Disposal Rate Research Articles

What the Lactate Shuttle Means for Sports Nutrition

The discovery of the lactate shuttle (LS) mechanism may have two opposite perceptions, It may mean very little, because the body normally and inexorably uses the LS mechanism. On the contrary, one may support the viewpoint that understanding the LS mechanism offers immense opportunities for understanding nutrition and metabolism in general, as well as in a sports nutrition supplementation setting. In fact, regardless of the specific form of the carbohydrate (CHO) nutrient taken, the bodily CHO energy flux is from a hexose sugar glucose or glucose polymer (glycogen and starches) to lactate with subsequent somatic tissue oxidation or storage as liver glycogen. In fact, because oxygen and lactate flow together through the circulation to sites of utilization, the bodily carbon energy flow is essentially the lactate disposal rate. Consequently, one can consume glucose or glucose polymers in various forms (glycogen, maltodextrin, potato, corn starch, and fructose or high-fructose corn syrup), and the intestinal wall, liver, integument, and active and inactive muscles make lactate which is the chief energy fuel for red skeletal muscle, heart, brain, erythrocytes, and kidneys. Therefore, if one wants to hasten the delivery of CHO energy delivery, instead of providing CHO foods, supplementation with lactate nutrient compounds can augment body energy flow.

Identification and phenotypic characterization of patients with LADA in a population of southeast Mexico

Latent autoimmune diabetes in adults (LADA) has clinical and metabolic features of type 1 and type 2 diabetes. LADA does not have specific features for its diagnosis apart from autoantibody detection; however, these tests are not affordable in clinical settings. In this cross-sectional study, we analyzed clinical criteria, metabolic control, pharmacological treatment, and diabetic complications in two groups of patients with diabetes -LADA and T2D- in order to identify specific characteristic of these clinical entities. Finally, we evaluated if the estimated glucose disposal rate (eGDR) and age at diagnosis of diabetes could be used as a diagnostic criterion for LADA. Demographic, biochemical, clinical and treatment were measured in 377 individuals with diabetes. The diagnostics of LADA were determined using Glutamic acid decarboxylase autoantibodies levels. Chi-square test or t-Student test were used to establish differences between groups. To identify factors associated with LADA, a logistic regression analysis was used. Finally, a ROC curve was plotted to assess the possible variables as diagnostic criteria for LADA. The 377 patients with diabetes were separated into 59 patients with LADA and 318 patients with T2D. Patients with LADA showed lower fasting glucose values, fewer diabetic complications, younger age at diagnosis of diabetes, higher insulin use, and higher eGDR in comparison to patients with T2D. Both groups had a mean BMI classified as overweight. The ROC evaluated the sensitivity and specificity, this analysis indicated that an age younger than 40.5 years and an eGDR value higher than 9.75 mg/kg/min correlated better with LADA. These parameters could be useful to identify patients suspected to have LADA at the first level of medical care in the population of southeastern Mexico and refer them to a second level of care.

Barriers to Exercise in Adults With Type 1 Diabetes and Insulin Resistance

ObjectiveOur aim in this study was to assess attitudes toward exercise and quality of life (QoL) in adults with type 1 diabetes (T1D) with and without insulin resistance (IR). MethodsWe pooled baseline pretreatment data from a subset of individuals with T1D from 2 randomized controlled trials. Estimated glucose disposal rate (eGDR), a validated surrogate marker of IR, was calculated using an established formula to classify individuals according to IR status with a cutpoint of <6 mg/kg/min for the determination of IR. Self-reported barriers to exercise were obtained using a validated questionnaire, the Barriers to Physical Activity in T1D (BAPAD-1). In addition, QoL was determined using the 36-item Short Form (SF-36) questionnaire. Differences between dichotomized variables were assessed using the independent t test, Mann–Whitney U test, or Fisher exact test. Linear regression was employed to explore the association of eGDR with BAPAD-1 and QoL scores, with sequential adjustment for potential confounders. ResultsOf the 85 individuals included in our study, 39 were classified as having IR. The mean BAPAD-1 total score was higher for individuals with IR (IR: 3.87±0.61; non-IR: 2.83±0.55; p<0.001). The highest exercise barrier scores for individuals with IR were risk of hypoglycemia (5.67±1.26) and risk of hyperglycemia (5.23±1.20), whereas the highest scoring exercise barrier scores for non-IR individuals were not diabetes-related, with low level of fitness (3.91±1.26) and physical health status, excluding diabetes (3.67±1.48), ranked highest. QoL scores were comparable between groups (p>0.05). ConclusionsRisk of hypoglycemia was the greatest barrier to exercise in individuals with T1D with IR, whereas non–diabetes-related barriers to exercise were more salient in individuals with T1D without IR.

