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Introduction: With increasing access to intermittently scanned continuous glucose monitoring (isCGM) , with the FSL, it is essential to understand the effect of TIR and TBR on HbA1c, DRD, and resource utilisation in people living with diabetes Methods: Clinicians from 1NHS UK hospitals submitted FSL user data for16,034 participants, (96% type 1 diabetes) of whom 6859 had follow-up data, collected during routine clinical care and submitted to a web-based secure tool. Linear regression analysis was used to estimate the age, gender and baseline HbA1c adjusted reduction in HbA1c in the TIR categories. Results: Follow up TIR data were available for 3250 (47%) participants of which, 1241 (38%) reported TIR in line with the international consensus (3.9-mmol/l) . After adjustments for age gender, baseline HbA1c and duration of diabetes follow-up TIR ≥50% was associated with an 0.8% (8.75 mmol/mol) reduction in HbA1c (P5% (7% vs. 11%) but was not statistically significant (P=0.31) . Conclusion: In a large cohort of UK FSL users, we demonstrate a significant reduction in HbA1c, diabetes-related distress and resource utilisation which was associated with improved TIR Disclosure H.Deshmukh: None. T.Sathyapalan: n/a. B.Pieri: None. E.G.Wilmot: Advisory Panel; Abbott Diabetes, Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, Medtronic, Sanofi, Research Support; Insulet Corporation, Novo Nordisk, Speaker's Bureau; Abbott Diabetes, Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, Novo Nordisk, Sanofi. P.Choudhary: Advisory Panel; Abbott Diabetes, Lilly Diabetes, Medtronic, Research Support; Novo Nordisk, Speaker's Bureau; Dexcom, Inc., Glooko, Inc., Insulet Corporation, Sanofi. N.Shah: None. V.Tsatlidis: None. A.N.Lumb: Advisory Panel; Abbott, Dexcom, Inc., Research Support; Abbott, Novo Nordisk, Speaker's Bureau; Abbott, Dexcom, Inc., Insulet Corporation, Novo Nordisk. R.E.Ryder: None. C.Walton: None. Funding NIHR clinical lectureship

Saxenda, Liraglutide 3.0 mg, is a glucagon-like peptide-1 (GLP-1) analogue that is licensed for the treatment of adults with overweight and obesity. In this commentary we review the NICE technology appraisal (TA664) on the use of Saxenda in the National Health Service (NHS) and its implication in clinical practice.

This paper explores a low-cost method to bridge analog public safety Land mobile radio (LMR) systems into a standards based Long Term Evolution (LTE) MCPTT system. Design goals included robustness, cost, and the creation of a system that closely conforms to released and future standards. A proof of concept prototype that successfully bridges an analog LMR system with a standards compliant LTE based MCPTT system was developed and tested. The results and design details will be covered in this paper.

We have investigated the release of gases and volatile organic compounds (VOCs) from a carbon fibre reinforced epoxy composite matrix used in aircraft structural components. Analysis was performed at several temperatures both up to and above the recommended operating temperature (121 °C) for the material, to a maximum of 250 °C. Gas chromatography-mass spectrometry (GC-MS) combined with thermal desorption (TD-GC-MS) was used to identify and quantify VOCs, and in parallel real-time gas detection with commercial off-the-shelf (COTS) gas sensors. Under hydrocarbon free air, CO, SO2, NO, NO2 and VOCs (mainly aldehydes, ketones and a carboxylic acid) were detected as the gaseous products released during the thermal exposure of the material up to 250 °C, accompanied by increased relative humidity (4%). At temperatures up to 150 °C, gas and volatile emission was limited.

To determine the ocular complications in school-age children and adolescents surviving at least 1 year following allogeneic bone marrow transplantation.Retrospective cohort study.In this institutional study, 162 patients (7-18 years old) met our inclusion criteria with a mean age of 13.4 years at bone marrow transplantation. Follow-up ranged from 13 months to 12 years (mean 4 years; median 3.2 years). Patient charts were screened for cataract formation, dry eye, and other anterior and posterior segment diseases.Cataract formation was noted in 57 patients. Univariate analysis showed that fractionated total body irradiation, race, and use of cytarabine significantly increased the incidence of cataract formation (P0.05). Multivariate analysis of significant variables showed that total body irradiation was a risk factor for cataract formation. Of the 57 patients (97 eyes) who developed cataracts after bone marrow transplantation, 4 patients (6 eyes) required cataract surgery. After surgery, all patients had visual acuities of 20/20 to 20/25. Of the 162 patients, 51 developed dry eyes. Univariate analysis showed that age at transplantation; steroid use, chronic graft-versus-host disease; use of fludarabine, melphalan, and thiotepa; and receiving no pre-transplantation conditioning regimen prior to bone marrow transplant significantly increased the risk of dry eye syndrome (P0.05). In multivariate analysis, chronic graft-versus-host disease was a significant risk factor for dry eye syndrome.Due to the high incidence of cataract formation and dry eye disease in this population, this study proposes these patients be screened using examinations by a pediatric or general ophthalmologist at least every year.

