to <10 years, 10 to 16 years) and time period of diagnosis (T1: 1990-1994, T2: 1995-1999; T3: 2000-2004 and T4: 2005-2009). Factors associated with BMI standard deviation score (time period, age group, gender and socio-economic status) were examined using multivariable linear regression.

RESULTS

The mean BMI standard deviation score (±sd) increased between T1 and T2 (0.54 ± 1.14 vs 0.81 ± 1.14, P = 0.002), but remained steady thereafter (T3: 0.85 ± 1.11, T4: 0.87 ± 1.09; T2 to T4: P = 0.40). Similarly, the prevalence of overweight and obesity increased from T1 to T2 (26 to 35%, P = 0.01), but was unchanged thereafter (T3: 34%, T4: 34%; T2 to T4: P = 0.90). On multivariable regression analysis, a higher BMI standard deviation score was associated with younger age (≥5 years vs <5 years, β=-0.40, 95% CI -0.51 to -0.28, P < 0.001), later time period (T2 to T4 vs T1, β=0.30, 95% CI 0.16-0.45, P < 0.001) and male gender (β=0.25, 95% CI 0.15-0.34, P < 0.001).

CONCLUSION

The prevalence of overweight and obesity has remained unchanged in children at diagnosis of Type 1 diabetes over 15 years. These findings suggest that higher adiposity alone cannot account for the continued rising incidence of Type 1 diabetes in recent years.

Thyroid autoimmunity in Type 1 diabetes: systematic review and meta-analysis

AIMS

To review the incidence and evidence for screening for thyroid autoimmunity and thyroid dysfunction in Type 1 diabetes.

METHODS

Systematic review and meta-analysis. Inclusion criteria were prospective cohort studies screening for thyroid autoimmunity and/or dysfunction (defined as an abnormal thyroid-stimulating hormone level) in Type 1 diabetes. Exclusion criteria included pregnancy and thyroid dysfunction before diabetes onset. Outcomes examined were: incidence of thyroid autoimmunity and/or dysfunction; association between thyroid autoimmunity and dysfunction; and cost-effectiveness. Data sources were MEDLINE, EMBASE, the Cochrane Library, manual searching and contact with authors, with limitations to English language and human studies. Meta-analysis was performed using random effects models.

RESULTS

We identified 14 eligible studies, involving 2972 young people and 789 adults with Type 1 diabetes. Follow-up ranged from 1-18 years. None of the studies were of good methodological quality (Newcastle Ottowa Scale score > 7). The incidence of thyroid dysfunction (11 studies) ranged from 27 (95% CI 15-45) to 246 (95% CI 118-453) per 10 000 patient-years and thyroid autoimmunity (four studies) from 13 (95% CI 0.3-71) to 326 (95% CI 194-510). The risk of thyroid dysfunction was higher in those with thyroid autoimmunity: summary risk ratio 25 (95% CI 9-71) and was higher in children (49, 95% CI 16-150) compared with adults (7, 95% CI 3-13). No studies examined cost-effectiveness of screening.

CONCLUSIONS

There is a markedly increased risk of thyroid dysfunction in people with Type 1 diabetes and thyroid autoimmunity. The optimal method or frequency of screening could not be determined from available data. Future studies should examine whether screening improves clinical outcomes in this population.

Early elevation of albumin excretion rate is associated with poor gluten-free diet adherence in young people with coeliac disease and diabetes

AIMS

There are conflicting data on microvascular complications in coexisting Type 1 diabetes and coeliac disease. We compared complications rates in youth with or without coeliac disease and examined the association between gluten-free diet adherence and complications.

METHODS

This was a comparative study of adolescents (2510 without coeliac disease, 129 with coeliac disease); 60 (47%) did not adhere to a gluten-free diet--defined as elevated anti-tissue transglutaminase or endomysial immunoglobulin A titres. Retinopathy was detected using 7-field fundal photography and albumin excretion rate by timed overnight urine collections, with early elevation defined as albumin excretion rate ≥ 7.5 μg/min. Logistic regression was used to examine the association between complications and explanatory variables, including coeliac disease vs. no coeliac disease, gluten-free diet adherence vs. non-adherence, diabetes duration and HbA1c .