Fate and Removal of Microplastics from Industrial Wastewaters

Industrial sites are typically located in close proximity to bodies of water, making industrial wastewater a prevalent source of pollution. Microplastics, which are plastic fragments generated from everyday activities or industrial operations and are smaller than 5 mm in size, can readily find their way into wastewater treatment plants (WWTPs). The objective of this research was to offer extensive insight into the fate of microplastics in industrial WWTPs worldwide, as well as to explore the effectiveness of diverse advanced treatment technologies in eliminating microplastics. The prevalence of microplastics and their negative impact on aquatic environments has been acknowledged in recent years. The progressive discharge of plastic waste, insufficient detection processes with specialized elimination methods and a sluggish disposal rate have led to the continuous presence of microplastics in various ecosystems worldwide, such as domestic wastewater and industrial wastewater. Research outcomes have revealed that they can adsorb a variety of pathogens, heavy metals and chemical substances that are commonly used in production processes. Microplastics can be consumed by aquatic life, which might lead them up the food chain to human bodies, resulting in potential digestion tract blockage, digestion disturbance and diminished reproductive growth. Microplastics have thus become a growing threat and cause for concern, demanding the containment of their dispersion. This work offers a critical evaluation of current and developing techniques for microplastic detection and separation from industrial wastewater, which are the most challenging endeavors when treating systems containing microplastics. A review of the effect of microplastics on aquatic environments and human health is also conducted. This analysis offers a comprehensive view of the full microplastic detection and removal strategies and their related concerns in order to establish a waste disposal standard that minimizes the potential hazardous effects of microplastics in aquatic systems.

High tissue-sodium associates with systemic inflammation and insulin resistance in obese individuals

Background and aimsHigh sodium intake is associated with obesity and insulin resistance, and high extracellular sodium content may induce systemic inflammation, leading to cardiovascular disease. In this study, we aim to investigate whether high tissue sodium accumulation relates with obesity-related insulin resistance and whether the pro-inflammatory effects of excess tissue sodium accumulation may contribute to such association. Methods and resultsIn a cross-sectional study of 30 obese and 53 non-obese subjects, we measured insulin sensitivity determined as glucose disposal rate (GDR) using hyperinsulinemic euglycemic clamp, and tissue sodium content using 23Na magnetic resonance imaging. Median age was 48 years, 68% were female and 41% were African American. Median (interquartile range) BMI was 33 (31.5, 36.3) and 25 (23.5, 27.2) kg/m2 in the obese and non-obese individuals, respectively. In obese individuals, insulin sensitivity negatively correlated with muscle (r = −0.45, p = 0.01) and skin sodium (r = −0.46, p = 0.01). In interaction analysis among obese individuals, tissue sodium had a greater effect on insulin sensitivity at higher levels of high-sensitivity C-reactive protein (p-interaction = 0.03 and 0.01 for muscle and skin Na+, respectively) and interleukin-6 (p-interaction = 0.024 and 0.003 for muscle and skin Na+, respectively). In interaction analysis of the entire cohort, the association between muscle sodium and insulin sensitivity was stronger with increasing levels of serum leptin (p-interaction = 0.01). ConclusionsHigher muscle and skin sodium are associated with insulin resistance in obese patients. Whether high tissue sodium accumulation has a mechanistic role in the development of obesity-related insulin resistance through systemic inflammation and leptin dysregulation remains to be examined in future studies.Clinicaltrials.gov registration: NCT02236520.

