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As opposed to his younger brother Isaac, Ishmael is a relatively minor character in the patriarchal narratives of the Old Testament. Islam, however, which largely adopts the biblical Pentateuch as a holy book of Islam given by God to Musa (Moses), re-interprets Ishmael's role in one significant event: the offering demanded by God as demonstration of Abraham's faith. In Islam, Ishmael supplants Isaac as the intended sacrificial lamb. This article examines both the biblical and the Qur'ānic Isaac and Ishmael narratives from the perspective of academic curiosity to determine the grounds for, and the validity of the Islamic claim. [ABSTRACT FROM AUTHOR]

This study demonstrates that the putative ER-located Hsp90, XVGrp94, is upregulated under conditions of stress, and is the first report of such upregulation in response to desiccation stress. XVGrp94 was identified by differential screening of a cDNA library from a dehydrated resurrection plant Xerophyta viscosa Baker. Sequence analysis revealed that the cDNA potentially encoded a protein of 812 amino acids with a calculated molecular weight of 92.83kDa. Amino acid sequence comparisons revealed significant homology to several Grp94s from plants with the highest similarity to Grp94 from Oryza sativa (82.74%), Catharanthus roseus (81.97%), Hordeum vulgare (80.10%) and Arabidopsis thaliana (77.45%). The sequence contains the Hsp90 protein family signature, NKDIFL, a putative eukaryotic secretory signal, and the endoplasmic reticulum targeting and retention signal, KDEL. Residues that interact with ATP within the N-terminal domain of Hsp90s are conserved in the N-domain of the putative XVGrp94, indicating that it is potentially capable of ATP binding and hydrolysis. Southern blot analysis confirmed the presence of the XVGrp94 gene within the X. viscosa genome and the results suggest the possibility of homologues. Western blot analysis showed that the XVGrp94 expression increased significantly in response to heat and dehydration, and slightly in response to high salinity. No response was seen in response to high light, cold treatment or exogenous ABA (abscisic acid) application. [ABSTRACT FROM AUTHOR]

Examines the need for pregnant diabetics to self-monitor their blood glucose. Reduction of perinatal mortality in diabetic pregnancy; Maintenance of blood glucose concentration; Measurement of blood glucose concentrations.

In order to determine the level of glycaemic control attainable and the related benefit of intensive insulin therapy in routine clinical diabetes practice, a cross-sectional survey of an adult diabetes clinic population was undertaken. We audited 2,066 adult patients with diabetes: age 5 +/- 15yr (mean +/- SD); 1,207 (58%) male; 72% Caucasians, 1,261 (61%) on insulin. Mean HbA1c was 6.7 +/- l.7% (normal <5.5%) with no significant effects of age, sex, racial origin, micro- and/or macrovascular complications, but treatment category was significant: HbA1c on diet 6.4 +/- 1.6%, on tablets 6.6 +/- l.6% and on insulin 6.8. +/- 1.7% (p<0.01). Amongst insulin-treated patients (age 54 +/- 16yr; 56% male; 76% Caucasian), 1,072 (85%) were on conventional insulin regimens and 189 (15%) on intensive insulin regimens. No significant effects were found for age, sex, race, complications or insulin regimen (HbA1c conventional 6.7 +/- 1.7% vs intensive 6.9. +/- 1.7%) despite the intensive group being younger (56 +/- 16yr vs 39 +/- 13y, p<0.001). In patients aged <40yr and treated with insulin within one year of diagnosis (n=293, age 31 +/- 6yr, 54% male, 83% Caucasians, 105 (36%) on intensive regimens) HbA1c was 6.8 +/- 1.7% in conventional vs 7.0 +/- 1.7% in intensively treated patients (ns). We conclude that, in routine practice, conventional and intensive insulin regimens achieve equivalent glycaemic control and are both favourably comparable to the intensively managed group of the DCCT. [ABSTRACT FROM AUTHOR]

Investigates the condition of patients defaulted from a diabetic clinic in Wolverhampton, England. Comparison on the body weight between non-insulin (NI) dependent and insulin dependent defaulters; Development of a high diastolic blood pressure among NI dependents; Differences of medical supervision between defaulters and regular clinic attenders.

