Struggling over new asset geographies

In this response, we address criticisms of our definition of assetization from an accounting perspective, its overlap with financialization, and the relationship between value and valuation it posits. We reflect on a future agenda around assetization emphasizing the political dimensions of externalizing future costs and the implications of rising inflation.

Assetization and the 'new asset geographies'

An asset is both a resource and property, in that it generates income streams with its sale price based on the capitalization of those revenues. Although an asset's income streams can be financially sliced up, aggregated, and speculated upon across highly diverse geographies, there still has to be something underpinning these financial operations. Something has to generate the income that a political economic actor can lay claim to through a property or other right, entailing a process of enclosure, rent extraction, property formation, and capitalization. Geographers and other social scientists are producing a growing literature illustrating the range of new (and old) asset classes created by capitalists in their search for revenue streams, for which we argue assetization is a necessary concept to focus on the moment of enclosure and rent extraction. It is a pressing task for human geographers to unpack the diverse and contingent 'asset geographies' entailed in this assetization process. As a middle range concept and empirical problematic, we argue that assetization is an important focal point for wider debates in human geography by focusing attention on the moment of enclosure, rent extraction, and material remaking of society which the making of a financial asset implies.

Reflexive expectations in innovation financing: An analysis of venture capital as a mode of valuation

Social studies of expectations are premised on the notion that the future is brought into the present, and thereby expectations about the future come to shape our actions, decisions, and practices in ways that performatively bring about the imagined future. In this article, I examine how social actors themselves understand, construct, and deploy future expectations in innovation financing, focusing specifically on the venture capital industry financing of the life sciences sector. I do so to analyse how these reflexive efforts configure the valuation and investment decisions of these social actors and others. I build on analytical perspectives in STS and adjacent fields such as organization studies and economic sociology that analyse the role of expectations - manifested as stories, narratives, and accounts - in social action. To do so, I unpack how reflexivity comes to configure valuation and investment decisions, and the goals (e.g. exits) they rationalize.

Changing publication practices and the typification of the journal article in science and technology studies

In this article, we study the development of the STS journal article format since the 1980s. Our analysis is based on quantitative data that suggest that the diversity of various journal publication types has diminished over the past four decades, while the format of research articles has become increasingly typified. We contextualize these historical shifts in qualitative terms, drawing on a set of 76 interviews with STS scholars and other stakeholders in scholarly publishing. Here, we first portray the STS publication culture of the 1980s and early 1990s. We then contrast this with an analysis of publishing practices today, which are characterized by a much more structured research process that is largely organized around the production of typified journal articles. Whereas earlier studies have often emphasized the importance of rhetorical persuasion strategies as drivers in the development of scholarly communication formats, our analysis highlights a complementary and historically novel set of shaping factors, namely, increasingly quantified research (self-)assessment practices in the context of a projectification of academic life. We argue that reliance on a highly structured publication format is a distinct strategy for making STS scholarship 'doable' in the sense of facilitating the planning ability and daily conduct of research across a variety of levels - including the writing process, collaboration with peers, attracting funding, and interaction with journals. We conclude by reflecting on the advantages and downsides of the typification of journal articles for STS.

Editorial Work and the Peer Review Economy of STS Journals

In this paper, we analyze the role of science and technology studies (STS) journal editors in organizing and maintaining the peer review economy. We specifically conceptualize peer review as a gift economy running on perpetually renewed experiences of mutual indebtedness among members of an intellectual community. While the peer review system is conventionally presented as self-regulating, we draw attention to its vulnerabilities and to the essential curating function of editors. Aside from inherent complexities, there are various shifts in the broader political-economic and sociotechnical organization of scholarly publishing that have recently made it more difficult for editors to organize robust cycles of gift exchange. This includes the increasing importance of journal metrics and associated changes in authorship practices; the growth and differentiation of the STS journal landscape; and changes in publishing funding models and the structure of the publishing market through which interactions among authors, editors, and reviewers are reconfigured. To maintain a functioning peer review economy in the face of numerous pressures, editors must balance contradictory imperatives: the need to triage intellectual production and rely on established cycles of gift exchange for efficiency, and the need to expand cycles of gift exchange to ensure the sustainability and diversity of the peer review economy.