RESULTS

Median age at last assessment was 16.5 years. Those with coeliac disease vs. those without were younger at diabetes diagnosis (7.1 vs. 8.6 years, P < 0.001) and had longer diabetes duration (9.3 vs. 7.2 years, P < 0.001). HbA1c was lower in those with coeliac disease vs. those without (67 vs. 70 mmol/mol, 8.3 vs. 8.6%, P = 0.04) and adherence to a gluten-free diet vs. non-adherence (66 vs. 72 mmol/mol, 8.2 vs. 8.7%, P = 0.003). There were no differences in complication rates between those with coeliac disease vs. those without (retinopathy 22 vs. 23%, elevated albumin excretion rate 31 vs. 28%). Non-adherence to a gluten-free diet was associated with elevated albumin excretion rate (40 vs. 23%, P = 0.04). In multivariable logistic regression, elevated albumin excretion rate was associated with non-adherence to a gluten-free diet (odds ratio 2.37, 95% CI 1.04-5.40, P = 0.04) and diabetes duration (odds ratio 1.13, 95% CI 1.02-1.25, P = 0.03), but not HbA1c .

CONCLUSIONS

While glycaemic control is better in patients with coeliac disease, non-adherence to a gluten-free diet is associated with elevated albumin excretion rate. The possible protection of a gluten-free diet on complications warrants further investigation.

Blood β-hydroxybutyrate vs. urine acetoacetate testing for the prevention and management of ketoacidosis in Type 1 diabetes: a systematic review

AIM

Diabetic ketoacidosis is a life-threatening complication of Type 1 diabetes. Blood β-hydroxybutyrate testing is now widely available as an alternative to urine acetoacetate testing for detecting ketosis. The aim of this study was to review the effectiveness of capillary or serum β-hydroxybutyrate compared with urine acetoacetate testing in prevention and management of diabetic ketoacidosis.

METHODS

MEDLINE, EMBASE, EBM Reviews, The Cochrane Library and CINAHL (until April 2012, no language restrictions, studies in humans) were searched for experimental and observational studies comparing the effectiveness of blood β-hydroxybutyrate and urine acetoacetate testing. Outcomes examined were prevention of diabetic ketoacidosis, time to recovery from diabetic ketoacidosis, healthcare costs and patient or caregiver satisfaction. Additional sources included reference lists, conference proceedings and contact with experts in the field.

RESULTS

Four studies (two randomized controlled trials and two cohort studies) met eligibility criteria, including 299 participants across 11 centres. Risk of bias was low to moderate. Blood ketone testing compared with urine testing was associated with reduced frequency of hospitalization (one study), reduced time to recovery from diabetic ketoacidosis (three studies), cost benefits (one study) and greater satisfaction (one study, intervention group only). No study assessed prevention of diabetic ketoacidosis. Meta-analysis could not be performed because of heterogeneity in study design and published data.

CONCLUSIONS

There is evidence suggesting that blood β-hydroxybutyrate testing is more effective than urine acetoacetate testing in reducing emergency department assessment, hospitalization and time to recovery from diabetic ketoacidosis, as well as potentially lowering healthcare expenditure. Further research in both young people and adults is needed.

Coeliac disease in Type 1 diabetes from 1990 to 2009: higher incidence in young children after longer diabetes duration

AIMS

To determine the incidence of coeliac disease in young people with Type 1 diabetes and to examine the effect of age at diabetes onset and disease duration.

METHODS

This was a clinic-based observational cohort study of 4379 people aged ≤ 18 years (49% male) between 1990 and 2009 from Sydney, Australia. Screening for coeliac disease was performed at diagnosis and 1-2 yearly using anti-endomysial and/or anti-tissue transglutaminase immunoglobulin A (IgA) antibodies. Coeliac disease was diagnosed by small bowel biopsy based on Marsh score ≥ III.