This self repair system is based upon harmless ground borne bacteria as the self-healing agent. The bacteria are activated after the concrete is cracked and the bacterial spores are exposed to moisture and air. The bacterial reproduction process creates a calcite by-product which fills the cracks in the concrete. By sealing the cracks in concrete, an effective barrier to air or liquid borne deleterious materials are formed and as a consequence of this, enhanced durability is achieved in the structure, resulting in lower life cycle costs. The concrete/mortar prisms were cracked and tested for water flow. They were then left for 56 days to heal and were subject to a test for water tightness. Healing was observed and a reduced water flow (74% and 32% healed) measured with the healed samples when compared to the specimens that were cracked and subjected to a water flow test without any healing agent. The number of samples were limited and a larger scale test is recommended for further work; however, this is a proof of concept of the process of healing and testing.

A novel suite of instrumentation for the characterisation of materials held inside an air-tight tube furnace operated up to 250 °C has been developed. Real-time detection of released gases (volatile organic compounds (VOCs), CO2, NO, NO2, SO2, CO and O2) was achieved combining commercial off-the-shelf (COTS) gas sensors and sorbent tubes for further qualitative and semi-quantitative analysis by gas chromatography-mass spectrometry coupled to thermal desorption (TD-GC-MS). The test system was designed to provide a controlled flow (1000 cm3 min−1) of hydrocarbon free air through the furnace. The furnace temperature ramp was set at a rate of 5 °C min−1 with 10 min dwell points at 70 °C, 150 °C, 200 °C and 250 °C to allow time for stabilisation and further headspace sampling onto sorbent tubes. Experimental design of the instrumentation is described here and an example data set upon exposure to a gas sample is presented.

Aims: The FreeStyle Libre (FSL) flash glucose monitoring device was made available on the UK National Health Services (NHS) drug tariff in 2017. This national audit aims to explore the UK real world experience of FSL and the impact on glycaemic control. Methods: Clinicians were invited to submit FSL user data to a secure web-based tool held within the NHS N3 network. Data were analysed from available initial submissions from the 60 out of 120 NHS hospital trusts registered for the audit. R3.5.0 was used for statistical analysis and T-test was used to compare the baseline and follow-up HbA1c. Within-person variations of HbA1c calculated adj-HbA1c-SD=SD/sq. Root [n/(n−1)]. Results: Data were available for 2,438 (2,348 people with type 1 diabetes) FSL users; age 34(IQR =19-51) years, 54% female, diabetes duration 14 (IQR=19-51) years, and BMI of 24(IQR=21-28) kg/m2 and participants had 10 (IQR=7-12) scans/day. The baseline HbA1c was 67.8(±17) (8.4%), and after a median follow-up of 6 months (n=625) HbA1c reduced to 61.8 (±14) (7.8%) mmol/l (P8.5%) mmol/mol; HbA1c reduced from 85.8 mmol/mol (±15) (10%) to 73.1 mmol/mol (±15) (8.8%)). FSL use was also associated with reduced within-person HbA1c variability (5.37 pre-FSL vs. 3.15 post-FSL, P Conclusions: These initial FSL audit data demonstrate significantly improved glycaemic control, reduction in HbA1c variability and less hyperglycaemia related hospital admissions in the first 6 months follow-up. Data collection is ongoing. Further analyses with longer follow-up may confirm these findings and inform future clinical practice and policy. Disclosure H. Deshmukh: None. E.G. Wilmot: Advisory Panel; Self; Dexcom, Inc. Research Support; Self; Diabetes UK. Speaker's Bureau; Self; Abbott, Eli Lilly and Company, Novo Nordisk Inc., Sanofi. D. Bishop: None. D.W. Lipscomb: Advisory Panel; Self; Sanofi. Speaker's Bureau; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Novo Nordisk A/S, Sanofi. Stock/Shareholder; Self; ABCAM, EKF Diagnostics, GlaxoSmithKline plc., Renalytix AI PLC. R. Banatwalla: None. R. Zaidi: None. Z.V. Smith: None. L. Overend: Other Relationship; Self; Lilly Diabetes, Novo Nordisk Inc. S. Kamaruddin: None. C.M. Hall: None. J. Macfadyen: None. A. Kilvert: Advisory Panel; Self; Sanofi. R.E. Ryder: Advisory Panel; Self; Novo Nordisk A/S. Speaker's Bureau; Self; Bioquest. C. Walton: Advisory Panel; Spouse/Partner; Celgene Corporation. Speaker's Bureau; Spouse/Partner; Leo Pharma, Novartis Pharmaceuticals Corporation. T. Sathyapalan: Speaker's Bureau; Self; Novo Nordisk Foundation. Other Relationship; Self; Bristol-Myers Squibb Company, Eli Lilly and Company, Sanofi-Aventis. Funding Association of British Clinical Diabetologists