Looking at the Big picture: Reclassifying water disposal wells into injectors to safeguard field reserves and future potential

The Deep Water Disposal project was initiated in 1995 with the aim of managing excess water output from the primary facility. The injection into a shared deep formation has resulted in a significant boost to the pressure in nearby fields. This effect can be observed through pressure measurements, which demonstrate that the field was in a state of depletion before the commencement of water disposal. However, the pressure stabilized once stable disposal rates were established. Recently, a decline in nearby fields' pressure has been noticed in response to lower disposal rates[5]. The objective of this study is to evaluate the level of pressure support in adjacent areas resulting from the volume of waste disposal and establish the necessary disposal rate needed to sustain the desired pressures. Ultimately, the goal is to reclassify the relevant portion of deep-water disposal volume as proper water injection[1], to avoid any unnecessary decommissioning of the disposal wells and hence losing this energy source to the reservoir. This Novel approach of mixing operational and reservoir data deals directly with the topic of voidage replacement, pressure decline, reservoir behavior, impact of deep water disposal and water injection of performance, and conducting simple forecasting methodology that is fit for purpose to come up with practical results to be directly applied in a real life situation.

Insulin resistance is more frequent in type 1 diabetes patients with long disease duration.

To investigate the clinical status of insulin resistance (IR) and its correlation with disease duration in patients with type 1 diabetes (T1D). Cross-sectional data from a T1D cohort were obtained (n=923). IR-related metabolic disorders including hypertension, obesity, and dyslipidemia were used as outcome variables to explore the cut-off point for estimated glucose disposal rate (eGDR) by restricted cubic spline (RCS) curve. Regression models were used for multivariate analysis of the clinical factors associated with IR. The correlation between the status of IR and diabetes duration was depicted with the RCS curve. IR-related metabolic disorders were observed in 39.4% of patients, with 9.1% meeting the criteria for metabolic syndrome. Specifically, patients with ≥10years of T1D were more likely to have IR-related metabolic disorders (54.7% vs. 36.9%, p<0.05). The presence of IR, defined as an eGDR ≤9.0mg/kg/min, was observed in 42.2% of patients. Patients with IR had a longer diabetes duration (3.5 vs. 2.7, years, p=0.003) and higher insulin dose (0.5 vs. 0.4, units per kg per day, p<0.001). Moreover, the presence of IR showed a gradual increase during 10years' disease duration and further analysis showed that diabetes duration ≥10years was a key element behind the development of IR and IR-related metabolic disorders. The status of IR is common in T1D patients, especially in those with ≥10years of disease duration. Therapies targeting balancing glycaemic control and IR are needed to decrease the future risk of cardiovascular diseases in T1D. ClinicalTrials.gov NCT03610984 (cohort study of patients with type 1 diabetes).

Insulin resistance in patients with cancer: a systematic review and meta-analysis

Background Insulin resistance is a critical cause of metabolic dysfunctions. Metabolic dysfunction is common in patients with cancer and is associated with higher cancer recurrence rates and reduced overall survival. Yet, insulin resistance is rarely considered in the clinic and thus it is uncertain how frequently this condition occurs in patients with cancer. Methods To address this knowledge gap, we performed a systematic review and a meta-analysis guided by the Preferred Items for Systematic Review and Meta-Analyses (PRISMA) statement. We included studies assessing insulin resistance in patients with various cancer diagnoses, using the gold-standard hyperinsulinemic–euglycemic clamp method. Studies eligible for inclusion were as follows: (1) included cancer patients older than 18 years of age; (2) included an age-matched control group consisting of individuals without cancer or other types of neoplasms; (3) measured insulin sensitivity using the hyperinsulinemic–euglycemic clamp method. We searched the databases MEDLINE, Embase, and Cochrane Central Register of Controlled Trials for articles published from database inception through March 2023 with no language restriction, supplemented by backward and forward citation searching. Bias was assessed using funnel plot. Findings Fifteen studies satisfied the criteria. The mean insulin-stimulated rate of glucose disposal (Rd) was 7.5 mg/kg/min in control subjects (n = 154), and 4.7 mg/kg/min in patients with a cancer diagnosis (n = 187). Thus, the Rd mean difference was −2.61 mg/kg/min [95% confidence interval, −3.04; −2.19], p<.01). Heterogeneity among the included studies was insignificant (p=.24). Interpretation These findings suggest that patients with a cancer diagnosis are markedly insulin resistant. As metabolic dysfunction in patients with cancer associates with increased recurrence and reduced overall survival, future studies should address if ameliorating insulin resistance in this population can improve these outcomes thereby improving patient care. Key points Metabolic dysfunction increases cancer recurrence rates and reduces survival for patients with cancer. Insulin resistance is a critical cause of metabolic dysfunctions. To date, no comprehensive compilation of research investigating insulin resistance in cancer patients has been produced. In this meta-analysis, we found that patients with various cancers were markedly insulin-resistant.