A case is presented of a young female insulin-dependent diabetic (IDDM) patient who required continuous hospitalisation over a two year period for factitiously produced ketoacidosis (DKA). Her instability resolved after implantation of an insulin infusion pump as well as psychiatric therapy. Eighteen months later, however, she presented with recurrent severe hypoglycaemia, also shown to be factitious. She again resolved, and over nine years of subsequent follow-up she remains well with non-problematic glycaemic control. [ABSTRACT FROM AUTHOR]

A 34-year-old woman with a history of congenital hypothyroidism and 15 years of obstructive sleep apnoea was admitted with a left submandibular swelling secondary to a dental infection. A CT scan of the neck identified an incidental 27 mm tongue base mass and the absence of any cervical thyroid tissue. This mass was not observable on examination of the oropharynx but was seen on fine nasendoscopy while thyroid function tests showed good thyroid stimulating hormone suppression. Her acute dental infection was treated and, following multidisciplinary team discussion, she was diagnosed with an ectopic lingual thyroid. She was offered different management options including no intervention and radio-iodide treatment but opted for transoral robotic resection. The lesion was resected en bloc with clear margins and histology confirmed lingual thyroid tissue. Since the procedure, she has remained free of sleep apnoea with a significantly improved quality of life., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

This study is a baseline analysis of the demographic and behavioral characteristics of freshmen students recruited to enter a longitudinal multi-component intervention program based on the Brief Alcohol Screening, and Intervention for College Students (BASICS) program. The aim of the study was to determine the associations among the participants' gender, ethnicity, age, drinking, psychological problems, sexual contacts, and illegal substance use. Freshmen participants (n = 186) were between the ages of 18 and 20 with a mean age of 18.51 ± 0.62, and 37.6% of the participants were males. Three surveys were administered at baseline: the Daily Drinking Questionnaire (DDQ; Collins, Parks, & Marlatt, 1985 ); Rutgers Alcohol Problem Index (RAPI; White & Labouvie, 1989 ), Government Performance and Results Act (GPRA; Office of Management and Budget [OMB], 1993 ), Client Outcome Measures for Discretionary Programs and Best Practices grantees. Descriptive statistics were used to determine the behavioral characteristics. During past 30 days participants on average consumed alcohol on 7.3 ± 5.2 days, used illegal substances 3.0 ± 7.2 days and had 5.3 ± 7.0 sexual contacts and less 2.1 ± 4.6 unprotected sexual contacts (USC). Results of this baseline analysis demonstrate the diversity of the program participant demographic characteristics and behavioral patterns. This study contributes valuable implications for the design of interventions programs to address high-risk behaviors among freshmen college students.

Choose and Book combines three major elements of NHS organisational development. Patients are offered increasing choice about where they receive specialist advice, they have more control over the booking of their appointments, and a Choose and Book information technology (IT) application is being implemented to facilitate both these aspects of care. By exploring these three elements, some of the causes of difficulty in clinical implementation and the additional information required to inform choice are identified.

A review of the current state of research in the genetics of obsessive-compulsive disorder (OCD) is presented. OCD is a neuropsychiatric condition that affects 1-2% of the population and often has an early age at onset of symptoms. OCD has been shown to be familial, and a major gene effect has been reported. However, phenotypic and genetic heterogeneity of OCD poses multiple challenges for locating susceptibility genes. Strategies such as the use of phenotypic subtyping (using tic disorders or other anxiety disorders) and endophenotyping based on brain mechanisms underlying OCD (functional brain imaging and neuropsychological measures) may open ways to understand the genetic components of OCD. Using child probands and extended families for linkage an association studies is another venue to obtain greater informative families for genetic studies. A better understanding of environmental triggers, OCD subtypes and OCD pathophysiology will lead to locating genes that confer risk to OCD.

