Primary Language, Income and the Intensification of Anti-glycemic Medications in Managed Care: the (TRIAD) Study

BACKGROUND Patients who speak Spanish and/or have low socioeconomic status are at greater risk of suboptimal glycemic control. Inadequate intensification of anti-glycemic medications may partially explain this disparity. OBJECTIVE To examine the associations between primary language, income, and medication intensification. DESIGN Cohort study with 18-month follow-up. PARTICIPANTS One thousand nine hundred and thirty-nine patients with Type 2 diabetes who were not using insulin enrolled in the Translating Research into Action for Diabetes Study (TRIAD), a study of diabetes care in managed care. MEASUREMENTS Using administrative pharmacy data, we compared the odds of medication intensification for patients with baseline A1c ≥ 8%, by primary language and annual income. Covariates included age, sex, race/ethnicity, education, Charlson score, diabetes duration, baseline A1c, type of diabetes treatment, and health plan. RESULTS Overall, 42.4% of patients were taking intensified regimens at the time of follow-up. We found no difference in the odds of intensification for English speakers versus Spanish speakers. However, compared to patients with incomes 75,000 (OR 2.22, 1.53-3.24) had increased odds of intensification. This latter pattern did not differ statistically by race. CONCLUSIONS Low-income patients were less likely to receive medication intensification compared to higher-income patients, but primary language (Spanish vs. English) was not associated with differences in intensification in a managed care setting. Future studies are needed to explain the reduced rate of intensification among low income patients in managed care

Using Long-Term Ecological Datasets to Unravel the Impacts of Short-Term Meteorological Disturbances on Phytoplankton Communities

Extreme meteorological events such as storms are increasing in frequency and intensity, but our knowledge of their impacts on aquatic ecosystems and emergent system properties is limited. Understanding the ecological impacts of storms on the dynamics of primary producers remains a challenge that needs to be addressed to assess the vulnerability of freshwater ecosystems to extreme weather conditions and climate change. One promising approach to gain insights into storm impacts on phytoplankton community dynamics is to analyse long-term monitoring datasets. However, such an approach requires disentangling the impacts of short-term meteorological disturbances from the effects of the seasonal trajectories of meteorological conditions. To this end, we applied boosted regression tree models to phytoplankton time series from eight relatively large lakes on four continents, coupled with a procedure adapted to detect and quantify rare events. Overall, the patterns and potential drivers we identified provide important insights into the responses of lakes to short-term meteorological events and highlight differences in the response of phytoplankton communities according to lake morphological characteristics. Our results indicated that deepened thermoclines and lake-specific combinations of drivers describing altered thermal structures caused deviations from the typical trajectories of seasonal phytoplankton succession. For shallow polymictic lakes, shifts in phytoplankton succession also depended on changes in light availability. Overall, our study highlights the value of long-term monitoring to improve our understanding of phytoplankton sensitivity to short-term meteorological disturbances.Full Tex

The relationship between spatial distribution and diet of Arctic charr (Salvelinus alpinus) in Loch Ness, U.K.

The pelagic fish community of Loch Ness, U.K., is dominated by Arctic charr, Salvelinus alpinus. Previous studies have shown that the distribution of zooplankton along the south-west to north-east axis of this elongate loch is very dynamic and determined largely by prevailing winds, but Arctic charr are consistently more abundant in the southern half of the loch. In July 1993, the diet compositions of 161 Arctic charr from 53 to 330 mm in length were determined and related to their spatial distribution and those of microcrustacean zooplankton and pelagic chironomid larvae and pupae. Diets were dominated by chironomid larvae, with chironomid pupae, Bythotrephes longimanus, Bosmina coregoni and Daphnia hyalina also frequently taken. Over the whole study period, B. longimanus were more important in the diet of fish from the northern half of the loch, while chironomid larvae were more important for fish from the southern half. As a result, per capita prey weight of fish from the south was greater than that of fish from the north. However, wind-induced changes in the distribution of zooplankton along the loch were accompanied by a change in the diet composition of Arctic charr from the south