Estimated glucose disposal rate (eGDR) in rural Bangladeshi population and its correlation with cardiometabolic risks

Background and objectives: For decades type 2 diabetes mellitus (T2DM) and insulin resistance (IR) are increasingly gaining importance as an underlying mechanism for increased risk of cardiovascular diseases (CVD). IR is related to various cardiometabolic adverse effects. Hyperinsulinemic-euglycemic clamp technique, the gold standard method for measuring IR, is an invasive and complex procedure. Estimation of glucose disposal rate (eGDR) is an easy alternative tool for measuring IR. There is no known study on eGDR level in Bangladeshi native population. Therefore, this study was undertaken to determine the eGDR values in a healthy working rural Bangladeshi population. Materials and methods: Six villages were selected purposively as the study sites. All healthy working people aged ≥20 years in selected rural community were considered eligible. Those who consented to participate in the study were enrolled. Investigations included a) interviewing for social and clinical history, b) anthropometry and measurement of blood pressure and d) estimation of HbA1c and biochemical indices. The eGDR (mg/kg/min) was calculated using formula: eGDR = 21.158 − (0.09 * WC) − (3.407 * HT) − (0.551 * HbA1c); where WC = waist circumference in cm, HT = hypertension (yes = 1/no = 0), and HbA1c = HbA1c (%). Results: A total of 93 (m/w = 29/64) participants were enrolled in the study. The prevalence rates of hypertension, diabetes and metabolic syndrome (MSyn) were 34%, 31.1% and 16.1%, respectively. The mean eGDR value was 9.9 (±0.149; 95% CI: 9.62–10.2) mg/kg/min. Most of the values of biophysical characteristics were normal. The comparison between participants with and without MSyn showed that the former had significantly lower eGDR (9.05±1.24 vs.10.10±1.37, p&lt;0.01). Inverse correlations of eGDR with the obesity, glycemia and lipidemia (weight, waist, FBG, T-chol, and TG) were significant. Declining eGDR were significant with rising WHR, WHtR, TG/HDLR and T-chol/HDLR (for all, p&lt;0.05). Conclusions: The study revealed the level of eGDR in a healthy working people of a rural community of Bangladesh. Moreover, eGDR was found to decrease significantly with the increasing cardiometabolic risks. The study revealed a higher prevalence of hypertension, diabetes and metabolic syndrome in apparently healthy working people highlighting susceptibility of Bangladeshi natives to non-communicable diseases. IMC J Med Sci. 2023; 17(2):005. DOI: https://doi.org/10.55010/imcjms.17.015 *Correspondence: M Abu Sayeed, Department of Community Medicine, Ibrahim Medical College, 1/A, Ibrahim Sarani, Segunbagicha, Dhaka 1000, Bangladesh. Email: sayeed1950@gmail.com

Estimated glucose disposal rate is associated with retinopathy and kidney disease in young people with type 1 diabetes: a nationwide observational study

