ABSTRACT
In patients with diabetes mellitus (DM), adequate glucose control is of major importance. When treatment schemes become more complicated, proper self-management through intermittent self-measurement of blood glucose (SMBG), among others, becomes crucial in achieving this goal. In the last decade, continuous glucose monitoring (CGM) has been on the rise, providing not only intermittent information but also information on continuous glucose trends. The FreeStyle Libre (FSL) Flash CGM system is a CGM system mainly used for patients with DM and is designed based on the same techniques as early CGMs. Compared with earlier CGMs, the FSL is factory calibrated, has no automated readings or direct alarms, and is cheaper to use. Although less accurate compared with the gold standard for SMBG, users report high satisfaction because it is easy to use and can help users monitor glucose trends. The Flash Monitor Register in the Netherlands (FLARE-NL) study aims to assess the effects of FSL Flash CGM use in daily practice. The study has a before-after design, with each participant being his or her own control. Users will be followed for at least 1 year. The endpoints include changes in HbA1c, frequency and severity of hypoglycemias, and quality of life. In addition, the effects of its use on work absenteeism rate, diabetes-related hospital admission rate, and daily functioning (including sports performance) will be studied. Furthermore, cost-benefit analysis based on the combination of registered information within the health insurance data will be investigated. Ultimately, the data gathered in this study will help increase the knowledge and skills of the use of the Flash CGM in daily practice and assess the financial impact on the use of the Flash CGM within the Dutch healthcare system.
ABSTRACT
Six proton-emitting states in 19Ne were studied through the inelastic scattering reaction H(19Ne,p);{19}Ne; (p)18F. Their energies and widths were derived from the protons detected at zero degree, while proton-proton angular correlations between the detector at zero degree and a segmented annular detector were used to determine their spin value. In addition to the known states, a new broad J=1/2 resonance has been evidenced at E_{x} approximately 7.9 MeV, approximately 1.45 MeV above the proton emission threshold. By introducing this resonance, the 18F(p,alpha)15O destruction rate in novae is significantly enhanced. This reduces the chance to observe the cosmic gamma-ray emission of 18F from novae in space telescopes.
ABSTRACT
AIMS: To ascertain the type and extent of problems requiring advocacy in paediatrics. To develop an approach for analysing problems according to their root causes and the level of society at which advocacy is needed. METHODS: Nine paediatricians kept detailed clinical diaries for two weeks to identify problems. Classifications were developed to categorise problems by cause and the level of society at which they needed to be addressed. The press was surveyed for one week for childhood issues attracting media attention. RESULTS: 60 problems requiring advocacy were identified. Root causes included failures within agencies, between agencies, and inadequate provision. In addition to advocacy required individually, "political" action was needed at the community level (16 issues), city level (16 issues), and nationally (15 issues). 103 articles were found in the press, these did not relate closely to issues identified by clinicians. CONCLUSIONS: Many opportunities for advocacy arise in the course of daily work. A systematic way of analysing them has been developed for use in planning action. To optimise the health and health care of children, there is a need to train and support paediatricians in advocacy work for local as well as national issues. Ten issues were identified that might be prioritised by paediatricians working on an agenda for action.
Subject(s)
Child Health Services/organization & administration , Patient Advocacy , Pediatrics/organization & administration , Child , Diagnosis, Differential , England , Humans , Lobbying , Mass Media , Medical Records , Prospective Studies , Social ConditionsABSTRACT
The utility of ombrotrophic bogs as archives of atmospheric mercury deposition was assessed with an investigation in Arlberg Bog, Minnesota, U.S.A. Since the use of ombrotrophic bogs as archives depends on the immobility of deposited trace metals, we examined the postdepositional transport processes revealed by the solid-phase distributions of mercury and ancillary metals (Fe, Al, Mn, and Pb) in this bog. We modeled metal speciation in bog porewaters as a function of pe in order to understand metal behavior in ombrotrophic peat. Specifically, we considered the effect of water movement and resultant shifts in redox potential gradients on metal retention. Our results indicate that Hg and Pb are immobile in ombrotrophic peat, so their distribution can be used to determine temporal changes in deposition. To substantiate the deposition estimates determined in this study, we emphasized the importance of confirming the validity of the dating scheme, assessing the degree of horizontal homogeneity in the accumulation record, and providing evidence for retention of Hg based on geochemical modeling. As recorded in Arlberg Bog, historic atmospheric Hg deposition increased gradually after the mid-1800s, peaked between 1950 and 1960, and may have declined thereafter. Preindustrial deposition was about 4 micrograms/m2 year and recent deposition about 19 micrograms/m2 year. The results of this study indicate that deposition at Arlberg Bog has been influenced by a regional and/or local-scale source.
