Pediatric endocrine society survey of diabetes practices in the United States: What is the current state?

BACKGROUND: The Practice Management Committee (PMC) of the Pediatric Endocrine Society (PES) conducted a survey of its membership in February/March, 2016 to assess the current state of pediatric diabetes care delivery across multiple practice types in the United States. METHODS: The PES distributed an anonymous electronic survey (Survey Monkey) via email to its membership and requested that only one survey be completed for each practice. RESULTS: Ninety-three unique entries from the US were entered into analysis. Care is predominantly delivered by multidisciplinary teams, based at academic institutions (65.6%), with >85% of the provider types being physicians. Each 1.0 full time equivalent certified diabetes educators serves on average 367 diabetic youth. Fee-for-service remains the standard method of reimbursement with 57% of practices reporting financial loss. Survey respondents identified under-reimbursement as a major barrier to improving patient outcomes and lack of behavioral health (BH) providers as a key gap in services provided. CONCLUSIONS: Our survey reveals wide variation in all aspects of pediatric diabetes care delivery in the United States. Pediatric Endocrinologists responding to the survey identified a lack of resources and the current fee for service payment model as a major impediment to practice and the lack of integrated BH staff as a key gap in service. The respondents strongly support its organizations' involvement in the dissemination of standards for care delivery and advocacy for a national payment model aligned with chronic diabetes care in the context of our emerging value-based healthcare system.

Crystal structure of bis-(1,3-di-amino-propane-κ(2) N,N')bis-[2-(4-nitro-phen-yl)acetato-κO]zinc(II).

In the structure of the title compound, [Zn(C8H6NO4)2(C3H10N2)2], the Zn(II) atom is located on a center of symmetry with one independent Zn-O distance of 2.199 (2) Å, and two Zn-N distances of 2.157 (2) and 2.144 (2) Å. The overall coordination geometry around the Zn(II) atom is octa-hedral. Several types of hydrogen-bonding inter-actions are evident. Both intra-molecular [2.959 (3) Å] and inter-molecular [3.118 (3) and 3.124 (3) Šinter-actions occur between the O atoms of the acetate group and the amino N atoms, and weak inter-molecular C-H-O inter-actions involving the nitro groups, leading to an extended chain of the molecules aligned along the ac plane.