A workshop was convened to examine factors determining patient self-management and implications for those providing care. It was attended by 15 doctors and 15 nurses with considerable expertise in education for those with diabetes. Discussion included: the experience of training programmes to date; factors determining effective patient self-management; the implications for training of professionals, skills required, their current availability and proposals for their development. The conclusions were that training and experience of these skills are both inadequate. Programmes of training, which are equally applicable to the management of other chronic diseases, should be embedded in the system of care and delivered at local level. Regional or national programmes are required to develop trainers in all districts able to deliver and maintain local programmes. This critical element of care in diabetes must be adequately funded if self-care standards are to be improved and expensive complications prevented.

In controlled trials intensified diabetes therapy including multiple insulin injection regimes has been shown to improve glycaemic and microvascular disease outcomes in insulin dependent diabetes but this is not clear in routine outpatient practice. We undertook a pragmatic cross sectional study of 200 patients with Type 1 diabetes aged 18-50 years. There were 108 on two insulin injections/day (conventional) and 92 on four injections/day (multiple) with no significant difference for age, sex, social class, body mass index, diabetes duration, hypoglycaemia rate or complications prevalence. The relationship of insulin injection regime used with diabetes knowledge, psychological factors and glycaemic control outcomes was evaluated. Percent glycated HbA1c concentrations (normal range < 5.5%) were worse in the multiple injection group (7.5 +/- 1.7 vs. 6.8 +/- 1.4%, P < 0.001) (mean +/- SD). Their scores for diabetes knowledge (72.5 +/- 8.2 vs. 69.0 +/- 9.8, P < 0.01) were better but treatment satisfaction (29.9 +/- 5.1 vs. 28.5 +/- 6.1, ns) and well-being (49.1 +/- 10.7 vs. 46.5 +/- 12.7, ns) scores were not. Parameters of perceived locus of control were (multiple v conventional): personal (self), 24.5 +/- 5.0 vs. 22.3 +/- 5.9, P < 0.05; medical (doctor), 11.8 +/- 5.1 vs. 10.8 +/- 5.8, ns; situational (chance), 7.9 +/- 5.1 vs. 8.9 +/- 5.9, ns. In multiple regression of HbA1c versus multiple variables only insulin regime (P < 0.001) was significant. We conclude that in routine clinical practice the use of intensive insulin regimes are associated with worse glycaemic control despite patients being marginally more knowledgeable and self directed.

The diastereoselective synthesis of 2,3-methanophenylalanine methyl esters (5) has been achieved in 58% yield. The preparation of the dehydropeptides (1, R = Me; 2, R = H) and the cyclopropylpeptides (3, R = Me; 4, R = H) possessing good binding affinities for the CCK-A and CCK-B receptors is described. Conformational studies of the dipeptide esters 1 and 3 indicated the presence of a beta-turn within the peptide backbone, although there was no preference in type. The Phe and Trp moieties, however, did prefer to be situated on the same side of the peptide turn which is favourable for receptor binding.