Rethinking Value in the Bio-economy: Finance, Assetization, and the Management of Value

Current debates in science and technology studies emphasize that the bio-economy-or, the articulation of capitalism and biotechnology-is built on notions of commodity production, commodification, and materiality, emphasizing that it is possible to derive value from body parts, molecular and cellular tissues, biological processes, and so on. What is missing from these perspectives, however, is consideration of the political-economic actors, knowledges, and practices involved in the creation and management of value. As part of a rethinking of value in the bio-economy, this article analyzes three key political-economic processes: financialization, capitalization, and assetization. In doing so, it argues that value is managed as part of a series of valuation practices, it is not inherent in biological materialities.

Biobanks in Oral Health: Promises and Implications of Post-Neoliberal Science and Innovation

While biobanks are established explicitly as scientific infrastructures, they are de facto political-economic ones too. Many biobanks, particularly population-based biobanks, are framed under the rubric of the bio-economy as national political-economic assets that benefit domestic business, while national populations are framed as a natural resource whose genomics, proteomics, and related biological material and national health data can be exploited. We outline how many biobanks epitomize this 'neoliberal' form of science and innovation in which research is driven by market priorities (e.g., profit, shareholder value) underpinned by state or government policies. As both scientific and political-economic infrastructures, biobanks end up entangled in an array of problems associated with market-driven science and innovation. These include: profit trumping other considerations; rentiership trumping entrepreneurship; and applied research trumping basic research. As a result, there has been a push behind new forms of 'post-neoliberal' science and innovation strategies based on principles of openness and collaboration, especially in relation to biobanks. The proliferation of biobanks and the putative transition in both scientific practice and political economy from neoliberalism to post-neoliberalism demands fresh social scientific analyses, particularly as biobanks become further established in fields such as oral health and personalized dentistry. To the best of our knowledge, this is the first analysis of biobanks with a view to what we can anticipate from biobanks and distributed post-genomics global science in the current era of oral health biomarkers.

An Appeal to the Global Health Community for a Tripartite Innovation: An "Essential Diagnostics List," "Health in All Policies," and "See-Through 21(st) Century Science and Ethics"

Diagnostics spanning a wide range of new biotechnologies, including proteomics, metabolomics, and nanotechnology, are emerging as companion tests to innovative medicines. In this Opinion, we present the rationale for promulgating an "Essential Diagnostics List." Additionally, we explain the ways in which adopting a vision for "Health in All Policies" could link essential diagnostics with robust and timely societal outcomes such as sustainable development, human rights, gender parity, and alleviation of poverty. We do so in three ways. First, we propose the need for a new, "see through" taxonomy for knowledge-based innovation as we transition from the material industries (e.g., textiles, plastic, cement, glass) dominant in the 20(th) century to the anticipated knowledge industry of the 21st century. If knowledge is the currency of the present century, then it is sensible to adopt an approach that thoroughly examines scientific knowledge, starting with the production aims, methods, quality, distribution, access, and the ends it purports to serve. Second, we explain that this knowledge trajectory focus on innovation is crucial and applicable across all sectors, including public, private, or public-private partnerships, as it underscores the fact that scientific knowledge is a co-product of technology, human values, and social systems. By making the value systems embedded in scientific design and knowledge co-production transparent, we all stand to benefit from sustainable and transparent science. Third, we appeal to the global health community to consider the necessary qualities of good governance for 21st century organizations that will embark on developing essential diagnostics. These have importance not only for science and knowledge-based innovation, but also for the ways in which we can build open, healthy, and peaceful civil societies today and for future generations.

