'Speaking up' is defined as the raising of concerns by health care professionals for the benefit of patient safety and care quality upon recognising or becoming aware of the risky or deficient actions of others within health care teams in a hospital environment [ 4, 5].
14, 22 T2DM is a metabolic disorder characterized by high blood glucose and develops in the presence of deficient insulin action, which can be attributed to either insufficient production or excretion of insulin, resistance to the actions of insulin, or both.
Diabetes mellitus is a metabolic disorder characterized by abnormal carbohydrate, protein and fat metabolism due to deficient insulin action on target tissues which results in hyperglycemia [1].
Deficient insulin action results from inadequate insulin secretion and/or diminished tissue responses to insulin at one or more points in the complex pathways of hormone action.
Similarly in adulthood, either excessive or deficient glucocorticoid action affects myriad brain functions, altering biochemistry, neurotransmission, cell structure, birth and death [118,120,160,234,235,285]. Thus accurate control of glucocorticoid levels and cellular action is critical for brain development and function.
Deficient androgen action during this time window leads to permanent reductions in size of the penis, prostate and testis and increased risk of malformations such as hypospadias and cryptorchidism (Welsh et al., 2008).
An absent SVC response represents a new biomarker for the metabolic syndrome and the exaggerated inflammatory response, which characterizes the metabolic syndrome, may be an outcome of deficient glucocorticoid action in vascular tissue.
Measurement of urinary, salivary, or blood (e.g., cord blood) testosterone levels in relation to AGI in future studies should help to clarify this issue, as should establishment of more detailed normative data for AGI in boys and girls and the evaluation of AGI in boys with established evidence of deficient androgen action, such as those with hypospadias.
Mice deficient in leptin action are obese with altered microbiota and increased susceptibility to certain intestinal pathogens.
Because the production of AMPs by the gut epithelium alters gut microbial composition (18), we speculated that changes in the gut microbiome observed in mice deficient in leptin action might stem from altered AMP expression.