RESULTS

Coeliac disease was confirmed by biopsy in 185; of these, 61 (33%) were endomysial or tissue transglutaminase IgA antibody-positive at diabetes diagnosis. Mean age at diabetes onset was 6.6 ± 4.0 vs. 8.4 ± 4.1 years in those without coeliac disease (P < 0.001). Mean incidence was 7.7 per 1000 person years (95% CI 6.6-8.9) over 20 years. Incidence was higher in children aged < 5 years at diabetes diagnosis (10.4 per 1000 person years) vs. ≥ 5 years (6.4 per 1000), incidence rate ratio 1.6 (95% CI 1.2-2.2, P = 0.002). Coeliac disease was diagnosed after 2, 5 and 10 years of diabetes in 45, 78 and 94% of cases, respectively. Median time to coeliac disease diagnosis was longer in children aged < 5 years at diabetes onset (3.3 years) compared with older children (0.7 years, P < 0.001).

CONCLUSIONS

Coeliac disease is common in young people with Type 1 diabetes; the risk is greatest with diabetes onset < 5 years, but after longer diabetes duration. Screening for coeliac disease should be performed at diabetes diagnosis and for at least 10 years in young children.

Australia's national trends in the incidence of Type 1 diabetes in 0-14-year-olds, 2000-2006

AIMS

To determine the national incidence of Type 1 diabetes in children aged 0-14 years and examine trends in incidence between 2000 and 2006 by age, sex and calendar year.

METHODS

Case ascertainment was from the Australian National Diabetes Register, a prospective population-based incidence register established in 1999, with two sources of ascertainment: the National Diabetes Services Scheme and the Australasian Paediatric Endocrine Group's state-based registers. Denominator data were from the Australian Bureau of Statistics.

RESULTS

There were 6350 new cases of Type 1 diabetes (3323 boys and 3027 girls). Case ascertainment was 97.1% complete using the capture-recapture method. The mean adjusted incidence rate for 2000-2006 was 21.6 per 100,000 person-years [95% confidence interval (CI) 21.0, 22.1], and increased from 19.8 in 2000 to 23.4 per 100,000 in 2006, an average increase of 2.8% (95% CI 1.5, 4.1) per year. Mean incidence for the 7-year period increased with age, and was significantly higher in boys aged 0-4 years and 10-14 years than in girls of the same age.

CONCLUSIONS

The incidence of Type 1 diabetes among 0-14-year-olds in Australia is very high compared with available data from many other countries. The rate of increase observed globally in the last decade has continued well into this decade in Australia. The rising incidence cannot be explained by changes in genetic susceptibility; there is an urgent need to examine the environmental factors that have contributed to this increase. The findings of this study also have important implications for resource planning.

Correlates of placental infection with cytomegalovirus, parvovirus B19 or human herpes virus 7

Vertical transmission of viruses is an important cause of morbidity in the fetus and neonate. Placental viral infection indicates risk of vertical transmission, but not always transmission to, or disease of the fetus. Specimens from mothers and babies from three groups-two prospective and one retrospective cohort-were tested for pathogens of teratogenic potential using multiplex PCR. Placental infection was present in 13% of the 105 samples collected. Assessment of the prospective cohorts showed cytomegalovirus (CMV) detected in 4% of placentae from unselected women, parvovirus B19 in 1% and Ureaplasma parvum in 1% of placentae. In a retrospective cohort of women at high risk of transmitting congenital infection due to seroconversion during pregnancy, miscarriage or stillbirth, CMV was detected in 64% and human herpes virus type 7 in 9% of placentae. Of 14 PCR-positive placentae, two were associated with the birth of a living symptomatic infant, two with stillbirth, one with miscarriage, and two with elective terminations of pregnancy. Directed laboratory assessment of women at high risk of transmitting congenital infection, on the basis of clinical or laboratory markers, is important for accurate diagnosis of adverse outcomes of pregnancy. However, routine screening for viruses in the placentae from women with a low-risk serological profile for transmitting congenital infection is unlikely to result in significant numbers of additional diagnoses and is confounded by inadequacy of current diagnostic methods. The major pathogen detected in all cases of placental infection associated with fetal death was human CMV.

