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Aims/hypothesis: Metformin lowers postprandial glycaemic excursions in individuals with type 2 diabetes by modulating gastrointestinal function, including the stimulation of glucagon-like peptide-1 (GLP-1). The impact of varying the timing of metformin administration on postprandial glucose metabolism is poorly defined. We evaluated the effects of metformin, administered at different intervals before an intraduodenal glucose infusion, on the subsequent glycaemic, insulinaemic and GLP-1 responses in metformin-treated type 2 diabetes. Methods: Sixteen participants with type 2 diabetes that was relatively well-controlled by metformin monotherapy were studied on four separate days in a crossover design. On each day, participants were randomised to receive a bolus infusion of metformin (1000 mg in 50 ml 0.9% saline) via a nasoduodenal catheter at t = −60, −30 or 0 min (and saline at the other timepoints) or saline at all timepoints (control), followed by an intraduodenal glucose infusion of 12.56 kJ/min (3 kcal/min) at t = 0–60 min. The treatments were blinded to both participants and investigators involved in the study procedures. Plasma glucose, insulin and total GLP-1 levels were measured every 30 min between t = −60 min and t = 120 min. Results: There was a treatment-by-time interaction for metformin in reducing plasma glucose levels and increasing plasma GLP-1 and insulin levels (p<0.05 for each). The reduction in plasma glucose levels was greater when metformin was administered at t = −60 or −30 min vs t = 0 min (p<0.05 for each), and the increases in plasma GLP-1 levels were evident only when metformin was administered at t = −60 or −30 min (p<0.05 for each). Although metformin did not influence insulin sensitivity, it enhanced glucose-induced insulin secretion (p<0.05), and the increases in plasma insulin levels were comparable on the 3 days when metformin was given. Conclusions/interpretation: In well-controlled metformin-treated type 2 diabetes, glucose-lowering by metformin is greater when it is given before, rather than with, enteral glucose, and this is associated with a greater GLP-1 response. These observations suggest that administration of metformin before meals may optimise its effect in improving postprandial glycaemic control. Trial registration: www.anzctr.org.au ACTRN12621000878875 Funding: The study was not funded by a specific research grant. [ABSTRACT FROM AUTHOR]

Background: Gastric emptying (GE), with wide inter-individual but lesser intra-individual variations, is a major determinant of postprandial glycaemia in health and type 2 diabetes (T2D). However, it is uncertain whether GE of a carbohydrate-containing liquid meal is predictive of the glycaemic response to physiological meals, and whether antecedent hyperglycaemia influences GE in T2D. We evaluated the relationships of (i) the glycaemic response to both a glucose drink and mixed meals with GE of a 75 g glucose drink, and (ii) GE of a glucose drink with antecedent glycaemic control, in T2D. Methods: Fifty-five treatment-naive Chinese adults with newly diagnosed T2D consumed standardised meals at breakfast, lunch and dinner with continuous interstitial glucose monitoring. On the subsequent day, a 75 g glucose drink containing 150 mg 13C-acetate was ingested to assess GE (breath test) and plasma glucose response. Serum fructosamine and HbA1c were also measured. Results: Plasma glucose incremental area under the curve (iAUC) within 2 hours after oral glucose was related inversely to the gastric half-emptying time (T50) (r = −0.34, P = 0.012). The iAUCs for interstitial glucose within 2 hours after breakfast (r = −0.34, P = 0.012) and dinner (r = −0.28, P = 0.040) were also related inversely to the T50 of oral glucose. The latter, however, was unrelated to antecedent fasting plasma glucose, 24-hour mean interstitial glucose, serum fructosamine, or HbA1c. Conclusions: In newly diagnosed, treatment-naive, Chinese with T2D, GE of a 75 g glucose drink predicts the glycaemic response to both a glucose drink and mixed meals, but is not influenced by spontaneous short-, medium- or longer-term elevation in glycaemia. [ABSTRACT FROM AUTHOR]

Background and aims: Bariatric surgery is the most effective treatment in individuals with obesity to achieve remission of type 2 diabetes. Post-bariatric surgery hypoglycaemia occurs frequently, and management remains suboptimal, because of a poor understanding of the underlying pathophysiology. The glucoregulatory hormone responses to nutrients in individuals with and without post-bariatric surgery hypoglycaemia have not been systematically examined. Materials and methods: The study protocol was prospectively registered with PROSPERO. PubMed, EMBASE, Web of Science and the Cochrane databases were searched for publications between January 1990 and November 2021 using MeSH terms related to post-bariatric surgery hypoglycaemia. Studies were included if they evaluated individuals with post-bariatric surgery hypoglycaemia and included measurements of plasma glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic polypeptide (GIP), insulin, C-peptide and/or glucagon concentrations following an ingested nutrient load. Glycated haemoglobin (HbA1c) was also evaluated. A random-effects meta-analysis was performed, and Hedges' g (standardised mean difference) and 95% confidence intervals were reported for all outcomes where sufficient studies were available. The τ2 estimate and I2 statistic were used as tests for heterogeneity and a funnel plot with the Egger regression-based test was used to evaluate for publication bias. Results: From 377 identified publications, 12 were included in the analysis. In all 12 studies, the type of bariatric surgery was Roux-en-Y gastric bypass (RYGB). Comparing individuals with and without post-bariatric surgery hypoglycaemia following an ingested nutrient load, the standardised mean difference in peak GLP-1 was 0.57 (95% CI, 0.32, 0.82), peak GIP 0.05 (-0.26, 0.36), peak insulin 0.84 (0.44, 1.23), peak C-peptide 0.69 (0.28, 1.1) and peak glucagon 0.05 (-0.26, 0.36). HbA1c was less in individuals with hypoglycaemia − 0.40 (-0.67, -0.12). There was no evidence of substantial heterogeneity in any outcome except for peak insulin: τ2 = 0.2, I2 = 54.3. No publication bias was evident. Conclusion: Following RYGB, postprandial peak plasma GLP-1, insulin and C-peptide concentrations are greater in individuals with post-bariatric surgery hypoglycaemia, while HbA1c is less. These observations support the concept that antagonism of GLP-1 would prove beneficial in the management of individuals with hypoglycaemia following RYGB. PROSPERO Registration Number: CRD42021287515. [ABSTRACT FROM AUTHOR]