The FSL flash glucose monitoring device can reduce hypoglycaemia in people with diabetes. This national audit explores UK real world experience of FSL with respect to hypoglycaemia awareness in people with diabetes. Clinicians using FSL were invited to submit data to a secure web-based tool held within the NHS N3 network. Data were analysed from available initial submissions from the 60 out of 120 NHS trusts registered for the audit. R3.5 was used for statistical analysis and T-test and Mann Whitney-U tests was used to compare the baseline and follow-up GOLD score and brief Diabetes Distress Screening Score (DDSS) respectively. Data were available for 2,438 (2,348 people with type 1 diabetes) FSL users; age 34(IQR =19-51) years, 54% female, diabetes duration 14 (IQR=19-51) years, and BMI of 24(IQR=21-28) kg/m2. In those with follow-up and baseline GOLD score (n=566), the median Gold score decreased significantly from 3.29(±1.85) at baseline to 2.79(±1.91), P Disclosure E.G. Wilmot: Advisory Panel; Self; Dexcom, Inc. Research Support; Self; Diabetes UK. Speaker's Bureau; Self; Abbott, Eli Lilly and Company, Novo Nordisk Inc., Sanofi. H. Deshmukh: None. D. Bishop: None. D.W. Lipscomb: Advisory Panel; Self; Sanofi. Speaker's Bureau; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Novo Nordisk A/S, Sanofi. Stock/Shareholder; Self; ABCAM, EKF Diagnostics, GlaxoSmithKline plc., Renalytix AI PLC. R. Banatwalla: None. R. Zaidi: None. Z.V. Smith: None. L. Overend: Other Relationship; Self; Lilly Diabetes, Novo Nordisk Inc. S. Kamaruddin: None. C.M. Hall: None. A. Kilvert: Advisory Panel; Self; Sanofi. J. Macfadyen: None. T. Sathyapalan: Speaker's Bureau; Self; Novo Nordisk Foundation. Other Relationship; Self; Bristol-Myers Squibb Company, Eli Lilly and Company, Sanofi-Aventis. C. Walton: Advisory Panel; Spouse/Partner; Celgene Corporation. Speaker's Bureau; Spouse/Partner; Leo Pharma, Novartis Pharmaceuticals Corporation. R.E. Ryder: Advisory Panel; Self; Novo Nordisk A/S. Speaker's Bureau; Self; Bioquest.

Public willingness to use decentralised sanitation facilities or arising water products is discouraged due to malodour, preventing improved sanitation practices or water reuse opportunities in low income countries. Whilst odour is characterised in the gas phase, it originates in the liquid phase. Consequently, controlling odour at source could prevent gas-phase partitioning and limit produced water contamination. This study therefore developed an analytical method for the quantitation of a range of liquid phase volatile organic compounds (VOCs) classified into eight chemical groups, known to be primary indicators of faecal odour, to provide characterisation of real fluids and to permit evaluation of several potential membrane separation technologies for liquid phase odourant separation. The gas chromatography mass spectrometry method provided quantitation in the range of 0.005 mg L−1 to 100 mg L−1 with instrument detection limits ranging from 0.005 mg L−1 to 0.124 mg L−1. Linear calibration curves were achieved (r2 > 0.99) with acceptable accuracy (77-115%) and precision (

This paper demonstrates that highly reflective Cr/B₄C multilayer interference coatings with nanometric layer thicknesses, designed to operate in the soft X-ray photon energy range, have stable reflective performance for a period of 3 years after deposition. The microstructure and chemical composition of layers and interfaces within Cr/B₄C multilayers is also examined, with emphasis on the B₄C-on-Cr interface where a significant diffusion layer is formed and on the oxide in the top B₄C layer. Multiple characterization techniques (X-ray reflectivity at different photon energies, X-ray photoelectron spectroscopy, transmission electron microscopy, electron diffraction and X-ray diffraction) are employed and the results reveal a consistent picture of the Cr/B₄C layer structure.