The re-emerging burden of rickets: a decade of experience from Sydney

AIM

To define the demographics and clinical characteristics of cases presenting with nutritional rickets to paediatric centres in Sydney, Australia.

METHODS

Retrospective descriptive study of 126 cases seen from 1993 to 2003 with a diagnosis of vitamin D deficiency and/or confirmed rickets defined by long bone x ray changes.

RESULTS

A steady increase was seen in the number of cases per year, with a doubling of cases from 2002 to 2003. Median age of presentation was 15.1 months, with 25% presenting at less than 6 months of age. The most common presenting features were hypocalcaemic seizures (33%) and bowed legs (22%). Males presented at a younger age, with a lower weight SDS, and more often with seizures. The caseload was almost exclusively from recently immigrated children or first generation offspring of immigrant parents, with the region of origin predominantly the Indian subcontinent (37%), Africa (33%), and the Middle East (11%). Seventy nine per cent of the cases were born in Australia. Eleven cases (all aged <7 months) presented atypically with hyperphosphataemia.

CONCLUSIONS

This large case series shows that a significant and increasing caseload of vitamin D deficiency remains, even in a developed country with high sunlight hours. Cases mirror recent immigration trends. Since birth or residence in Australia does not appear to be protective, screening of at risk immigrant families should be implemented through public health policies.

Molecular epidemiology of enterovirus 71 over two decades in an Australian urban community

Enterovirus 71 (EV71), first isolated in 1969, has been responsible for numerous outbreaks of hand, foot and mouth disease (HFMD) with a small proportion of cases associated with neurological disease. Since 1997 there has been a significant increase in both the prevalence and virulence of EV71 in the Asia-Pacific region. We have examined the genetic diversity of EV71 in a large Australian city (Sydney N.S.W.) over a nineteen-year period. We determined the VP1 gene sequence of forty-eight EV71 strains isolated between 1983 and 2001. Analysis by molecular phylogeny revealed the presence of four subgenogroups B2, B4, C1 and C2. The results indicate that the major lineage circulating in Sydney N.S.W. was subgenogroup C1 with a recent switch in dominance to B4 in 2000 and 2001.

Development of multiplex PCRs for detection of common viral pathogens and agents of congenital infections

Potential causes of congenital infection include Toxoplasma gondii and viruses such as cytomegalovirus (CMV), enterovirus, hepatitis C virus, herpes simplex virus types 1 and 2 (HSV-1 and -2), human herpesvirus types 6, 7, and 8, lymphocytic choriomeningitis virus, parvovirus, rubella virus, and varicella-zoster virus. Testing for each of these agents using nucleic acid tests is time consuming and the availability of clinical samples such as amniotic fluid or neonatal blood is often limited. The aim of this study was to develop multiplex PCRs (mPCRs) for detection of DNA and RNA agents in the investigation of congenital infection and an mPCR for the viruses most commonly requested in a diagnostic virology laboratory (CMV, Epstein-Barr virus, enterovirus, HSV-1, HSV-2, and varicella-zoster virus). The assays were assessed using known pathogen-positive tissues (cultures, placentae, plasma, and amniotic fluid) and limits of detection were determined for all the agents studied using serial dilutions of plasmid targets. Nested PCR was performed as the most sensitive assay currently available, and detection of the amplicons using hybridization to labeled probes and enzyme-linked immunosorbent assay detection was incorporated into three of the four assays. This allowed detection of 10 to 10(2) copies of each agent in the samples processed. In several patients, an unexpected infection was diagnosed, including a case of encephalitis where HSV was the initial clinical suspicion but CMV was detected. In the majority of these cases the alternative agent could be confirmed using reference culture, serology, or fluorescence methods and was of relevance to clinical care of the patient. The methods described here provide useful techniques for diagnosing congenital infections and a paradigm for assessment of new multiplex PCRs for use in the diagnostic laboratory.