AimsThe aim of this study was to investigate the association between estimated glucose disposal rate (eGDR), a proxy for insulin resistance, and retinopathy or kidney disease, i.e. micro-, or macroalbuminuria, in young individuals with type 1 diabetes (T1D).Material and MethodsUsing data from the Swedish pediatric registry for diabetes (SweDiabKids) and the registry for adults (NDR), all individuals with T1D with a duration of diabetes of less than 10 years between 1998 and 2017 were included. We calculated the crude incidence rates with 95% confidence intervals (CIs) and used multivariable Cox regression to estimate crude and adjusted hazard ratios (HRs) for two cohorts: retinopathy cohort or kidney disease cohort, stratified by eGDR categories: < 4, 4 to 5.99, 6 to 7.99, and ≥ 8 mg/kg/min (reference).ResultsA total of 22 146 (10 289 retinopathy cohort, and 11 857 kidney disease cohort with an overlapping of 9575) children and adults with T1D (median age 21 years, female 42% and diabetes duration of 6 and 7 years, respectively for the cohorts) were studied. During a median follow-up of 4.8 years (IQR 2.6–7.7) there were 5040 (24.7%), 1909 (48.1%), 504 (52.3%) and 179 (57.6%) events for retinopathy in individuals with an eGDR ≥ 8, 7.99 to 6, 5.99 to 4, and < 4 mg/kg/min, respectively. Corresponding numbers for kidney disease was 1321 (6.5%), 526 (13.3%), 255 (26.8%) and 145 (46.6%). After multiple adjustments for different covariates, individuals with an eGDR 7.99 to 6, 5.99 to 4 and < 4 mg/kg/min, had an increased risk of retinopathy compared to those with an eGDR ≥ 8 mg/kg/min (adjusted HRs, 95% CIs) 1.29 (1.20 to 1.40); 1.50 (1.31 to 1.71) and 1.74 (1.41 to 2.14). Corresponding numbers for kidney disease was (adjusted HRs, 95% CIs) 1.30 (1.11 to 1.52); 1.58 (1.25 to 1.99) and 1.33 (0.95 to 1.86), respectively.ConclusionseGDR, a proxy for insulin resistance, is associated with retinopathy and kidney disease in young adults with T1D. The risk of retinopathy increased with lower eGDR. The risk of kidney disease also increased with lower eGDR; however results show no association between the lowest eGDR and kidney disease. eGDR can be helpful to identify young T1D individuals at risk.

On a Closed-Loop Supply Chain with Graded Returns

We use optimal control theory to determine the optimal manufacturing, remanufacturing, and disposal rates in a closed-loop supply chain. The returned items are of different quality levels. The firm grades the returned items according to their quality. Each class of returned items is remanufactured and stocked separately. Also, all items are subject to deterioration and the deterioration rate depends on the class. Finally, each class of items is sold to a different segment of customers. An illustrative example is presented along with a sensitivity analysis on some of the system parameters.

Critical analysis of waste management systems utilizing a performance assessment and optimization model

The management of solid waste has been recognized as the cornerstone for sustainable development and closed loop circular economy models. Moreover, solid waste management is at the forefront of initiatives seeking to cut greenhouse gas emissions. This research stems from the limited success that solid waste management programs have had in the context of developing countries and the need to overcome the obstacles and impediments hampering the implementation of a sustainable solid waste management framework. It aims to facilitate the optimization process of the applied technical, operational, and managerial schemes, streamline sustainable practices and close the circularity gap that currently exists in waste management taking Lebanon as a case example. Accordingly, a performance assessment and optimization tool was developed to evaluate the administrative, environmental, and operational performance of 27 unions of municipalities and large municipalities encompassing more than 90 villages/cities. The model compares different technologies based on a set of user defined constraints and groups municipalities and operational facilities into four classes: (A) Superior, (B) Satisfactory, (C) Poor, and (D) No service. The excessive amounts of disposal rates, failure in the adoption of a comprehensive solid waste management framework, the absence of a contingency plan, and the consistent reliance on ad hoc strategies for handling solid waste characterized the sector in Lebanon. A thorough analysis of the various waste management systems revealed that none could be classified as “superior”, with the ratings of most schemes compounded in the lower end of the spectrum.