Lisbonizing versus Financializing Europe? The Lisbon Agenda and the (un)Making of the European Knowledge-Based Economy

The Lisbon Agenda was meant to make the European Union ‘the most dynamic and competitive knowledge-based economy (KBE) in the world’ by 2010. As that date has now come and gone, it is apt to ask whether the Lisbon Agenda achieved its objective. We engage with this very question by analyzing new empirical material on the supposed transition to a KBE. Theoretically, we problematize the very notion that EU policies promoted the emergence of a KBE by highlighting how the Lisbon Agenda was tied to the financialization of the European economy. Our findings illustrate the abject failure of the EU's decade-long strategy to foster a new economy and better employment opportunities. We show that the main winners of the EU's economic strategy have been the finance sector and those who work in it. In summary, we argue that, despite the earlier assurances of Bell and Drucker, it is not the scientist or engineer but the banker who has been empowered to command a higher price in the new world of the KBE.

Field intensive care--weaning and extubation

Injury following ballistic trauma is the most prevalent indication for providing organ system support within an ICU in the field. Following damage control surgery, postoperative ventilatory support may be required, but multiple factors may influence the indications for and duration of invasive mechanical ventilation. Ballistic trauma and surgery may trigger the systemic inflammatory response syndrome (SIRS) and are important causative factors in the development of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). However, their pathophysiological effect on the respiratory system is unpredictable and variable. Invasive mechanical ventilation is associated with numerous complications and the return to spontaneous ventilation has many physiological benefits. Following trauma, shorter periods of ICU sedation-amnesia and a protocol for early weaning and extubation, may minimize complications and have a beneficial effect on their psychological recovery. In the presence of stable respiratory function, appropriate analgesia and favourable operational and transfer criteria, we believe that the prompt restoration of spontaneous ventilation and early tracheal extubation should be a clinical objective for casualties within the field ICU.

Operational anaesthesia for the management of traumatic brain injury

The primary brain insult that occurs at the time of head injury, is determined by the degree of neuronal damage or death and so cannot be influenced by further treatment. The focus of immediate and ongoing care from the point of wounding to intensive care management at Role 4 should be to reduce or prevent any secondary brain injury. The interventions and triage decisions must be reassessed at every stage of the process, but should focus on appropriate airway management, maintenance of oxygenation and carbon dioxide levels and maintenance of adequate cerebral perfusion pressure. Early identification of raised intracranial pressure and appropriate surgical intervention are imperative. Concurrent injuries must also be managed appropriately. Attention to detail at every stage of the evacuation chain should allow the head-injured patient the best chance of recovery.

Who benefits from Intensive Care in the field?

The limited capacity and resources of a Field Hospital Intensive Care Unit may necessitate the triage or prioritisation of critically ill patients requiring admission. The use of critical care resources by members of the local population in certain Areas of Operation, who can not be discharged or transferred to equivalent care in their local health service, impacts significantly on bed occupancy. Therefore available resources must be distributed efficiently and equitably with decisions guided by the principles of advocacy for the patient. Patients must be admitted only on the concept of potential benefit and reasonable chance of recovery, which would not be available elsewhere. Discriminating between seriously ill patients before admission and decision making regarding withdrawal of care is very difficult. Senior clinicians working regularly in a critical care setting demonstrate a better level of discrimination in assessing outcome of seriously ill patients and are best placed to make decisions regarding admission, continuation and withdrawal of treatment.

Dose-dependent subcutaneous absorption of porcine, bovine and human NPH insulins

The absorption of 125I-labelled porcine, bovine and human neutral protamine Hagedorn (NPH) insulins was compared in 40 diabetic patients after subcutaneous injections in the thighs using doses of 6 and 24 IU (40 IU/ml). Furthermore, the absorption of porcine NPH insulin was compared with bovine NPH insulin and porcine lente type insulin in the same dose (6 IU). All these intermediately acting insulins showed similar absorption rates when administered in the same dose. However, an increase in the injected dose from 6 to 24 IU resulted in a decrease of approximately 30% in the absorption rate of all NPH insulins.