Gastric emptying is a major determinant of postprandial blood glucose, accounting for ~35% of variance in peak glucose in both healthy individuals and those with type 2 diabetes. Gastric emptying is frequently disordered in individuals with diabetes (both abnormally delayed and accelerated). Delayed gastric emptying, i.e. diabetic gastroparesis, may be linked to upper gastrointestinal symptoms for which current treatment remains suboptimal; pharmacological acceleration of delayed emptying is only weakly associated with symptom improvement. Accordingly, the relationship between symptoms and delayed gastric emptying is not simply 'cause and effect'. In insulin-treated patients, disordered gastric emptying, even when not associated with gastrointestinal symptoms, can cause a mismatch between the onset of insulin action and the availability of absorbed carbohydrate, leading to suboptimal glycaemic control. In patients with type 2 diabetes, interventions that slow gastric emptying, e.g. glucagon-like peptide-1 receptor agonists, reduce postprandial blood glucose. This review focuses on recent insights into the impact of gastric emptying on postprandial blood glucose, effects of diabetes therapy on gastric emptying and the management of disordered gastric emptying in diabetes. In view of the broad relevance of gastric emptying to diabetes management, it is important that future clinical trials evaluating novel therapies that may affect gastric emptying should quantify the latter with an appropriate technique, such as scintigraphy or a stable isotope breath test. [ABSTRACT FROM AUTHOR]

Introduction: It is uncertain whether lixisenatide has postprandial insulinotropic effects when its effect on slowing gastric emptying is considered, in healthy subjects and type 2 diabetes mellitus (T2DM). We evaluated the effects of single administration of 10 μg sc lixisenatide on glycaemia, insulin secretion and gastric emptying (GE), measured using the 'gold standard' technique of scintigraphy following an oral glucose load (75 g glucose). Methods: Fifteen healthy subjects (nine men, six women; age 67.2 ± 2.3 years) and 15 patients with T2DM (nine men, six women; age 61.9 ± 2.3 years) had measurements of GE, plasma glucose, insulin and C-peptide for 180 min after a radiolabeled 75 g glucose drink on two separate days. All subjects received lixisenatide (10 μg sc) or placebo in a randomised, double-blind, crossover fashion 30 min before the drink. Insulin secretory response (ISR) was determined using the C-peptide deconvolution method. Results: GE was markedly slowed by lixisenatide compared with placebo in both healthy subjects (1.45 ± 0.10 kcal/min for placebo vs. 0.60 ± 0.14 kcal/min for lixisenatide) and diabetes (1.57 ± 0.06 kcal/min for placebo vs. 0.75 ± 0.13 kcal/min for lixisenatide) (both P < 0.001) with no difference between the two groups (P = 0.42). There was a moderate to strong inverse correlation between the early insulin secretory response calculated at 60 min and gastric retention at 60 min with lixisenatide treatment in healthy subjects (r = − 0.8, P = 0.0003) and a trend in type 2 diabetes (r = − 0.4, P = NS), compared with no relationships in the placebo arms (r = − 0.02, P = NS, healthy subjects) and (r = − 0.16, P = NS, type 2 diabetes). Conclusion: The marked slowing of GE of glucose induced by lixisenatide is associated with attenuation in the rise of postprandial glucose in both healthy subjects and diabetes and early insulin secretory response in healthy subjects. Clinical Trials Registration Number: NCT02308254. [ABSTRACT FROM AUTHOR]

Economic evaluation combines costs and benefits to support decision-making when assessing new interventions using preference-based measures to measure and value benefits in health or health-related quality of life. These health-focused instruments have limited ability to capture wider impacts on informal carers or outcomes in other sectors such as social care. Sector-specific instruments can be used but this is problematic when the impact of an intervention straddles different sectors. An alternative approach is to develop a generic preference-based measure that is sufficiently broad to capture important cross-sector outcomes. We consider the options for the selection of domains for a cross-sector generic measure including how to identify domains, who should provide information on the domains and how this should be framed. Beyond domain identification, considerations of criteria and stakeholder needs are also identified. This paper sets out the case for an approach that relies on the voice of patients, social care users and informal carers as the main source of domains and describes how the approach was operationalised in the 'Extending the QALY' project which developed the new measure, the EQ-HWB (EQ health and wellbeing instrument). We conclude by discussing the strengths and limitations of this approach. The new measure should be sufficiently generic to be used to consistently evaluate health and social care interventions, yet also sensitive enough to pick up important changes in quality of life in patients, social care users and carers. [ABSTRACT FROM AUTHOR]

Research on the use of digital games suggests they can enhance students' learning; however, teachers often play an important role in mediating gameplay and a game's educational goals. The purpose of the study was to investigate implementation approaches of nine biology teachers using an immersive digital game in their science classes, focusing on factors that contributed to their ability to instruct with the game, and how their enactment of the game influenced the class experience. Analysis of teacher data, which included daily feedback and pre- and post-implementation surveys, multiple classroom observations, teaching artifacts, and an extended interview, identified a range of individual instructional decisions as well as similarities and differences across the cohort. Most notably, a pattern of instructional orchestration emerged, resembling co-teaching—a reciprocal and supportive "relationship" between the teacher and the game. The game informed teachers' thinking about their genetics curriculum and enhanced their instructional practice, while teachers leveraged digital tools to shape students' gameplay and to improve on what the game offered. Key descriptive findings are discussed, identifying digital game features that may improve teacher instruction with games in classrooms. [ABSTRACT FROM AUTHOR]

Background: The rate of gastric emptying and glucoregulatory hormones are key determinants of postprandial glycaemia. Intragastric administration of L-tryptophan slows gastric emptying and reduces the glycaemic response to a nutrient drink in lean individuals and those with obesity. We investigated whether tryptophan decreases postprandial glycaemia and slows gastric emptying in type 2 diabetes (T2D). Methods: Twelve men with T2D (age: 63 ± 2 years, HbA1c: 49.7 ± 2.5 mmol/mol, BMI: 30 ± 1 kg/m2) received, on three separate occasions, 3 g ('Trp-3') or 1.5 g ('Trp-1.5') tryptophan, or control (0.9% saline), intragastrically, in randomised, double-blind fashion, 30 min before a mixed-nutrient drink (500 kcal, 74 g carbohydrates), containing 3 g 3-O-methyl-D-glucose (3-OMG) to assess glucose absorption. Venous blood samples were obtained at baseline, after tryptophan, and for 2 h post-drink for measurements of plasma glucose, C-peptide, glucagon and 3-OMG. Gastric emptying of the drink was quantified using two-dimensional ultrasound. Results: Tryptophan alone stimulated C-peptide (P = 0.002) and glucagon (P = 0.04), but did not affect fasting glucose. In response to the drink, Trp-3 lowered plasma glucose from t = 15–30 min and from t = 30–45 min compared with control and Trp-1.5, respectively (both P < 0.05), with no differences in peak glucose between treatments. Gastric emptying tended to be slower after Trp-3, but not Trp-1.5, than control (P = 0.06). Plasma C-peptide, glucagon and 3-OMG increased on all days, with no major differences between treatments. Conclusions: In people with T2D, intragastric administration of 3 g tryptophan modestly slows gastric emptying, associated with a delayed rise, but not an overall lowering of, postprandial glucose. [ABSTRACT FROM AUTHOR]