Estimating Sustainable Long-Term Fluid Disposal Rates in the Alberta Basin

Reliable regional-scale permeability data and minimum sustained injectivity rate estimates are key parameters required to mitigate economic risk in the site selection, design, and development of commercial-scale carbon sequestration projects, but are seldom available. We used extensive publicly available disposal well data from over 4000 disposal wells to assess and history-match regional permeability estimates and provide the frequency distribution for disposal well injection rates in each of 66 disposal formations in the Alberta Basin. We then used core data and laboratory analyses from over 3000 cores to construct 3D geological, geomechanical and petrophysical models for 22 of these disposal formations. We subsequently used these models and the history-matched regional permeability estimates to conduct coupled geomechanical and reservoir simulation modeling (using the ResFrac™, Palo Alto, CA, USA, numerical simulator) to assess: (i) well performance in each formation when injecting carbon dioxide for a 20-year period; (ii) carbon dioxide saturation and reservoir response at the end of the 20-year injection period; (iii) reliability of our simulated rates compared to an actual commercial sequestration project. We found that: (i) the injection rate from our simulations closely matched actual performance of the commercial case; (ii) only 7 of the 22 disposal formations analyzed appeared capable of supporting carbon dioxide injectors operating at greater than 200,000 tons per year/well; (iii) three of these formations could support injectors operating at rates comparable to the successful commercial-scale case; (iv) carbon dioxide presence and a formation pressure increase of at least 25% above pre-injection pressure can be expected at the boundaries of the (12 km × 12 km) model domain at the end of 20 years of injection.

Relationship Between Estimated Glucose Disposal Rate and Type 2 Diabetic Retinopathy.

To investigate the association between diabetic retinopathy (DR), DR intensity, and estimated glucose disposal rate (eGDR) in individuals with type2diabetes mellitus (T2DM). This study comprised 1762 T2DM patients who were admitted between January and December, 2021. Overall, the DR was identified in 430 patients. Based on the eGDR, the participants were divided into four study groups. One-way analysis of variance was used to compare the groups. The correlations between eGDR and DR risk, eGDR, and DR severity were analyzed using regression analysis. Furthermore, these relationships were analyzed in different sex groups. Patients with T2DM had a 19.75% (348/1762) DR detection rate, whereas those with DR had a 22.41% (78/348) proliferative DR detection rate. The DR group had substantially reducedlevels of eGDR compared with the non-DR group. Multivariate logistic regression analysis demonstrated that reduced eGDR was an independent risk factor for DR, after adjusting forconfounding variables. eGDR correlated significantly with proliferative DR in women but not in men. In Chinese individuals with T2DM, lower eGDR was independently associated with a higher risk of DR.

Insulin resistance and hepatic steatosis in type 1 diabetes mellitus and their association with diabetic chronic complications.

The aim of this study was to evaluate insulin resistance and hepatic steatosis and their association with diabetes duration, control and chronic complications in patients with type 1 diabetes. We studied medical records of 181 consecutive hospitalized adult patients with type 1 diabetes. Estimated glucose disposal rate (eGDR), Insulin Sensitivity Score (ISS), Fatty Liver Index (FLI) and Hepatic Steatosis Index (HSI) were calculated. Patients in the 1st tertile of eGDR (<4.1 mg/kg-1-min-1) and ISS (<4.8) had higher prevalence of ischemic cardiovascular disease (ICVD) (P<0.001), hepatic steatosis, higher gamma glutamyl transpeptidase, HSI, FLI compared with participants from the 2nd and 3rd tertile of eGDR and ISS. Compared with those without steatosis, patients with ultrasound-diagnosed steatosis (30.5%) had a lower ISS (4.4±1.9 vs. 6.3±2.4, P<0.001), eGDR (4.5±3.0 vs. 5.8±2.7, P=0.01), higher FLI (72.5±25.1 vs. 51.0±27.2, P<0.001), HSI (37.5±6.1 vs. 35.2±4.7, P=0.03) and prevalence of ICVD (71.7 vs. 45.7%, P=0.004) and retinopathy (69.6 vs. 52.4%, P=0.03). Factors independently associated with hepatic steatosis were only ICVD (OR=2.584, P=0.029), ISS (OR 0.148, P<0.001), aspartate aminotransferase (OR=1.025, P=0.038) and male gender (OR=2.726, P=0.016). Insulin resistance and hepatic steatosis are common in type 1 diabetes and have a significant association with ICVD, independently of diabetes duration, control and insulin doses.

Impact of overweight and obesity on epicardial adipose tissue in children with type 1 diabetes.