PURPOSE: To investigate ocular complications associated with bone marrow transplant and associated continued maintenance therapy in a preschool population. METHODS: The medical records of patients

The developed world has seen an alarming increase in the incidence of gastrointestinal diseases, among the most common of which is Crohn’s disease (CD) in the young. The current “gold standard” techniques for diagnosis are often costly, time consuming, inefficient, invasive, and offer poor sensitivities and specificities. This paper compares the performances of three hyphenated instrumental techniques that have been suggested as rapid methods for the non‐invasive diagnosis of CD from urine. These techniques are gas chromatography‐mass spectrometry (GC‐MS), high performance liquid chromatography‐mass spectrometry (HPLC‐MS) and selected ion flow tube mass spectrometry (SIFT‐MS). Each of these techniques is followed by multivariate classification to provide a diagnosis based on the acquired data. The most promising results for potentially diagnosing CD was via HPLC‐MS. An overall classification accuracy of 73% (74% specificity; 73% sensitivity) was achieved for differentiating CD from healthy controls, statistically significant at 95% confidence.

Experiments into the relationship between diet and health have been an area of high interest for a long time. In this study, we investigate the application of multivariate data analysis to differentiate between rat populations fed on two different diets: normal rat diet (control) and Western affluent diet (WAD). Two sets of data were acquired and analysed: one from a biochemical clinical analyser, taking measurements of blood-based biochemical markers; the other from the analysis of the volatile organic compounds (VOCs) emitted from faecal samples from the same animals using selected ion flow tube mass spectrometry (SIFT-MS). Five classes were considered: weanlings, 12 month controls, 12 month WADs, 18 month controls, and 18 month WADs. Data from the biochemical analyser, weanlings and 18 month WAD fed rats showed significant differences from the other measurement classes. This was shown in both the exploratory analysis and through multivariate classification. Classification of control diet versus WAD diets suggested there are differences between classes with 92% accuracy for the 12 month classes and 91% for the 18 month classes. Cholesterol markers, especially as low density lipoprotein-cholesterol (LDL), were the main factor in influencing WAD samples. The data from the SIFT-MS analysis also produced very good classification accuracies. Classification of control diet versus WAD diets using the H3O(+) precursor ion data suggested there are differences between classes with 71% accuracy for the 12 month classes and 100% for the 18 month classes. These findings confirm that total cholesterol and LDL-cholesterol are elevated in the 18 month WAD-fed rats. We therefore suggest that the analysis of VOCs from faecal samples in conjunction with multivariate data analysis may be a useful alternative to blood analysis for the detection of parameters of health.

Laser spectroscopy provides the basis of instrumentation developed for the diagnosis of infectious disease, via quantification of organic biomarkers that are produced by associated bacteria. The technology is centred on a multichannel pulsed quantum cascade laser system that allows multiple lasers with different wavelengths to be used simultaneously, each selected to monitor a different diagnostic biomarker. The instrument also utilizes a hollow silica waveguide (HSW) gas cell which has a very high ratio of interaction pathlength to internal volume. This allows sensitive detection of low volume gas species from small volume biological samples. The spectroscopic performance of a range of HSW gas cells with different lengths and bore diameters has been assessed using methane as a test gas and a best-case limit of detection of 0.26 ppm was determined. The response time of this cell was measured as a 1,000 sccm flow of methane passed through it and was found to be 0.75 s. These results are compared with those obtained using a multi-pass Herriot cell. A prototype instrument has been built and approved for clinical trials for detection of lung infection in acute-care patients via analysis of ventilator breath. Demonstration of the instrument for headspace gas analysis is made by monitoring the methane emission from bovine faeces. The manufacture of a hospital-ready device for monitoring biomarkers of infection in the exhaled breath of intensive care ventilator patients is also presented.