Background: Perinatal exposure to air pollution and immune system dysregulation are two factors consistently associated with autism spectrum disorders (ASD) and other neurodevelopmental outcomes. However, little is known about how air pollution may influence maternal immune function during pregnancy. Objectives: To assess the relationship between mid-gestational circulating levels of maternal cytokines/chemokines and previous month air pollution exposure across neurodevelopmental groups, and to assess whether cytokines/chemokines mediate the relationship between air pollution exposures and risk of ASD and/or intellectual disability (ID) in the Early Markers for Autism (EMA) study. Methods: EMA is a population-based, nested case–control study which linked archived maternal serum samples collected during weeks 15–19 of gestation for routine prenatal screening, birth records, and Department of Developmental Services (DDS) records. Children receiving DDS services for ASD without intellectual disability (ASD without ID; n = 199), ASD with ID (ASD with ID; n = 180), ID without ASD (ID; n = 164), and children from the general population (GP; n = 414) with no DDS services were included in this analysis. Serum samples were quantified for 22 cytokines/chemokines using Luminex multiplex analysis technology. Air pollution exposure for the month prior to maternal serum collection was assigned based on the Environmental Protection Agency's Air Quality System data using the maternal residential address reported during the prenatal screening visit. Results: Previous month air pollution exposure and mid-gestational maternal cytokine and chemokine levels were significantly correlated, though weak in magnitude (ranging from − 0.16 to 0.13). Ten pairs of mid-pregnancy immune markers and previous month air pollutants were significantly associated within one of the child neurodevelopmental groups, adjusted for covariates (p < 0.001). Mid-pregnancy air pollution was not associated with any neurodevelopmental outcome. IL-6 remained associated with ASD with ID even after adjusting for air pollution exposure. Conclusion: This study suggests that maternal immune activation is associated with risk for neurodevelopmental disorders. Furthermore, that prenatal air pollution exposure is associated with small, but perhaps biologically relevant, effects on maternal immune system function during pregnancy. Additional studies are needed to better evaluate how prenatal exposure to air pollution affects the trajectory of maternal immune activation during pregnancy, if windows of heightened susceptibility can be identified, and how these factors influence neurodevelopment of the offspring. [ABSTRACT FROM AUTHOR]

Aims: Glucose-dependent insulinotropic polypeptide (GIP) is released primarily from the proximal small intestine and glucagon-like peptide-1 (GLP-1) from the more distal small intestine and colon. Their relative importance to the incretin effect in health has been contentious in the past, although it now appears that GIP has the dominant role. It is uncertain whether there is a relationship between GIP and GLP-1 secretion. We aimed to evaluate the relationship between plasma GIP and GLP-1 responses to a 75-g oral glucose load in individuals with normal (NGT) and impaired glucose tolerance (IGT). Methods: One hundred healthy subjects had measurements of blood glucose, serum insulin, plasma GIP and GLP-1 concentrations for 240 min after a 300 mL drink containing 75 g glucose. Results: Fifty had NGT and 41 IGT; 9 had type 2 diabetes and were excluded from analysis. In both groups, there were increases in plasma GIP and GLP-1 following the glucose drink, with no difference in the magnitude of the responses between t = 0–240 min. There was a weak relationship between the iAUC0–240 min for GIP and GLP-1 in the combined (r = 0.23, P = 0.015) and in the IGT (r = 0.34, P = 0.01), but not in the NGT (r = 0.15, P = 0.14) group. Conclusions: There is a weak relationship between oral glucose-induced GIP and GLP-1 secretions in non-diabetic subjects. [ABSTRACT FROM AUTHOR]

I provide a brief précis of Aaron Zimmerman's book, Belief: A Pragmatic Picture, then explore two possible problems for the view. The first concerns whether the account of belief can successfully intervene in the debate between those who hold emotions are partly constituted by evaluative beliefs and those who deny this. The second concerns whether the view can explain that distinctive form of white ignorance that is manifest in an unwillingness to draw relatively obvious action-guiding beliefs from widely shared information. Thinking about cases of this kind raises the question of whether Zimmerman's account is problematically individualist, because of downplaying the importance of converging on an account of belief given the role of belief attribution in a suite of critical practices that are essential to communities of inquiry. If we, collectively, must commit to converging on an account of belief, but different accounts serve the interests of different groups, then the meta-level thesis that we should choose an account on pragmatic grounds raises the question of whose interests such an account should serve. [ABSTRACT FROM AUTHOR]

Purpose Of Review: Gastroparesis is an important complication of diabetes that may have a major impact on the quality of life as a result of upper gastrointestinal symptoms and impaired glycaemic control. Current management strategies include optimising blood glucose control, dietary modifications and supportive nutrition. Pharmacologic approaches with drugs that have prokinetic and/or antiemetic effects are also used widely; however, current available treatments have major limitations. There is increasing recognition that the rate of gastric emptying (GE) is a key determinant of the glycaemic response to a meal.Recent Findings: There is ongoing uncertainty regarding the impact of longstanding hyperglycaemia on GE, which requires clarification. New diagnostic techniques have been developed to better characterise the mechanisms underlying gastroparesis in individual patients, and these have the potential to lead to more personalised therapy. Management of gastroparesis is complex and suboptimal; novel approaches are desirable. This review summarises recent advances in the understanding of diabetic gastroparesis, with an emphasis on the current therapies that influence GE, and the bidirectional relationship between glycaemic control and GE. [ABSTRACT FROM AUTHOR]

In this article, I explore the role of affective feedback loops in creating and sustaining trust and distrust. Some emotions, such as fear and contempt, drive out trust; others, such as esteem and empathy, drive out distrust. The mechanism here is causal, but not merely causal: affective looping works through changing how the agent interprets the words, deeds, and motives of the other, thus making trust or distrust appear justified. Looping influences not only dyadic trust, but also climates, and networks of trust and distrust. Not all trust-entrenching looping is virtuous, nor all distrust-entrenching looping vicious, but distrust looping is a powerful way to justify xenophobic public policy. I explore options for remedy. [ABSTRACT FROM AUTHOR]