Epicardial adipose tissue (EAT) thickness, a novel marker of cardiovascular disease (CVD), is increased in children with a healthy weight and type 1 diabetes (T1D). The prevalence of obesity has increased in children with T1D and may confer additional CVD risk. The purpose of this study was to examine EAT thickness in youth with and without T1D in the setting of overweight/obesity. Youth with overweight/obesity and T1D (n=38) or without T1D (n=34) between the ages of 6-18 years were included in this study. Echocardiogram using spectral and color flow Doppler was used to measure EAT and cardiac function. Waist circumference, blood pressure, and HbA1c, were used to calculate estimated glucose disposal rate (eGDR) to estimate insulin resistance in children with T1D. EAT thickness was not significantly different in youth with T1D compared to controls (2.10±0.67mm vs. 1.90±0.59mm, p=0.19). When groups were combined, EAT significantly correlated with age (r=0.449, p≤0.001), BMI (r=0.538, p≤0.001), waist circumference (r=0.552, p≤0.001), systolic BP (r=0.247, p=0.036), myocardial performance index (r=-0.287, p=0.015), ejection fraction (r=-0.442, p≤0.001), and cardiac output index (r=-0.306, p=0.009). In the group with T1D, diastolic BP (r=0.39, p=0.02) and eGDR (r=-0.48, p=0.002) correlated with EAT. EAT was associated with measures of adiposity and insulin resistance but does not differ by diabetes status among youth with overweight/obesity. These findings suggest that adiposity rather than glycemia is the main driver of EAT thickness among youth with T1D.

Assessing non-hazardous solid waste business characteristics of Western Canadian provinces

This study addresses a gap that exists in studying waste business characteristics and the performance of a waste management system (WMS). Temporal and spatial analyses of the WMS in four Western Canadian provinces are systematically assessed over a 16-year period. The average waste business size in Canada ranged from 13.4 to 22.1 employees per business. Jurisdictions with lower disposal rates generally have larger waste companies. An average employee handled 1098 to 1426 t of waste annually. The diversion rates tended to be higher when less waste is managed per employee, suggesting total employee count may be important to improve WMS sustainability in Canada. Waste transfer costs are substantial during the study period, totaled $1276 million annually, or about 40.7% of the total government waste spending. BC only spent an average of 2.5% of the budget on operation of recycling facilities, but has the highest waste diversion rate. Expenditure distribution alone is unable to explain BC's superior waste diversion performance. Capital expenditures have been increasing from $15.7/t to $26.2/t. In this study, a business with more full-time employees correlates well with higher operating revenues. Part time workers were more predominant in SK, and may be responsible for the subpar diversion rate and operating revenue. More research is needed to determine waste business characteristics given increasing interest in circular economy and WMS efficiency.

Reverse channel selection for commercial product returns under time-to-market and product value considerations

AbstractThe advent of mobile channels have changed retail business models, the choice of retail mix, and shopper behavior. As consumers do not differentiate among the channels where they try, purchase and/or take delivery of their product, they also expect maximum flexibility in the product returns process. On average, retailers forecasted returns to reach about 16.6% of the total merchandise that customers purchased in 2021, according to the National Retail Federation, which is an increase from an average return rate of 10.6% in 2020. The resulting cost of returns amounted to $761 billion worth of merchandise in 2021 (Repko in A more than $761 billion dilemma: retailers’ returns jump as online sales grow. https://www.cnbc.com/2022/01/25/retailers-average-return-rate-jumps-to-16point6percent-as-online-sales-grow-.html. Accessed 17 June 2022, 2022). For retailers and manufacturers, integration of different reverse channels is extremely important to deliver the seamless experience demanded by today’s discerning consumer while ensuring the profitable handling of the returned products as well as ensuring the environmental sustainability of the retailing operations. Regardless of which channel receives a return, the reverse logistics network should have the flexibility and the capability to remarket or to recover the value in the returned product in a cost efficient and timely manner that maximizes firm profitability. To the best of our knowledge, this paper is one of the first studies that develops a linear programming model with profit maximization objective to help determine how to optimally decide the returned product touch point(s) in the reverse logistics network. Unlike the extant literature, our model explicitly incorporates the marginal value of time for returns, product characteristics as well as the underling reverse logistics network configuration in return channel selection strategy. We present a comprehensive analysis on how and to what extent the return channel selection is dependent on the product characteristics such as time-based value decay rate, defective rates, and disposal rates as well as the network structure. Using data from HP and Bosch Power tools operations as well as real geographical US data, we show that our decision model can effectively help determine the reverse logistics network and the type of facility where a product is returned as a function of product characteristics and economic parameters. Our work emphasizes that product returns and waste reduction, improved firm sustainability and profitability can co-exist through effective reverse logistics planning.