The Neoliberal Underpinnings of the Bioeconomy: the Ideological Discourses and Practices of Economic Competitiveness

When we talk about ideology and new genetics we tend to think of concepts like geneticisation and genetic essentialism, which present genetics and biology in deterministic terms. However, the aim of this article is to consider how a particular economic ideology - neoliberalism - has affected the bioeconomy rather than assuming that it is the inherent qualities of biotechnology that determine market value. In order to do this, the paper focuses on the discourses and practices of economic competitiveness that pervade biotechnology policy-making in the UK, Europe and the USA. Finally it will consider how the manufacture of scarcity - in order to produce the bioeconomy - has led to a problematic focus on a specific innovation paradigm that may prove detrimental to the development and distribution of new biotechnologies.

Beneficence, determinism and justice: an engagement with the argument for the genetic selection of intelligence

In 2001, Julian Savulescu wrote an article entitled 'Procreative Beneficence: Why We Should Select the Best Children', in which he argued for the genetic selection of intelligence in children. That article contributes to a debate on whether genetic research on intelligence should be undertaken at all and, if so, should intelligence selection be available to potential parents. As such, the question of intelligence selection relates to wider issues concerning the genetic determinism of behavioural traits, i.e. alcoholism. This article is designed as an engagement in the intelligence selection debate using an analysis of Savulescu's arguments to raise a series of problematic issues in relation to the ethics of parental selection of intelligence. These problematic issues relate to wider assumptions that are made in order to put forward intelligence selection as a viable ethical option. Such assumptions are more generic in character, but still relate to Savulescu's article, concerning issues of genetic determinism, private allocation and inequality, and, finally, individual versus aggregate justice. The conclusion focuses on what the implications are for the question of agency, especially if intelligence selection is allowed.

The diurnal rhythm in isometric muscular performance differs with eumenorrheic menstrual cycle phase

The aim of this study was to examine the effect of the interaction of circamensal and diurnal rhythms in temperature upon the production of maximal voluntary muscle force. Ten eumenorrheic females (mean age: 24 +/- 3 yr mean body mass: 58.4 +/- 6.9 kg) participated in the experiment at both 06:00 and 18:00h at the mid-point of both the follicular and luteal phases of the menstrual cycle. Subjects performed tasks of maximal isometric lifting strength (MILS) at knee height, and endurance time (t) for lifting 45% of MILS, upon an isometric lift dynamometer. Body temperature was elevated at 18:00h and in the luteal phase by 0.52 +/- 0.4 and 0.26 +/- 0.35 degrees C, respectively. The amplitude of the diurnal variation in temperature was blunted by 0.3 degrees C within the luteal phase. Maximal isometric performance was elevated by 8% at 18:00h in the luteal phase of the cycle (p < 0.05 interaction for MILS) but unaffected by time of day in the follicular phase. Endurance time was unaffected by time or phase (p > 0.05). It should be noted that the classic diurnal rhythm in maximal voluntary isometric muscle force may not be evident in all phases of the female menstrual cycle.

Technical note: repeatability of measurement in determining stature in sitting and standing postures

The aim of this study was to determine the effect of sitting and standing postures on the repeatability of a stadiometer designed to detect small variations in spinal length. Two groups of ten healthy subjects, with no previous or known history of back problems, participated in this study. One group was measured in the standing posture, while the other group was measured in a sitting posture. All subjects gave informed consent to participate in this study. Subjects had a set of landmarks defining the spinal contour marked on their backs and then stood in the stadiometer for three series of ten measurements to be performed. At the end of each measurement, the subjects were requested to move away from and then be repositioned in the stadiometer. Subjects improved the repeatability across the measurement series. At the end of the second measurement series, all subjects presented mean standard deviations of 0.43 +/- 0.08 mm (range 0.30-0.50 mm) in the standing posture. In the sitting posture, deviations of less than 0.05 mm were obtained only at the end of the third measurement series (0.48 +/- 0.08 mm; range 0.34-0.62 mm), suggesting that this posture required three measurement series before repeatable measurements could be assured rather than two in the standing posture.