Prevalence of diabetes complications 6 years after diagnosis in an incident cohort of childhood diabetes

AIMS

To examine the prevalence of early diabetes complications 6 years after diagnosis of diabetes. The hypothesis that initial contact with a multidisciplinary team would be associated with a reduced risk of microvascular complications was tested in this cohort.

METHODS

Participants were recruited from an incident cohort of children aged < 15 years diagnosed between 1990 and 1992 in NSW, Australia. Initial management at a teaching hospital was documented at case notification. At 6 years, health care questionnaires and complications were assessed: retinopathy by 7-field stereoscopic retinal photography and elevated albumin excretion rate (AER) defined as the median of three overnight urine collections > or = 7.5 microg/min. Case attainment was 58% (209/361) with participants younger than non-participants and more likely living in an urban than rural location.

RESULTS

Retinopathy was present in 24%, median AER > or = 7.5 microg/min in 18%, and median AER > or = 20 microg/min in 2%. In multivariate analysis, initial management at a teaching hospital or consultation with all three allied health professionals combined with pubertal staging and cholesterol or HbA1c were all determinants of risk for retinopathy.

CONCLUSIONS

Early retinopathy and elevated AER are common in children 6 years after diagnosis. Initial allied health contact and management at a teaching hospital were associated with a reduced risk of microvascular complications in this cohort.

Survival after pulmonary edema due to enterovirus 71 encephalitis

BACKGROUND

A distinctive pattern of enterovirus 71 (EV71) infection, characterized by fever, exanthem, acute pulmonary edema (PE), brainstem encephalitis, and flaccid paresis, affects infants and young children. Most die rapidly owing to respiratory failure and fulminant PE.

METHOD

The authors report short- and long-term outcome of six survivors of the acute illness.

RESULTS

In the context of acute PE and widespread weakness, recognition of the underlying neurologic disorder was facilitated by the distinctive pattern of MRI signal abnormalities in posterior pons and medulla. EV71-specific PCR of clinical samples helped confirm the diagnosis. Acute PE was managed with mechanical ventilation, afterload reduction, and inotrope support, and resolved completely over days. One patient with minimal neurologic recovery died 9 weeks after disease onset. The other patients have residual neurologic dysfunction, varying from subtle monoparesis to severe bulbar dysfunction, central and peripheral respiratory failure, and flaccid quadriparesis. Faster neurologic recovery was associated with less long-term deficit. Long-term outcome was similar in patients treated with and without pleconaril or IV immunoglobulin. Three long-term survivors treated with IV corticosteroids had less severe long-term neurologic disability than two not treated with steroids.

CONCLUSION

Acute pulmonary edema and encephalomyelitis occurs with EV71 infection in infants. Long-term neurologic outcome varied from minor, focal weakness to profound, global motor dysfunction with respiratory failure.

Sampling for sand flies (Diptera: Psychodidae) among prairie dog colonies on ranches with histories of vesicular stomatitis in new Mexico and Colorado

The possible presence of sand flies (Diptera: Psychodidae) among colonies of Gunnison's prairie dogs, Cynomys gunnisoni Baird, was investigated on or near ranches with histories of vesicular stomatitis (VS) in domestic livestock in the mid-Rio Grande River Valley, NM, and west-slope region of Colorado. Sampling was conducted at six locations, three in each region, using three methods: standard down-draft suction/light traps, up-draft suction/light traps (both supplemented with CO2), and burrow-emergence traps. Two male and four female sand flies, Lutzomyia apache, Young and Perkins were recovered from prairie dog colony and sand-sagebrush association habitats on a cattle ranch in Socorro County, NM. Sand flies were captured only in up-draft suction/light traps. This record is of interest for the following reasons: (1) sand flies have not been reported from the Rio Grande River Valley of New Mexico, (2) sand flies are biological vectors of VS viruses in other areas, (3) the mid-Rio Grande River Valley has been a focus of VS virus activity in domestic livestock during recent outbreaks, and (4) the source of vesicular stomatitis viruses that infect livestock in the western United States is unknown, but may involve introductions of virus from Mexico or an endemic cycle maintained by vector insects.