Research-based digital games hold great potential to be effective tools in supporting next-generation science learning. However, as with all instructional materials, teachers significantly influence their implementation and contribute to their effectiveness. To more fully understand the contributions and challenges of teacher implementation of digital games, we studied the replacement of existing high school biology genetics lessons over a 3- to 6-week period with Geniverse, an immersive, game-like learning environment designed to be used in classrooms. The Geniverse materials infuse virtual experimentation in genetics with a narrative of a quest to heal a genetic disease; incorporate the topics of meiosis and protein synthesis with inheritance; and include the science practices of explanation and argumentation. The research design involved a quasi-experiment with 48 high school teachers and about 2000 students, student science content knowledge and argumentation outcome measures, and analysis using hierarchical linear modeling. Results indicate that when Geniverse was implemented as the designers intended, student learning of genetics content was significantly greater than in the comparison, business-as-usual group. However, a wide range of levels of Geniverse implementation resulted in no significant difference between the groups as a whole. Students’ abilities to engage in scientific explanation and argumentation were greater in the Geniverse group, but these differences were not statistically significant. Observation, survey, and interview data indicate a range of barriers to implementation and teacher instructional decisions that may have influenced student outcomes. Implications for the role of the teacher in the implementation of game-based instructional materials are discussed. [ABSTRACT FROM AUTHOR]

Purpose: Maternal vitamin D deficiency during pregnancy is a widespread issue that may have long-lasting consequences on offspring adiposity. We sought to determine how maternal vitamin D deficiency during the perinatal period would affect offspring adipose tissue development and gene expression.Methods: Female C57BL/6 J mice were fed either a vitamin D deficient (VDD) or control diet from 4 weeks before pregnancy (periconception) until 7 days postparturition. Male offspring were weighed and euthanized at 75 days of age (early adult period), at which point serum was collected for biochemical analyses, and perigonadal and subcutaneous white adipose tissue (PGAT and SQAT, respectively) were excised, weighed, then flash-frozen for later histology and analyses of adipogenic gene expression.Results: All adult male offspring were nonobese; there were no significant differences in body weight, adipose pad weight, or adipocyte size. However, VDD-exposed offspring had greater expression of the adipogenic-regulating genes peroxisome proliferator-activated receptor gamma (Pparg) and vitamin D receptor (Vdr).Conclusions: This study suggests that exposure to vitamin D deficiency during the perinatal period can directly affect genes involved in the development of adipose tissue in nonobese offspring. These novel findings invite further investigation into the mechanisms by which maternal vitamin D status during pregnancy affects adipose development and metabolic health of offspring. [ABSTRACT FROM AUTHOR]

This study sought to determine the minimal clinically important difference (MCID) for two frequently used measures of symptom severity in Post-Traumatic Stress Disorder: the Clinician Administered PTSD Scale (CAPS) and the PTSD Symptom Checklist (PCL). Data from a randomized clinical trial of antipsychotic medication in military-related treatment-resistant PTSD (N= 267) included assessments 4 times over 26 weeks. Methods for estimating the MCID were based on both the anchor-based approach, using the Clinical Global Impressions (CGI) severity and improvement scales, rated by both clinicians and patients; and the distribution-based approach (based on standardized z-scores). Severity and change scores on the CAPS and PCL were converted to z-scores and compared across CGI levels using analysis of variance. The average difference in CAPS z-scores between each of three CGI levels between “moderate” to “severe” and from “no change” to “much improved” was 0.758 for clinician CGI ratings and 0.525 for patient CGI ratings and were similar for the PCL (0.483 and 0.471) with all differences significant at p<.0001). Clinically meaningful CAPS and PCL severity and change z-scores range between 0.5–0.8 standard deviations. The MCID estimates suggested here provide an empirical basis for determining whether statistically significant changes in CAPS and PCL scores are clinically meaningful. [ABSTRACT FROM AUTHOR]

The article presents a case study of reactive hypoglycaemia having breakthrough followed by intraduodenal glucose infusion in case of a type 2 diabetes patient. The article also includes the established result of reactive hypoglycaemia may lead to type 2 diabetes whereas postprandial reactive hypoglycaemia is rare in type 2 diabetes.

The management of diabetic gastroparesis often represents a significant clinical challenge in which the maintenance of nutrition is pivotal. Gastric emptying is delayed in 30% to 50% of patients with longstanding type 1 or type 2 diabetes and upper gastrointestinal symptoms also occur frequently. However, there is only a weak association between the presence of symptoms and delayed gastric emptying. Acute changes in blood glucose concentrations affect gastric motility in diabetes; hyperglycemia slows gastric emptying whereas hypoglycemia may accelerate it; blood glucose concentrations may also influence symptoms. It is now recognized that gastric emptying is a major determinant of postprandial glycemia and, therefore, there is considerable interest in the concept of modulating gastric emptying, by dietary or pharmacologic means, to optimize glycemic control in diabetes. [ABSTRACT FROM AUTHOR]

This study evaluated the relationship between gastric emptying and upper gastrointestinal symptoms with H. pylori status in patients with diabetes mellitus. Sixty-three outpatients (44 type 1, 19 type 2, age 45 +/- 1.5 years) underwent measurements of gastric emptying of a mixed solid and liquid meal, gastrointestinal symptoms (gastric and esophageal), glycemic control (HbA1c), and autonomic nerve function. Anti-H. pylori IgG antibodies were quantified using a validated kit. Gastric emptying of solid and/or liquid was delayed in 47 (75%) patients, and 31 (49%) had autonomic neuropathy. Fifteen (24%) of the patients were H. pylori positive. There were no differences in gastric emptying (solid retention at 100 min: 67.5 +/- 5.7% vs 63.2 +/- 3.6%; P = 0.63, liquid T50: 35.5 +/- 2.9 min vs 42.5 +/- 3.4 min; P = 0.42), upper gastrointestinal symptoms (gastric 3.9 +/- 0.7 vs 4.0 +/- 0.4; P = 0.94 or esophageal 1.7 +/- 0.5 vs 1.3 +/- 0.2; P = 0.42) or HbA1c (8.8 +/- 0.4% vs 8.6 +/- 0.2%; P = 0.89) between H. pylori-positive and -negative patients. We conclude that H. pylori infection is not associated with delayed gastric emptying or upper gastrointestinal symptoms in diabetes. [ABSTRACT FROM AUTHOR]