Putting the 'tele' into health-care effectively

Although the introduction of new technologies has been successful and become accepted practice in many areas of industry, traditional methods have tended to prevail in health-care. Telemedicine has been adopted by enthusiasts who recognize the potential benefits of a 'global health service'. However, the more widespread introduction of telemedicine requires considerable organizational change in the way health-care is delivered. More evaluation is required of clinical outcomes, organizational effects, benefits to health-care providers and users, and quality assurance.

The need to ensure that the globalization of information and telematics does not destabilize health-care worldwide

Modern telecommunication transcends institutional, organizational and cultural boundaries. In the context of health-care, this means that information, enquiries, demands and service provision can be routed anywhere, free of institutional or natural control. The Internet makes information available to anyone regardless of its quality, source or intention. Organizationally initiated applications such as telemedicine are usually intended to reinforce local systems, but their very design and intention indicate a potential rapidly to transcend inherited but electronically ineffectual boundaries. The consequences of such uncontrolled globalization of health-care activities will range from beneficial empowerment and quality improvement, to detrimental effects such as overloading of experts, and undermining of stable health-care systems. The major unplanned societal re-engineering effects in a paper-based culture are likely to be significant and global institutions need to respond by creating positive global frameworks and policies.

NHS reforms. Counting the costs

Localism predominates in purchaser-provider relationships, with markets strictly limited in practice. Block contracting predominates, largely to enable purchasers to bring pressure to bear on providers' costs and outputs. The administrative costs of operating the purchaser-provider split have led to a clear growth in the overall administrative costs within the NHS. Locality commissioning may conflict with the need to reorganise clinical services.

Primary care. Defining role

There is no nationally agreed definition of nurse practitioners or of the training required. The extent of the need for nurses to take on doctors' work needs to be established. A clear training framework is required.

Changes in maximal voluntary force of human adductor pollicis muscle during the menstrual cycle

1. Muscle strength of the adductor pollicis (AP) was studied throughout the menstrual cycle to determine whether any variation in force is similar to the known cyclical changes in ovarian hormones. Three groups of young women were studied: trained regularly menstruating athletes (trained), untrained regularly menstruating (untrained) and trained oral contraceptive pill users (OCU). In addition a group of untrained young men was studied as controls. 2. Maximum voluntary force (MVF) of AP was measured over a maximum period of 6 months. Ovulation was detected by luteinizing hormone measurements or change in basal body temperature. There was a significant increase in MVF (about 10%) during the follicular phase of the menstrual cycle when oestrogen levels are rising, in both the trained and untrained groups. This was followed by a similar in MVF around the time of ovulation. Neither the OCU nor the male subjects showed cyclical changes in MVF.

Pharmacokinetics and pharmacodynamics of recombinant factor VIIa

OBJECTIVE

To evaluate the pharmacokinetics and pharmacodynamics of recombinant activated factor VII (rFVIIa).

METHODS

Single-dose pharmacokinetics of three dose levels (17.5, 35, and 70 micrograms/kg) of rFVIIa were investigated in 15 patients with hemophilia with severe factor VIII or factor IX deficiency (with or without inhibitors) while they were in the nonbleeding state and during bleeding episodes. Factor VII clotting activity (FVII:C) was determined 5 minutes before and at 10, 20, and 50 minutes and 2, 4, 6, 8, 12, and 24 hours after rFVIIa administration. Model-independent pharmacokinetic analysis of FVII:C plasma concentration-time data included determination of plasma clearance, mean residence time, and volume of distribution. rFVIIa recovery was determined from the plasma FVII:C observed 10 minutes after administration. Pharmacodynamic assessments of prothrombin time, activated partial thromboplastic time, and Factor X values obtained concurrently with FVII:C samples were performed.