The rising incidence of childhood type 1 diabetes in New South Wales, Australia

OBJECTIVES

1. To determine the incidence of type 1 (insulin dependent) diabetes in children aged 0-14 years who were resident in the state of New South Wales, Australia over the period 1992-1996. 2. To analyse the trends in incidence over the period 1990-1996.

METHODS

Primary ascertainment of patients was performed using a prospective incidence register established in 1990. The secondary source of ascertainment was the National Diabetes Supply Scheme, a government subsidised scheme for diabetic supplies.

RESULTS

There were 1,230 patients identified over the five-year period. Using the capture-recapture method, ascertainment was estimated to be 99% complete. The lowest incidence occurred in 1992 (16.9 per 10(5) person years) and the highest incidence was in 1995 (21.7 per 10(5)). The crude incidence of IDDM from 1990-1996 was 17.8 per 10(5) and there was a statistically significant rise in the incidence of type 1 diabetes over this period (p=0.0003). The annual incidence has increased on average by 3.2% per year since 1990.

CONCLUSION

The incidence of childhood type 1 diabetes in NSW has increased significantly since 1990.

Influence of permethrin, diazinon and ivermectin treatments on insecticide resistance in the horn fly (Diptera: Muscidae)

The history of insecticide resistance in the horn fly, Haematobia irritans, and the relationship between the characteristics of horn fly biology and insecticide use on resistance development is discussed. Colonies of susceptible horn flies were selected for resistance with six insecticide treatment regimens: continuous single use of permethrin, diazinon and ivermectin: permethrin-diazinon (1:2) mixture; and permethrin-diazinon and permethrin-ivermectin rotation (4-month cycle). Under laboratory conditions, resistance developed during generations 21, 31 and 30 to permethrin, diazinon and ivermectin, respectively. The magnitude of resistance ranged from < 3-fold with ivermectin to 1470-fold with permethrin. Field studies demonstrated that use of a single class of insecticidal ear tag during the horn-fly season resulted in product failure within 3-4 years for pyrethroids and organophosphates, respectively. In laboratory studies, use of alternating insecticides or a mixture of insecticides delayed the onset of resistance for up to 12 generations and reduced the magnitude of pyrethroid resistance. In field studies, yearly alternated use of pyrethroids and organophosphates did not slow or reverse pyrethroid resistance (Barros et al., unpublished data), while a 2-year alternated use with organophosphates resulted in partial reversion of pyrethroid resistance. When pyrethroid and organophosphate ear tags were used in a mosaic strategy at two different locations, efficacy of products did not change during a 3-year period.

Host preference of mosquitoes in Bernalillo County, New Mexico

Host preference of mosquitoes was determined using animal-baited traps. Hosts used in the study were cattle, chickens, dogs, and horses. Ten mosquito species representing 4 genera were collected from the animal-baited traps. Aedes vexans, Aedes dorsalis, Culex quinquefasciatus. Culex tarsalis, and Culiseta inornata were used as indicator species for data analysis. Greater numbers of Ae. vexans, Ae. dorsalis, and Cs. inornata were collected from cattle and horses than from chickens or dogs. In addition, engorgement rates were higher on mammals than on chickens. Engorgement and attraction data for Cx. quinquefasciatus suggested a preference for chickens and dogs over cattle and horses. A slight preference for chickens and dogs was seen with Cx. tarsalis, but the degree of host preference of Cx. tarsalis was less than that in either Ae. vexans or Cx. quinquefasciatus.