Gastrointestinal diseases such as irritable bowel syndrome, Crohn’s disease (CD) and ulcerative colitis are a growing concern in the developed world. Current techniques for diagnosis are often costly, time consuming, inefficient, of great discomfort to the patient, and offer poor sensitivities and specificities. This paper describes the development and evaluation of a new methodology for the non-invasive diagnosis of such diseases using a combination of gas chromatography mass spectrometry (GC–MS) and chemometrics. Several potential sample matrices were tested: blood, breath, faeces and urine. Faecal samples provided the only statistically significant results, providing discrimination between CD and healthy controls with an overall classification accuracy of 85 % (78 % specificity; 93 % sensitivity). Differentiating CD from other diseases proved more challenging, with overall classification accuracy dropping to 79 % (83 % specificity; 68 % sensitivity). This diagnostic performance compares well with the gold standard technique of colonoscopy, suggesting that GC–MS may have potential as a non-invasive screening tool.

Background: The aim of this study was to determine whether volatile organic compounds (VOCs) present in the headspace of feces could be used to diagnose or distinguish between chronic diseases of the gastrointestinal tract and apparently healthy volunteers. Methods: A total of 87 people were recruited, divided between 4 categories: healthy volunteers (n = 19), Crohn's disease (n = 22), ulcerative colitis (n = 20), and irritable bowel syndrome (n = 26). They each supplied fecal samples before, and except for the healthy volunteers, after treatment. Fecal samples were incubated in a sample bag with added purified air at 40[degrees]C and headspace samples were taken and concentrated on thermal sorption tubes. Gas chromatography-mass spectrometry then desorbed and analyzed these. The concentrations of a selection of high-abundance compounds were determined and assessed for differences in concentration between the groups. Results: Crohn's disease samples showed significant elevations in the concentrations of ester and alcohol derivates of short-chain fatty acids and indole compared with the other groups; indole and phenol were elevated in ulcerative colitis and irritable bowel syndrome but not at a statistically significant level. After treatment, the levels of many of the VOCs were significantly reduced and were more similar to those concentrations in healthy controls. Conclusions: The abundance of a number of VOCs in feces differs markedly between Crohn's disease and other gastrointestinal conditions. Following treatment, the VOC profile is altered to more closely resemble that of healthy volunteers.

Little information exists regarding pediatric contrast-enhanced US. To assess the safety and feasibility of contrast-enhanced US of pediatric abdominal and pelvic tumors. This prospective study included eight boys and five girls (mean age, 10.8 years) with abdominal or pelvic tumors. Cohorts of three subjects underwent US with perflutren contrast agent at escalating dose levels. Neurological and funduscopic examination, electrocardiography and continuous pulse oximetry were performed before and after contrast administration. Three radiologists independently scored six imaging parameters on pre- and postcontrast sonography. Inter-reviewer agreement was measured by the Kappa statistic. No neurological, retinal, electrocardiographical or pulse oximetry changes were attributable to the contrast agent. Two subjects reported minor, transient symptoms. Postcontrast US parameter scores improved slightly in 8 of 12 subjects. Postcontrast ultrasound inter-reviewer agreement improved slightly for detection of tumor margins (precontrast = 0.20, postcontrast = 0.26), local tumor invasion (precontrast = -0.01, postcontrast = 0.10) and adenopathy (precontrast = 0.35, postcontrast = 0.44). Although our sample size is small, perflutren contrast agents appear to be safe and well tolerated in children. Contrast-enhanced sonography of pediatric abdominal and pelvic tumors is feasible, but larger studies are needed to define their safety and efficacy in children.

Coal tars have been identified as posing a threat to human health due to their toxic, mutagenic and carcinogenic characteristics. Workers involved in former gasholders decommissioning are potentially exposed to relevant concentrations of volatile and semi-volatile hydrocarbons upon opening up derelict tanks and during tar excavation/removal. While information on contaminated sites air-quality and its implications on medium-long term exposure is available, acute exposure issues associated with the execution of critical tasks are less understood. Calculations indicated that the concentration of a given contaminant in the gasholder vapour phase only depends on the coal tar composition, being only barely affected by the presence of water in the gasholder and the tar volume/void space ratio. Fugacity modelling suggested that risk-critical compounds such as benzene, naphthalene and other monocyclic and polycyclic aromatic hydrocarbons may gather in the gasholder air phase at significant concentrations. Gasholder emissions were measured on-site and compared with the workplace exposure limits (WELs) currently in use in UK. While levels for most of the toxic compounds were far lower than WELs, benzene air-concentrations where found to be above the accepted threshold. In addition due to the long exposure periods involved in gasholder decommissioning and the significant contribution given by naphthalene to the total coal tar vapour concentration, the adoption of a WEL for naphthalene may need to be considered to support operators in preventing human health risk at the workplace. The Level I fugacity approach used in this study demonstrated its suitability for applications to sealed environments such as gasholders and its further refining could provide a useful tool for land remediation risk assessors. Keywords: Coal tar, Gas emission, Volatile organic compounds, Fugacity, Human health risk