RESULTS

Sufficient data to allow pharmacokinetic parameter calculation were available for 25 nonbleeding episodes in 11 patients (17.5 micrograms/kg, n = 8; 35 micrograms/kg, n = 9; 70 micrograms/kg, n = 8) and for five bleeding episodes in three patients (17.5 micrograms/kg, n = 2; 35 micrograms/kg, n = 2; 35 micrograms/kg, n = 1). Recovery was calculated during 27 nonbleeding and 17 bleeding episodes. rFVIIa distribution volume is two to three times that of plasma. Median clearance was low--31.0 ml/hr.kg in nonbleeding episodes and 32.5 mg/hr.kg in bleeding episodes. In nonbleeding episodes, median mean residence time was 3.44 hours and median half-life was 2.89 hours. In bleeding episodes, the elimination rate appears to be higher, with a median mean residence time of 2.97 hours and a median half-life of 2.30 hours. Recovery was 45.6% during nonbleeding conditions and 43.5% during bleeding episodes (p = 0.0006); it was statistically lower with the highest dose level than with the 17.5 and 35 micrograms/kg doses (p = 0.007). A significant statistical relationship was observed between values of the prothrombin time and activated partial thromboplastin time, and values of FVII:C with use of maximum effect model.

CONCLUSIONS

The pharmacokinetics of rFVIIa are linear in the dose range evaluated. The results suggest potential value of prothrombin time determination in the monitoring of rFVIIa therapy.

The relation between isometric lifting strength and muscular fitness measures

The purpose of this study was to construct an isometric lift dynamometer and relate isometric lifting strength to dynamic measures of muscular fitness, leg and back strength and muscular power output. Thirty-one male subjects, aged 19-24 years, performed a standing broad jump (for distance), a vertical jump (for flight time), 3 maximal pulls (for peak power) on a rowing ergometer and maximal isometric leg and back extensions on a conventional dynamometer. The results of these tests were correlated with the maximum isometric lifting strength (MILS) obtained on the lift dynamometer using cluster correlation and multiple regression. Significant correlations (p < 0.001) were found between isometric lifting strength and back strength (BS) (r = 0.59), and leg strength (LS) (r = 0.74). A significant correlation was also noted between isometric lifting strength and both standing broad jump (SBJ) (r = 0.58, p < 0.001) and power output (PO) (r = 0.38, (p < 0.05). Multiple regression analysis was used to predict lifting performance from a battery of standard fitness tests. The prediction equation for maximal isometric lifting strength included the terms LS, BS, SBJ and PO (r = 0.80). The relation between isometric lifting strength and other muscular fitness variables suggest that the method used provides an acceptable measure of strength and an indication of the involvement of back and leg musculature in squat lifting.

Safety and initial clinical efficacy of three dose levels of recombinant activated factor VII (rFVIIa): results of a phase I study

The safety and efficacy of recombinant DNA-produced factor VIIa (rFVIIa) was investigated in 15 haemophilic patients in non-bleeding states and during bleeding episodes (mild to moderate joint bleed). Patients with severe haemophilia A without inhibitors (n = 4), haemophilia A with inhibitors (n = 10), and haemophilia B with inhibitor (n = 1) received one or more doses of rFVIIa during 32 non-bleeding study episodes and 23 bleeding episodes. The study was an open, uncontrolled, dose-escalation (17.5 micrograms/kg, 35 micrograms/kg, 70 micrograms/kg) trial. Physical evaluation, laboratory assessment, and immunology testing were conducted at baseline, monthly for 3 months and every 3 months thereafter. The immediate safety of rFVIIa was assessed by monitoring of D-dimer, fibrinogen, platelet count, antithrombin III, thrombin-antithrombin complex, and alpha 2-antiplasmin 5 min before and at multiple times throughout the following 24 h. Prothrombin time (PT) and activated partial thromboplastin time (aPTT) values were also obtained. Pain, swelling, joint circumference, and range of motion were recorded before administration of the initial dose of rFVIIa in bleeding patients and at 6, 12, and 24 h. Haemostatic response to rFVIIa was observed in patients with severe VIII and IX deficiency with and without inhibitors. Therapy with rFVIIa was judged effective in 19 of the 22 evaluable bleeding episodes at one or more time points. The 35 micrograms/kg and 70 micrograms/kg doses were associated with higher response rates at 6 and 12 h compared to the 17.5 micrograms/kg dose level. A second dose of rFVIIa was administered in 20 of the 22 bleeding episodes.(ABSTRACT TRUNCATED AT 250 WORDS)