Evaluation of cattle insecticide treatments on attraction, mortality, and fecundity of mosquitoes

Attraction, engorgement, mortality, and fecundity were observed on host-seeking Aedes vexans and Psorophora confinnis given the opportunity to feed on insecticide-treated steers in stable traps. Individual steers were treated with Ectrin ear tags, Ectrin spray, Terminator ear tags, Saber ear tags, or Ivomec injection or were left untreated. Aedes vexans and Ps. confinnis accounted for over 98% of 20,738 mosquitoes collected. Relative attraction ranged from 0.45 with Saber ear tag to 0.84 with Terminator ear tag. Engorgement rates of mosquitoes from insecticide-treated steers ranged from 55 to 91%. Engorgement was reduced 18-45% by Terminator ear tag, Ectrin spray, and Saber ear tag treatments. Forty-eight percent mortality of unengorged Ae. vexans and 61% mortality of unengorged Ps. confinnis was observed at collection with the Saber ear tag treatment. Percentage of mortality of engorged mosquitoes of both species was generally much lower. Ivomec injection treatment showed the greatest effect on delayed (48-h) mortality of engorged mosquitoes, with 41 and 82% mortality for Ae. vexans and Ps. confinnis, respectively. No insecticide treatment had a significant effect on fecundity.

Potential mosquito vectors of Dirofilaria immitis in Bernalillo County, New Mexico

The susceptibility of Aedes vexans, Culex quinquefasciatus, and Culex tarsalis to Dirofilaria immitis infections was evaluated in Bernalillo Co., New Mexico. Mosquitoes that had taken a blood meal from a D. immitis-infected dog were dissected and observed for developing larvae. Infection rates for Ae. vexans, Cx. quinquefasciatus, and Cx. tarsalis were 68.9, 40.6, and 30.2%, respectively. Infective D. immitis larvae developed after a minimum of 8 days in Ae. vexans vs. 14 days in both Cx. quinquefasciatus and Cx. tarsalis. Vector efficiency of Ae. vexans was 20.4%, with a mean of 5.9 infective larvae developing from a mean of 29 microfilariae ingested per mosquito. Vector efficiency in Cx. quinquefasciatus and Cx. tarsalis was 2.7 and 0.4%, respectively. These results suggest that Ae. vexans has the greatest potential for D. immitis transmission.

Pathogenesis of 2,2'-dichlorodiethyl sulfide in hairless guinea pigs

Developing skin lesions on hairless guinea pigs due to 2,2'-dichlorodiethyl sulfide (sulfur mustard, HD) exposure were examined to determine the time course for the appearance of histopathologic markers in relationship to skin NAD+ and NADP+ content after HD exposure. Hairless guinea pig skin was exposed to HD for 8 min by means of a vapor cup. Skin punches were taken at 1, 2, 4, 8, 12, 16, 20 and 24 h after HD exposure. Intracellular edema (IE) appeared at 2 h and increased steadily over 24 h. Epidermal necrosis (EN) and pustular epidermatitis (PE) developed at 8 h and reached a maximum at 16 h. Follicular necrosis (FN) appeared at 8 h and increased up to 24 h. Microvesicles (MV) developed between 12-16 h reaching a maximum at 24 h. Niacinamide (750 mg/kg, ip) pretreatment (30-min) reduced the incidence of MV (40%) and FN (45%) at 24 h, but did not reduce IE, EN, or PE. In all animals, skin NAD+ content decreased to a minimum (20% of control) at 16 h, but NAD+ decreases did not precede microvesicle formation. Skin NADP+ content increased (260%) between 1-2 h and returned to control at 4 h. Skin cell NADP+ increases may be indicative of an early phase of cellular oxidative stress that may contribute to HD-induced dermal pathogenesis. Since NAD+ reductions did not precede microvesication and NAM-induced increases in NAD+ content did not delay or reduce early cellular alterations, the contributory role of NAD+ to microvesicle formation may be limited and other biochemical changes should be investigated.