Objective: To determine the impact of posters advertising symptoms of diabetes on public knowledge of these symptoms., Design: Structured street interviews of members of the general public before, at the end of, and 10 weeks after a campaign advertising the main symptoms of diabetes., Setting: Basingstoke and Wolverhampton., Subjects: Three samples of 1000 members of the general public were interviewed. Samples were selected randomly but stratified to match the local population's age (20-75), sex, social class, and racial characteristics., Main Outcome Measures: Knowledge of symptoms of diabetes; perceived seriousness of diabetes; and induction of anxiety about symptoms in the target population., Results: Advertising significantly raised knowledge (without prompting) of symptoms: thirst, 245 before v 411 at end of campaign (P < 0.0001) v 341 after (P = 0.0012 v before); polyuria, 72 v 101 (P = 0.0211) v 92 (P = 0.5169); lethargy, 180 v 373 (P < 0.0001) v 298 (P < 0.0001); knowledge of weight loss and visual disturbance was unaffected. The number of subjects lacking knowledge of any symptoms was reduced from 550 to 388 (P < 0.0001). The perceived seriousness of diabetes was unaffected (mean 7.6 in each phase on a scale of 1 (not) to 10 (very). Before advertising, 449 (45%) claimed to have one or more symptoms of diabetes, but this number fell at the end of the campaign (403; P = 0.0419) and 10 weeks afterwards (278; P < 0.0001)., Conclusions: An advertising campaign raised public knowledge of diabetes symptoms without inducing fear of diabetes or anxiety about symptoms. Its potential for achieving earlier detection of non-insulin dependent diabetes should be evaluated.

An accurate pattern of blood-glucose changes in everyday life is the basis for treatment in insulin-dependent diabetes. 69 patients were taught to obtain their own blood-glucose profiles with a 'Reflomat' Boehringer Mannheim) reflectance meter on one working and one rest day, and to repeat these where necessary after adjustment of treatment. 2 did not complete the study satisfactorily. The other 67 produced profiles on 241 dyas. Even patients with a limited education could use the technique accurately and their readings correlated closely with simultaneous laboratory values (r = 0.96). Self-monitoring was especially useful in elucidating problems in diabetic control, preventing hypoglycaemia, and managing diabetic pregnancy. Unlike the measurement of HbA1c which only detects poor diabetic control, self-monitoring also shows how to improve it. Patients found self-monitoring more informative than urine tests; their active involvement in management of their disease resulted in better motivation, greater understanding of diabetes, and a sustained improvement in control. By the end of the study 32 of the 67 patients ahd profiles in which no more than one blood-glucose value exceeded 10 mmol/l. Smaller and more portable machines will make the technique more widely applicable.

Two new battery-operated digital reflectance meters for blood glucose measurement have been tested for precision and accuracy in a laboratory trial. Reflocheck (Boehringer Company Ltd) is calibrated from a bar code printed on each test strip, Reflolux (Boehringer Company Ltd) from a bar code on acetate film provided with each bottle of BM-Test-Glycemie 20-800R strips, which can also be read visually. Three aqueous standards (3.3, 8.3 and 11.7 mmol/l) were assayed 10 times on each of 10 days. Overall coefficients of variation for Reflocheck were 2.8, 1.7 and 2.0% and for Reflolux 3.1, 1.5 and 2.8% respectively. One hundred and four blood samples measured on the machines gave very high correlations with a manual hexokinase assay: for Reflocheck, y = 1.1x - 0.7, r = 0.99 and for Reflolux, y = 1.07x + 0.1, r = 0.99. In the range 2.2-10 mmol, errors of 1 mmol or more occurred on seven occasions with Reflocheck and eight with Reflolux (n = 80) but none of these errors was of therapeutic significance. The performance of both machines was as good or better than previously published data for similar instruments. The ease of calibration and accuracy of both machines are advantageous as is the use of BM-Test-Glycemie 20-800R by Reflolux which enables a check to be made on visual readings.

Two severely brittle diabetic patients were treated with "Infusaid" implantable insulin infusion pumps. Both were young females with recurrent ketoacidosis, prolonged or repeated hospital admissions, and subcutaneous insulin resistance. They also had psychological problems, and had seriously interfered with their treatment to induce glycaemic instability. Delivery of insulin from the pumps was intravenous (i.v.) in one patient, and intraperitoneal (i.p.) in the other. Following implantation, there was a marked improvement in glycosylated haemoglobin level (HbA1), fasting blood glucose (BG), daily insulin dose and hospitalizations. The beneficial effect has continued to date (9 months, and 12 months follow-up) with no major problems.