Experience with recombinant factor VIIA in an infant hemophiliac with inhibitors to FVIII:C undergoing emergency central line placement. A case report

An infant boy with severe factor VIII (FVIII) deficiency hemophilia and antibodies against coagulation FVIII is presented. This case is unique from the point of view of the young age of development and recognition of inhibitors to the FVIII and because this patient received recombinant factor VIIa (rFVIIa), prior to a life-saving surgical procedure. Conventional treatment options had been exhausted. The inhibitor was an IgG antibody that had rapidly increased to 100 Bethesda Units (BU). A broviac central line was placed to provide i.v. access for the purpose of treatment. Porcine FVIII had been used but an inhibitor rapidly developed to that product. Using rFVIIa, hemostasis was secured for placement of a second central line and to stop life-threatening mucosal bleeding. rVIIa was an effective treatment alternative for the management of this patient with inhibitors.

Endocrine, metabolic and cardiovascular responses to adrenaline after abdominal surgery

Adrenaline-induced changes in heart rate, blood pressure, plasma adrenaline and noradrenaline, cortisol, glucagon, insulin, cAMP, glucose lactate, glycerol and beta-hydroxybutyrate were studied preoperatively and 4 and 24 h after skin incision in 8 patients undergoing elective cholecystectomy. Late postoperative responses of blood glucose, plasma cAMP, lactate and glycerol to adrenaline infusion were reduced, whereas other responses were unaffected. Blood glucose appearance and disappearance rate as assessed by [3H]3-glucose infusion was unchanged pre- and postoperatively. The increase in glucose appearance rate following adrenaline was similar pre- and postoperatively. These findings suggest that several beta-receptor-mediated responses to adrenaline are reduced after abdominal surgery.

Metabolic state does not influence lymphocyte subsets in type 1 diabetic patients

In most studies the distribution of peripheral lymphocyte subsets at diagnosis of type 1 diabetes has been found to be altered. Lymphocyte subpopulations were therefore studied during longitudinal changes in the glycaemic control of 11 type 1 diabetics to investigate whether poor metabolic status affects these results. To avoid any influence of the etiopathogenetic mechanisms, the patients studied had a disease duration of 10 +/- 2 (SEM) years and all but one had no residual beta-cell function. The patients were selected randomly amongst those with a long record of poor glycaemic control and at the first examination they had a mean fasting blood glucose of 15 +/- 1 mmol/l and a mean glucosuria of 67 +/- 11 g/24 h. They were then hospitalized and strictly regulated using pump treatment, resulting in a massive reduction in glucosuria (0 +/- 0 g/24 h) and fasting blood glucose (6 +/- 1 mmol/l) at a second examination a week later. Five of the patients were tested for a third time 35 +/- 4 days later and were still in very good glycaemic control. Peripheral lymphocytes were labelled with monoclonal antibodies and examined by flow cytometry (FACS). Neither CD3+ (pan) T-lymphocytes, CD4+ (helper) T-cells, CD8+ (suppressor/cytotoxic) T-cells, the relation between CD4+ and CD8+ T-cells, nor the total amount of lymphocytes, changed significantly between the first, second, and third examination. None of the results were significantly different from those of healthy controls. There was no correlation between any of the immunological and metabolic parameters. It is concluded that metabolic influence on the distribution of lymphocyte subsets is unlikely.