Aims/hypothesis: A postprandial fall in BP occurs frequently in older individuals and in patients with type 2 diabetes. The magnitude of this decrease in BP is related to the rate of gastric emptying (GE). Intravenous administration of glucagon-like peptide-1 (GLP-1) attenuates the hypotensive response to intraduodenal glucose in healthy older individuals. We sought to determine the effects of exogenous GLP-1 on BP, GE, superior mesenteric artery (SMA) flow and glycaemic response to oral ingestion of glucose in healthy older individuals and patients with type 2 diabetes. Methods: Fourteen older volunteers (six men, eight women; age 72.1 ± 1.1 years) and ten patients with type 2 diabetes (six men, four women; age 68.7 ± 3.4 years; HbA 6.6 ± 0.2% [48.5 ± 2.0 mmol/mol]; nine with blood glucose managed with metformin, two with a sulfonylurea and one with a dipeptidyl-peptidase 4 inhibitor) received an i.v. infusion of GLP-1 (0.9 pmol kg min) or saline (154 mmol/l NaCl) for 150 min ( t = −30 min to t = 120 min) in randomised order. At t = 0 min, volunteers consumed a radiolabelled 75 g glucose drink. BP was assessed with an automated device, GE by scintigraphy and SMA flow by ultrasonography. Blood glucose and serum insulin were measured. Results: GLP-1 attenuated the fall in diastolic BP after the glucose drink in older individuals ( p < 0.05) and attenuated the fall in systolic and diastolic BP in patients with type 2 diabetes ( p < 0.05). GE was faster in patients with type 2 diabetes than in healthy individuals ( p < 0.05). In both groups, individuals had slower GE ( p < 0.001), decreased SMA flow ( p < 0.05) and a lower degree of glycaemia ( p < 0.001) when receiving GLP-1. Conclusions/interpretation: Intravenous GLP-1 attenuates the hypotensive response to orally administered glucose and decreases SMA flow, probably by slowing GE. GLP-1 and 'short-acting' GLP-1 agonists may be useful in the management of postprandial hypotension. [ABSTRACT FROM AUTHOR]

Burst-firing in distinct subsets of thalamic relay (TR) neurons is thought to be a key requirement for the propagation of absence seizures. However, in the well-regarded Genetic Absence Epilepsy Rats from Strasbourg (GAERS) model as yet there has been no link described between burst-firing in TR neurons and spike-and-wave discharges (SWDs). GAERS ventrobasal (VB) neurons are a specific subset of TR neurons that do not normally display burst-firing during absence seizures in the GAERS model, and here, we assessed the underlying relationship of VB burst-firing with I and T-type calcium currents between GAERS and non-epileptic control (NEC) animals. In response to 200-ms hyperpolarizing current injections, adult epileptic but not pre-epileptic GAERS VB neurons displayed suppressed burst-firing compared to NEC. In response to longer duration 1,000-ms hyperpolarizing current injections, both pre-epileptic and epileptic GAERS VB neurons required significantly more hyperpolarizing current injection to burst-fire than those of NEC animals. The current density of the Hyperpolarization and Cyclic Nucleotide-activated (HCN) current (I) was found to be increased in GAERS VB neurons, and the blockade of I relieved the suppressed burst-firing in both pre-epileptic P15-P20 and adult animals. In support, levels of HCN-1 and HCN-3 isoform channel proteins were increased in GAERS VB thalamic tissue. T-type calcium channel whole-cell currents were found to be decreased in P7-P9 GAERS VB neurons, and also noted was a decrease in Ca3.1 mRNA and protein levels in adults. Z944, a potent T-type calcium channel blocker with anti-epileptic properties, completely abolished hyperpolarization-induced VB burst-firing in both NEC and GAERS VB neurons. [ABSTRACT FROM AUTHOR]

BACKGROUND: Growth in the care of hospitalized patients by hospitalists has the potential to increase the productivity of office-based primary care physicians (PCPs) by allowing them to focus on outpatient practice. OBJECTIVE: Our aim was to examine the association between utilization of hospitalists and the productivity of office-based PCPs. DESIGN/PARTICIPANTS: The cross-sectional study was conducted using the 2008 Health Tracking Physician Survey Restricted Use File linked to the Area Resource File. We analyzed a total of 1,158 office-based PCPs representing a weighted total of 97,355 physicians. MAIN MEASURES: Utilization of hospitalists was defined as the percentage of a PCP's hospitalized patients treated by a hospitalist. The measures of PCPs' productivity were: (1) number of hospital visits per week, (2) number of office and outpatient clinic visits per week, and (3) direct patient care time per visit. KEY RESULTS: We found that the use of hospitalists was significantly associated with a decreased number of hospital visits. The use of hospitalists was also associated with an increased number of office visits, but this was only significant for high users. Physicians who used hospitalists for more than three-quarters of their hospitalized patients had an extra 8.8 office visits per week on average ( p = 0.05), which was equivalent to a 10 % increase in productivity over the predicted mean of 87 visits for physicians who did not use hospitalists. We did not find any significant differences in direct patient care time per visit. CONCLUSIONS: Our study demonstrates that the increase in productivity for the one-third of PCPs who use hospitalists extensively may not be sufficient to offset the current loss of PCP workforce. However, our findings provide cautious optimism that if more PCPs effectively and efficiently used hospitalists, this could help mitigate a PCP shortage and improve access to primary care services. [ABSTRACT FROM AUTHOR]

This discussion of Sally Haslanger's recent book, Resisting Reality: Social Construction and Social Critique (Oxford ), investigates how her theory of race and gender handles the problem of intersectionality; that is, the problem of how to understand the ways in which one's location in multiple socially constructed categories affects one's lived experiences, social roles, and relative privilege or disadvantage. Haslanger defines race and gender as locations within hierarchical social structures. This high-level structural analysis allows her to find commonality without claiming that, for example, all women share social roles or psychological characteristics. However, race-based oppression seems sometimes to cancel out gender-based privilege; thus raising the question of how, on Haslanger's model, we are to understand race and gender working together. [ABSTRACT FROM AUTHOR]

Introduction: 'Incretin-based' therapies, such as the glucagon-like peptide-1 (GLP-1) receptor agonists, represent a major advance in type 2 diabetes mellitus (T2DM) treatment. GLP-1 receptor agonists differ substantially in their duration of action, frequency of administration and clinical profile. Methods: This article reviews the mechanisms of action and clinical evidence for GLP-1 receptor targeting and discusses differences between GLP-1 therapies, focusing particularly on clinical data for the GLP-1 receptor agonist, lixisenatide. Results: GLP-1 therapies target islet cell 'defects' of insufficient insulin and excessive glucagon secretion in T2DM, in a glucose-dependent manner, with minimal risk of hypoglycemia. Different GLP-1 therapies exert differential effects on fasting and postprandial glycemia (both being major determinants of glycemic control). They also slow gastric emptying to different extents, probably accounting for different effects to reduce postprandial glycemia. The GetGoal phase 3 studies in T2DM have confirmed the efficacy of once-daily lixisenatide in reducing plasma glucose and glycated hemoglobin (HbA), with a pronounced lowering of postprandial plasma glucose (PPG), as monotherapy and as add-on to oral antidiabetic drugs and to basal insulin. Lixisenatide's ability to diminish PPG is probably partly mediated by its marked ability to delay gastric emptying. Lixisenatide is generally well tolerated, with possibly better gastrointestinal tolerability and lower risk of hypoglycemia than exenatide immediate release. Lixisenatide is associated with a beneficial effect on weight, with either no change or a decrease in body weight when administered as add-on therapy to basal insulin in overweight patients with T2DM. Conclusions: Lixisenatide improves glycemic control, by primarily affecting PPG, while preventing weight gain or reducing body weight with a low risk of hypoglycemia in T2DM. Lixisenatide is likely to represent a significant advance in the management of T2DM, perhaps particularly in those patients with relatively faster gastric emptying and lower levels of HbA, including those receiving basal insulin. [ABSTRACT FROM AUTHOR]