A review of ectoparasites and their effect on cattle production

Losses in livestock production due to ectoparasite infestations exceed $2.26 billion annually. Over 50 species of ectoparasites infest cattle throughout the United States. The horn fly, Haematobia irritans (L.), is the most important and widespread of the five to six major pest species of pastured cattle in the southern region. Results from the examination of production traits from cattle under ectoparasite burdens have been variable, ranging from no effect to significant reductions in weight gains. Because of this inconsistency, specific physiological and nutritional responses in cattle infested or not infested with horn flies have been examined. Data have shown significant differences in nitrogen retention, blood cortisol concentrations, vital signs, water consumption, and urine production. Implications are that total energy balance is altered when an animal is exposed to ectoparasite infestations, thereby resulting in decreased productivity.

The formation constants of ionomycin with divalent cations in 80% methanol/water

The protonation constants and complex formation constants of ionomycin have been determined in 80% methanol/water (w/w) at 25.0 degrees C and mu = 0.050 (tetraethylammonium perchlorate). Potentiometric and spectrometric titration techniques give the following values for the mixed-mode protonation constants of ionomycin: log KH1 = 11.94 +/- 0.02 and log KH2 = 6.80 +/- 0.03. Comparison of these values with those for model compounds indicates that KH1 and KH2 refer to equilibria involving the beta-diketone and carboxylic acid moieties, respectively. Titrations of ionomycin with metal ion at fixed values of pH produced changes in the UV-visual absorbance spectra which were analyzed to give conditional complex formation constants, KMI'. The pH dependence of the values of KMI' indicated that 1:1 divalent metal ion-ionomycin (MI) complexes and protonated MHI+ complexes were formed in the pH range studied. The values of log KMI ranged from 5.30 +/- 0.11 for Sr2+ to 10.25 +/- 0.03 for Ni2+. The selectivity pattern and relative affinities (in parentheses) for the formation of the species MI are as follows: Ni2+ (2000) greater than Zn2+ (600) greater than CO2+ (440) greater than Mn2+ (47) greater than Mg2+ (1.00) greater than Ca2+ (0.21) greater than Sr2+ (0.022). Logarithmic values of KMHI, for the reaction MI + H+ in equilibrium MHI+, ranged from 5.9 (Ni2+) to 8.4 (Sr2+). Calculations using the values of the equilibrium constants determined indicate that an appreciable fraction of the complexed ionophore exists as the protonated complex, MHI+, in the pH range of 6.5-8.5.

Cluster analytically derived MMPI profile subgroups of incarcerated adult rapists

Sex offenders are known to be heterogeneous in their patterns of personality functioning and behavior. The present study conducted a multivariate cluster analysis on the MMPIs of 120 incarcerated adult male rapists. The analysis resulted in the identification of five MMPI profile subgroups. Additional differences among subgroups were identified in the circumstances of the crime and responses to the Multiphasic Sex Inventory. Levels of psychopathology, as indicated by the MMPI, ranged from slight to extreme. Results are discussed with reference to previous MMPI research with sex offenders. Suggestions for future research are offered.

Mental health professionals and suspected cases of child abuse: an investigation of factors influencing reporting

The prevalence and effects of child abuse have been reported in numerous studies. Although mandatory reporting laws require professionals to report suspected cases of child abuse, studies have indicated that large percentages of mental health professionals report selectively. The present study investigates professionals' tendency to report and attribution of responsibility for child abuse. One-hundred and one mental health clinicians working within three community mental health centers (CMHCs) completed experimentally controlled vignettes manipulating victim age, type of abuse, and victim reactions during an interview. Results indicated 81% of the clinicians tended to report the presented case of child abuse. Clinicians' tendency to report depended on the level of certainty they had that abuse was occurring. Professionals' attribution of responsibility to the father and mother varied as a function of the type of abuse occurring. The impact of victim characteristics on clinicians' reporting is discussed.