Body adiposity markers and insulin resistance in patients with type 1 diabetes.

Body composition changes are associated with adverse effects such as increased insulin resistance (IR) in individuals with diabetes mellitus. This study aims to evaluate the association between different body adiposity markers and IR in adults with type 1 diabetes (T1D). The cross-sectional study included outpatient adults with T1D from a university public hospital in southern Brazil. The body adiposity markers studied were waist circumference (WC), waist-height ratio (WHtR), body mass index (BMI), conicity index (CI), lipid accumulation product (LAP) and body adiposity index (BAI). IR was calculated using an Estimated Glucose Disposal Rate (EGDR) equation (analyzed in tertiles), considering an inverse relation between EGDR and IR. Poisson regression models were used to estimate the odds ratio (OR) and 95% CIs of association of adiposity markers with IR. A total of 128 patients were enrolled (51% women), with a median EGDR of 7.2 (4.4-8.7) mg.kg-1.min-1. EGDR was negatively correlated with WC (r = -0.36, p < 0.01), WHtR (r = -0.39, p < 0.01), CI (r = -0.44, p < 0.01), LAP (r = -0.41, p < 0.01) and BMI (r = -0.24, p < 0.01). After regression analyses, WC (OR = 2.07; CIs: 1.12-3.337; p = 0.003), WHtR (OR = 2.77; CIs: 1.59-4.79; p < 0.001), CI (OR = 2.59; CIs: 1.43-4.66; p = 0.002), LAP (OR = 2.27; CIs: 1.25-4.11; p = 0.007) and BMI (OR = 1.78; CIs: 1.09-2.91; p = 0.019) remained associated with IR. The authors suggest using the studied adiposity markers as a routine since they were shown to be suitable parameters in association with IR.

Chronic physiologic hyperglycemia impairs insulin-mediated suppression of plasma glucagon concentration in healthy humans

Background and aimsHyperglucagonemia is a characteristic feature of type 2 diabetes mellitus (T2DM). We examined the effect of chronic (48–72 h) physiologic increase (+50 mg/dl) in plasma glucose concentration on suppression of plasma glucagon concentration by insulin and by hyperglycemia in normal glucose tolerance (NGT) individuals. Materials and methodsStudy One: 16 NGT subjects received OGTT and 3-step hyperinsulinemic (10, 20, 40 mU/m2·min) euglycemic clamp before and after 48 hour glucose infusion to increase plasma glucose by ~50 mg/dl. Study Two: 20 NGT subjects received OGTT and 2-step hyperglycemic (+125 and + 300 mg/dl) clamp before and after 72 hour glucose infusion. Plasma insulin, C-peptide and glucagon concentrations were measured during OGTT, euglycemic hyperinsulinemic and hyperglycemic clamps. Ratio of plasma glucagon/insulin was used as an index of insulin-mediated suppression of glucagon secretion. ResultsDuring all 3 insulin clamp steps (Study 1), plasma glucagon concentration was increased compared to baseline study, and plasma glucagon/insulin ratio was significantly reduced by 24 % (p < 0.05). The rate of insulin-stimulated glucose disposal was inversely correlated with plasma glucagon/insulin ratio (r = −0.44, p < 0.05) and with glucagon AUC (r = −0.48, p < 0.05). During the 2-step hyperglycemic clamp (Study 2) plasma glucagon was similar before and after 72 h of glucose infusion; however, glucagon/insulin ratio was significantly reduced (p < 0.05). Incremental area under plasma insulin curve during the first (r = −0.74, p < 0.001) and second (r = −0.85, p < 0.001) hyperglycemic clamp steps was strongly and inversely correlated with plasma glucagon/insulin ratio. ConclusionSustained (48–72 h) physiologic hyperglycemia (+50 mg/dl) caused whole body insulin resistance and impaired insulin-mediated suppression of glucagon secretion, suggesting a role for glucotoxicity in development of hyperglucagonemia in T2DM.