As cultural, social, political and economic changes take place, the secondary or high school curriculum should reflect and respond to changing needs and aspirations of students. Technology Education has been proactive in this arena as it has transformed over the decades to meet ever-changing societal needs. The most recent change to the discipline has been to add engineering and, as a result, adopting a new name and curriculum-Engineering and Technology Education. The added component and name change in Technology Education is causing discussions about what the new direction means, what professional preparation changes will be incurred, and what work graduating students will be prepared to do. In light of these changes, this study investigated perceptions of high school students in the United States of America about engineering and technology courses they take. To investigate whether students' perceptions are in accord with current changes in Engineering and Technology Education, 316 students enrolled in engineering and technology courses in Georgia schools that have an affiliation with the Georgia Engineering and Technology Education Association (GETEA) were surveyed. According to data analyses, students' perceptions can be divided into two factors. Educational Value of Course (factor 1) was extracted from statements measuring the degree to which the courses prepare students for employment and provide them with information regarding future employment. Personal Relevance of Course (factor 2) was derived from statements measuring students' perceptions about links between engineering and technology education and their personal lives. Such findings suggest these students valued their engineering and technology courses, planned to continue their education, made good grades, and had varied types of career expectations for jobs such as design engineers and architects. [ABSTRACT FROM AUTHOR]

single flow continuous culture fermenter system was used in this study to investigate the influence of dietary lipid supplements varying in their fatty acid content on the DNA concentration of selected rumen bacteria. Four continuous culture fermenters were used in a 4×4 Latin square design with four periods of 10 d each. Treatment diets were fed at 45 g/d (DM basis) in three equal portions during the day. The diets were: 1) control (CON), 2) control with animal fat source (SAT), 3) control with soybean oil (SBO), and 4) control with fish oil (FO). Lipid supplements were added at 3% of diet DM. The concentrations of total volatile fatty acids and acetate were not affected ( P>0.05) by lipid supplements. Concentrations of propionate, iso-butyrate, valerate and iso-valerate were highest ( P<0.05) with the FO diet compared with the other treatment diets. The concentration of til C18:l (vaccenic acid, VA) in effluents increased ( P<0.05) with SBO and FO diets and was highest with the SBO diet. The concentrations of C18:0 in effluents were lowest ( P<0.05) for the FO diet compared with the other treatment diets. Concentrations of DNA for Anaerovibrio lipolytica, and Butyrivibrio proteoclasticus in fermenters were similar ( P>0.05) for all diets. The DNA concentrations of Butyrivibrio fibrisolvens and Ruminococcus albus in fermenters were lowest ( P<0.05) with the FO diet but were similar ( P>0.05) among the other treatment diets. Selenomonas ruminantium DNA concentration in fermenters was highest ( P<0.05) with the FO diet. In conclusion, SBO had no effect on bacterial DNA concentrations tested in this study and the VA accumulation in the rumen observed on the FO diet may be due in part to FO influence on B. fibrisolvens, R. albus, and S. ruminantium. [ABSTRACT FROM AUTHOR]

Gastric emptying is frequently abnormal in patients with long-standing type 1 and type 2 diabetes mellitus. Symptoms commonly associated with disordered gastric emptying include nausea, vomiting, bloating and epigastric pain, while patients are also at risk of malnutrition, weight loss, impaired drug absorption, disordered glycaemic control and poor quality of life. Although often attributed to the presence of irreversible autonomic neuropathy, acute hyperglycaemia represents a potentially reversible cause of gastric dysfunction in diabetes. Scintigraphy represents the gold standard for measuring gastric emptying. The management of diabetic gastroparesis is less than optimal, partly because the pathogenesis has not been clearly defined. Treatment approaches include dietary modification and optimization of glycaemia, and the use of prokinetic drugs, while novel therapies such as gastric electrical stimulation are the subject of ongoing investigation. [ABSTRACT FROM AUTHOR]

BACKGROUND/OBJECTIVES: In patients with functional dyspepsia (FD), symptoms are frequently triggered, or exacerbated, by fatty foods. We hypothesized that in FD patients, a high-fat (high-FAT) meal would induce more symptoms than a high-carbohydrate (high-CHO) meal, associated with an altered secretion of cholecystokinin (CCK), peptide-YY (PYY), and ghrelin and an increased antral size, when compared to healthy subjects (HS). METHODS: FD symptoms, appetite perceptions, plasma hormones, and antral area were measured in 8 FD patients and 8 HS on three separate days after the ingestion of high-CHO or high-FAT (500 kcal/400 g) meals, or a low-nutrient control (180 kcal/400 g); the energy intake was quantified 60 min later. RESULTS: Nausea ( P < 0.01) and pain ( P= 0.05) were greater in FD after the high-FAT, when compared to high-CHO and control meals and in HS. Discomfort was greater after all meals in FD when compared to HS ( P < 0.05). Fasting CCK and stimulation of CCK by the high-FAT ( P < 0.01) meal were greater in FD, while fasting and postprandial PYY were lower ( P < 0.001) in FD than in HS, with no differences in fasting, or postprandial, plasma ghrelin between FD and HS. Fasting antral area was greater in FD ( P < 0.05), with no differences postprandially between FD and HS. There were no differences in the energy intake between the two groups. CONCLUSIONS: In FD patients: (a) a high-FAT meal induces more symptoms than an isocaloric high-CHO meal, and (b) fasting and postprandial plasma CCK concentrations are greater and PYY concentrations are less. Our findings have important implications for the development of diet-based therapies for the treatment of FD. [ABSTRACT FROM AUTHOR]