Basal rate subcutaneous insulin infusion: absorption kinetics and relation to local blood flow

Twenty diabetic patients received a constant subcutaneous infusion of 125I-labelled short-acting insulin (1.12 U/h) into the anterior abdominal wall. Measurement of the size of the insulin depot at the infusion site was performed by measuring the radioactivity and by using a calibration bolus to transform count rate to units of insulin in the depot. By the 133Xenon technique, local subcutaneous blood flow rate was measured on the contralateral side of the anterior abdominal wall. From the start of the infusion the SC depot built up slowly, but did not reach steady-state by 6 h. After 24 h of infusion, the size of the depot ranged between 2.7 and 10.9 U (5.2 +/- 0.5 U, mean +/- SE). The size of this steady-state depot was inversely correlated with SC blood flow. After stopping the infusion, insulin disappeared according to first order kinetics without any lag period. The insulin disappearance rate from the depot was positively correlated with the blood flow in a curvilinear fashion. The results suggest that the relationship between blood flow and the size of the insulin depot is best explained by a predominantly blood flow limited removal of insulin at low rates of blood flow, with increasing limitation by diffusion at higher rates.

Random blood glucose sampling as an early antenatal screening test for diabetes mellitus

Random blood glucose was measured on 1,992 pregnant women during the initial attendance at our antenatal clinic. The visit usually took place during the first part of the second trimester. Women with a random blood glucose concentration in excess of 6.1 mmol/l within 2 hours of the last meal and 5.6 mmol/l more than 2 hours after the last meal were referred for a fasting blood glucose measurement. A 75 g oral glucose tolerance test was performed in those cases where the fasting blood glucose exceeded 4.0 mmol/l. The cut-off levels were exceeded in 22 cases, but only one of these women was found to be suffering from previously unsuspected diabetes mellitus, based on the criteria of WHO (1). Five other cases of gestational diabetes were not detected by the random blood glucose method. It is concluded that random blood glucose measurements cannot be recommended as a safe and reliable screening procedure during the early part of the second trimester.

Effect of i.v. lignocaine on pain and the endocrine metabolic responses after surgery

Pain intensity, and blood glucose and plasma cortisol concentrations were measured following abdominal hysterectomy in 18 patients allocated randomly to receive either i.v. lignocaine 1.5 mg kg-1 plus 2 mg kg-1 h-1, or saline. The administration of lignocaine resulted in plasma concentrations between 1.5 and 2.0 micrograms ml-1 during the 2-h study period. However, the administration of lignocaine i.v. had no effect on the intensity of pain after surgery, or on the adrenocortical and hyperglycaemic responses to surgery.

Relationship between subcutaneous blood flow and absorption of lente type insulin

To study the relationship between the absorption of intermediate acting insulin and the local subcutaneous blood flow (SBF) 8 diabetic patients were given subcutaneous injections of 125I labeled human lente type insulin and 133Xenon in the abdominal wall. External measurements of the tracer disappearance were performed and the insulin absorption rate and SBF were calculated. A curvilinear relationship between the insulin absorption rate and SBF was demonstrated with an initial almost linear relation but with decreasing impact of SBF when this was in the higher physiological range.

Subcutaneous insulin infusion: change in basal infusion rate has no immediate effect on insulin absorption rate

Eight insulin-dependent diabetic patients were simultaneously given subcutaneous infusions (1.12 IU/h each) of 125I-labeled Actrapid insulin in each side of the abdominal wall. After 24 h of infusion, the size of the infused insulin depots was measured by external counting for 5 h. The basal infusion rate was then doubled in one side and halved in the other for the next 4 h. Finally, 1.12 IU/h of insulin was given in both sides of the abdominal wall for an additional 3 h. The changes in the size of the depots were measured, and the absorption rates for each hour were calculated. During the first 5 h of infusion, the depot size was almost constant (approximately 5 IU) with an absorption rate that equaled the infusion rate. Doubling the infusion rate led to a significant increase in depot size, but the absorption rate remained unchanged for the first 3 h, and only thereafter was a significant increase seen. When the infusion rate was reduced to the initial 1.12 IU/h, the absorption rate remained elevated during the next 3 h. Correspondingly, when the infusion rate was decreased, the depot size also decreased, but the absorption rate remained unchanged for the first 3 h. The results show that a change in the basal insulin infusion rate does not lead to any immediate change in the insulin absorption rate. This should be considered when planning an insulin-infusion program that includes alteration(s) in the basal-rate setting.