Delayed gastric emptying is frequently observed in patients with longstanding type 1 and type 2 diabetes mellitus. and potentially impacts on upper gastrointestinal symptoms, glycaemic control, nutrition and oral drug absorption. The pathogenesis remains unclear and management strategies are currently suboptimal. Therapeutic strategies focus on accelerating gastric emptying, controlling symptoms and improving glycaemic control. The potential adverse effects of hyperglycaemia on gastric emptying and upper gut symptoms indicate the importance of normalising blood glucose if possible. Nutritional and psychological supports are also important, but often neglected. A number of recent pharmacological and non-pharmacological therapies show promise, including gastric electrical stimulation. As with all chronic illnesses, a multidisciplinary approach to management is recommended, but there are few data regarding long-term outcomes. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The herbal preparation Iberogast® has been reported to improve upper abdominal symptoms in functional dyspepsia (FD) and to decrease fundic tone, increase antral contractility, and decrease afferent nerve sensitivity in experimental animals. The effects of Iberogast on the human gastrointestinal tract have not been evaluated. METHODS: We investigated the effects of oral control and Iberogast, each administered as a single dose (1.1 mL), in a double-blind randomized fashion, on proximal gastric volume (part A), antropyloroduodenal motility (part B), and gastric emptying and intragastric distribution of a solid/liquid meal (part C) for 120 minutes, in nine (part A), 12 (part B), and eight (part C) healthy men. RESULTS: Iberogast increased proximal gastric volume (max volume; control 104 ± 12 mL, Iberogast 174 ± 23 mL, P < 0.05) (part A), increased the motility index of antral pressure waves in the first 60 minutes ( P < 0.05) without affecting pyloric or duodenal pressures (part B), and slightly increased the retention of liquid in the total stomach between 10 and 50 minutes ( P < 0.01), but had no effect on gastric emptying of solids or intragastric distribution (part C). CONCLUSIONS: Iberogast affects gastric motility in humans, probably in a region-dependent manner. The stimulation of gastric relaxation and antral motility may contribute to the reported therapeutic efficacy of Iberogast in FD. [ABSTRACT FROM AUTHOR]

Genetic modification of nitrogen metabolism via bacterial NADPH- dependent glutamate dehydrogenase (GDH; E.C.4.1.2.1) favorably alters growth and metabolism of C3 plants. The aim of this study was to examine the effect of expression of GDH in the cytoplasmic compartment of Zea mays cells. The gdhA gene from Escherichia coli , that encoded a NADPH-GDH, was ligated to the ubiquitin promoter that incorporated the first intron enhancer and used to transform Z. mays cv. ‘H99’ embryo cultures by biolistics. R0–R3 generations included selfed inbreds, back-crossed inbreds, and hybrids with B73 derivatives. The lines with the highest GDH specific activity produced infertile R0 plants. The highest specific activity of GDH from the fertile Z. mays plants was sufficient to alter phenotypes. Plant damage caused by the phosphinothricin in gluphosinate-type herbicides, glutamine synthetase (GS; EC 6.1.3.2) inhibitors, was less pronounced in Z. mays plants with gdhA pat than in gusA pat plants. Germination and grain biomass production were increased in gdhA transgenic plants in the field during seasons with significant water deficits but not over all locations. Water deficit tolerance under controlled conditions was increased. Crops modified with gdhA may have value in semi-arid locations. [ABSTRACT FROM AUTHOR]

Gastrointestinal symptoms and disordered gut motility occur frequently in the diabetic population and are generally regarded as manifestations of gastrointestinal "autonomic dysfunction," although the relationships between both symptoms and dysmotility with abnormal cardiovascular autonomic function are weak. It is now recognized that the blood glucose concentration is both a determinant of and determined by gastrointestinal function. An improved de.nition of the underlying pathophysiology should facilitate the development of therapies that are targeted more effectively. [ABSTRACT FROM AUTHOR]

The aims of this study were to evaluate (i) the relationship between transpyloric flow (TF) assessed by Doppler ultrasonography and scintigraphy, (ii) the effects of healthy aging on TF and gastric emptying (GE), and (iii) the relationship between the glycemic response to oral glucose and TF. Ten healthy "young" (7 M, 3 F) and 8 "older" (4 M, 4 F), subjects had simultaneous measurements of TF, GE, and blood glucose after a 600-ml drink (75 g glucose labeled with 20 MBq 99mTc-sulfur colloid) while seated. TF measured by ultrasound was measured during drink ingestion and for 30 min thereafter. GE was measured scintigraphically for 180 min after drink ingestion. Blood glucose was measured before the drink and at regular intervals until 180 min. During drink ingestion, TF was greater (P < 0.05) and GE faster (retention at 60 min: 70.8+/-3.3 vs. 83.8+/-4.6%; P < 0.05) in young compared to older subjects. There was no difference in fasting blood glucose between the two groups but the magnitude of the rise in blood glucose was greater in the young compared to the older subjects; (at 15 min 2.4+/-0.3 vs. 1.5+/-0.5 mmol/L; P < 0.05). In contrast, after 90 min blood glucose concentrations were higher in the older subjects. There were significant relationships between the early blood glucose concentration and both TF (e.g., at 15 min: r = 0.56, P < 0.05) and GE (e.g., at 15 min: r = -0.51, P < 0.05). In conclusion, the results of this study indicate that (i) TF is initially less, and GE slower, in older compared to young subjects; (ii) the initial glycemic response to oral glucose is related to TF; and (iii) measurements of TF by ultrasound and scintigraphy correlate significantly. [ABSTRACT FROM AUTHOR]

The management of both diabetic and idiopathic gastroparesis often represents a substantial clinical challenge. In formulating recommendations for therapy, it should be recognized that these are based on less than optimal evidence; in particular, there are substantial deficiencies in current knowledge relating to the pathophysiology of gastroparesis, as well as the natural history of gastrointestinal symptoms, and the majority of pharmacologic trials have been short term and associated with methodologic limitations. Although the etiologic factors differ, the overall management principles are similar in the two conditions. Maintenance of adequate nutrition is pivotal, and parenteral nutrition may be required in severe cases associated with malnutrition. In patients with diabetes, rigorous attempts should be made to optimize glycemic control —hyperglycemia slows gastric emptying and may exacerbate symptoms and attenuate the effects of prokinetic drugs. Despite the relatively poor predictive value of symptoms, it is reasonable to suggest a trial of prokinetic therapy for about 4 weeks, rather than initially establishing the diagnosis by measurement of gastric emptying. However, it should be recognized that there is a substantial placebo response, a lack of evidence to support the cost effectiveness of such an approach, and that most patients will require prolonged therapy. In type 1 diabetic patients, prokinetic therapy may potentially benefit glycemic control, and this forms an additional rationale (albeit not established) for therapy. Some patients with diabetes and idiopathic gastroparesis with severe vomiting are unable to tolerate oral medication; in such cases subcutaneous metoclopramide may prove useful. Patients with intractable symptoms should be hospitalized and given intravenous erythromycin. The repertoire of prokinetic agents available in the United States is limited and includes metoclopramide, erythromycin, and cisapride (available by special program from its manufacturer); all of these drugs are associated with side effects. The use of metoclopramide may represent the first choice for chronic oral therapy, although it has been studied less comprehensively than cisapride. Combination therapy may be potentially more efficacious than the use of single agents. Dehydration and metabolic derangements should be corrected. The choice of chronic medical therapy should be individualized, taking factors such as age, presence of diabetes, concurrent medications, and comorbidities into account. In a small number of patients in whom medical treatment fails, surgery should be considered, and, if performed, done in a specialized center. A number of novel therapies, including gastric electrical stimulation, are currently being evaluated. [ABSTRACT FROM AUTHOR]

Postprandial hypotension occurs frequently in diabetes; the fall in blood pressure is greatest after ingestion of carbohydrate, particularly glucose and, in type 2 diabetes, is related to the rate of gastric emptying. The aim of this study was to determine whether slowing of gastric emptying by guar gum reduces the fall in blood pressure after oral glucose in patients with type 2 diabetes. Eleven type 2 patients managed by diet alone, age 61.9 +/- 1.3 years, had measurements of gastric emptying, blood pressure, blood glucose, and serum insulin on two occasions after ingestion of 300 ml water containing 50 g glucose, with or without 9 g guar gum. The magnitude of the fall in blood pressure was less (P < 0.05) and gastric emptying slower (P < 0.05) after guar. Blood glucose (P < 0.05) and serum insulin (P < 0.01) concentrations were lower after guar. The magnitude of the fall in systolic blood pressure was related to gastric emptying of glucose at 30 min on the control day (r = 0.67, P < 0.05). We conclude that guar gum attenuates the fall in blood pressure after oral glucose in patients with type 2 diabetes mellitus, presumably by slowing glucose absorption. [ABSTRACT FROM AUTHOR]

OBJECTIVES:Corticotropin-releasing factor (CRF) has been shown to affect GI motor function and appetite in animals. We have evaluated the effects of exogenous CRF on antropyloroduodenal motility and appetite in humans.METHODS:On 2 separate days, six healthy volunteers received, in randomized, double-blind fashion, i.v. CRF as a 1.0-μg/kg bolus (0–5 min) followed by a constant infusion (1.0 μg/kg/h) (5–150 min), or an identical volume of saline. At t = 28 min each subject drank 200 ml of a nutrient liquid containing 20 mg/kg of paracetamol. Antropyloroduodenal pressures were measured with sleeve/sidehole manometry and perceptions of appetite by visual analog scales. Venous blood was obtained for measurements of serum cortisol and paracetamol. At t = 150 min the manometric catheter was removed and subjects offered a buffet meal (150–180 min). The amount and macronutrient content of food consumed were quantified.RESULTS:CRF increased serum cortisol (p < 0.001), the number of isolated pyloric pressure waves (p < 0.05), duodenal pressure waves (p < 0.05), and the percentage of antegrade duodenal pressure waves (p < 0.05). CRF had no significant effect on the number of antral pressure waves, basal pyloric pressure, serum paracetamol concentrations, perceptions of appetite, or food intake.CONCLUSIONS:Intravenous CRF stimulates phasic pyloric and duodenal pressure waves in humans. [Copyright &y& Elsevier]

This paper describes a system for retrieving relevant portions of broadcast news shows starting with only the audio data. A novel method of automatically detecting and removing commercials is presented and shown to increase the performance of the system while also reducing the computational effort required. A sophisticated large vocabulary speech recogniser which produces high-quality transcriptions of the audio and a window-based retrieval system with post-retrieval merging are also described. Results are presented using the 1999 TREC-8 Spoken Document Retrieval data for the task where no story boundaries are known. Experiments investigating the effectiveness of all aspects of the system are described, and the relative benefits of automatically eliminating commercials, enforcing broadcast structure during retrieval, using relevance feedback, changing retrieval parameters and merging during post-processing are shown. An Average Precision of 46.8%, when duplicates are scored as irrelevant, is shown to be achievable using this system, with the corresponding word error rate of the recogniser being 20.5%. [ABSTRACT FROM AUTHOR]

The social-cognitive characteristics of 88 preschool boys with Oppositional Defiant Disorder (ODD) and 80 nondisruptive boys were assessed 3 times over a 2-year period. Three questions were addressed: (1) Do social-cognitive processes (encoding, attribution, problem solving, and response evaluation) distinguish clinic-referred preschool boys from peers without behavior problems? (2) What is the relation between preschoolers' social-cognitive processes and observed problem behavior? (3) Are the social-cognitive processes of clinic boys with ODD influenced by comorbidity with Attention Deficit Hyperactivity Disorder (ADHD)? Boys were presented hypothetical, peer-oriented social dilemmas to resolve. At all 3 assessments, clinic boys were twice as likely as were comparison group boys to generate aggressive solutions. Relative to comparison boys, clinic boys' encoding of social information was less accurate. The groups did not differ in their attributions or response evaluations. Verbal IQ and language skills were modestly correlated with problem solving and encoding. Within the clinic group, social-cognitive processes were not affected by ADHD comorbidity and they showed little relation to later diagnostic status or severity of behavior problems. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to an article related to ethnic disparities in glucose-dependent insulinotropic peptide (GIP) and insulin responses to intraduodenal glucose in health.

Abstract. Many radiopharmaceuticals and test meals that are used to measure gastric emptying are less than optimal. A vegetable-based solid meal, such as rice, labelled with a radiopharmaceutical that also has the capacity to measure gastric emptying of liquids, is likely to be ideal. The role of Technegas as a radioisotopic marker to measure gastric emptying of rice and liquids was evaluated. Technegas-labelled rice was incubated in 0.9% saline, 1 M HC1 and simulated gastric fluid (3.2 g/1 pepsi-nogen, pH 2-3) to assess stability of the label. In eight healthy volunteers gastric emptying of two meals - 200 g rice (370 kcal) and 75 g dextrose dissolved in 300 ml water (300 kcal), both labelled with 20 MBq of Technegas - was measured scintigraphically. Over 4 h, the average label stability was 93.7% +/- 0.5% in 0.9% saline, 91.0% +/- 0.4% in 1 M HCl and 93.6% +/- 0.7% in simulated gastric juice. The lag phase was longer for rice than dextrose (25 +/- 7 min vs 4 +/- 2 min; P<0.05), but there was no difference in the post-lag emptying rate (2.1 +/- 0.3 kcal/min vs 1.7 +/- 0.2 kcal/min; P=0.2) between the two meals. We conclude that Technegas is a suitable radiopharmaceutical for measurement of gastric emptying of rice and nutrient-containing liquids. [ABSTRACT FROM AUTHOR]