In 1994, Tennessee converted its Medicaid program to a managed care system--TennCare. Graduate medical education (GME) funding by TennCare was linked to several workforce goals that included increasing the number of residents training in primary care and increasing the number of primary care physicians practicing in underserved areas of Tennessee.To determine the effects of the TennCare GME plan on GME and the physician workforce of Tennessee.Bureau of TennCare GME data from 1996-2004 and American Medical Association Physician Masterfile data through 2003.Changes in filled residency positions and number of stipend supplements awarded after implementation of the TennCare GME plan. Changes in physician workforce characteristics between a 5-year period before and after implementation of TennCare.Filled primary care residency positions increased from 839 (45.2%) in 1996 to 906 (47.9%) in 2000, but declined to 862 (43.5%) by 2004. Eleven of 133 available primary care stipend supplements were awarded through 2004. The percentage of physicians remaining in Tennessee after completion of residency decreased from 46.2% before TennCare to 42.4% (P = .087) after implementation of TennCare. U.S. medical graduates remaining in state declined by 5.8% (P = .019).The major goals of the TennCare GME plan have not been achieved. Overall, physician retention has decreased and the number of U.S. medical graduates remaining in state has declined. State policymakers should consider other methods to increase the number of residents training in primary care and ultimately practicing in underserved areas of Tennessee.

Dry eye disease is a well-known late complication of radiation therapy and is often difficult to treat. We evaluated the usefulness of cyclosporine 0.05% ophthalmic emulsion for the treatment of radiation-associated dry eye in children. Eleven children received cyclosporine 0.05% emulsion twice daily after failure of conventional therapy. After 6 months, dry eye manifestations improved in three children (27.3%). The remaining eight children showed no improvement with cyclosporine 0.05% ophthalmic emulsion. These results suggest that twice-daily cyclosporine 0.05% ophthalmic emulsion has limited use in children with refractory radiation-associated chronic dry eye. Pediatr Blood Cancer 2013; 60: E35–E37. © 2013 Wiley Periodicals, Inc.

Retinal vasculitis represents a group of diseases characterized by inflammation affecting the retinal vasculature. It is an uncommon disorder that may occur as an isolated disease or more commonly in association with other ocular diseases or a variety of systemic diseases. With a wide variety of disease associations, a search for an underlying etiology should be undertaken based on a meticulous history, review of systems, and physical examination. The laboratory evaluation of patients with retinal vasculitis is an essential component of the work-up to facilitate detection of any underlying disease or to establish a limited differential diagnosis. The management of infectious causes of retinal vasculitis consists of antimicrobial therapy while noninfectious retinal vasculitis is managed with corticosteroids and/or immunosuppressive agents. Because retinal vasculitis is an uncommon disease, there are only a limited number of publications over the past year related to this topic.

Monitoring blood glucose concentrations is a necessary but tedious task for people suffering from diabetes. It has been noted that breath in people suffering with diabetes has a different odour and thus it may be possible to use breath analysis to monitor the blood glucose concentration. Here, we evaluate the analysis of breath using a portable device containing a single mixed metal oxide sensor during hypoglycaemic glucose clamps and compare that with the use of SIFT-MS described in previously published work on the same set of patients. Outputs from both devices have been correlated with the concentration of blood glucose in eight volunteers suffering from type 1 diabetes mellitus. The results demonstrate that acetone as measured by SIFT-MS and the sensor output from the breath sensing device both correlate linearly with blood glucose; however, the sensor response and acetone concentrations differ greatly between patients with the same blood glucose. It is therefore unlikely that breath analysis can entirely replace blood glucose testing.

Coal mining and production is a very large industry within Australia with over 100 active collieries. However, to run at a profit, the coal mines must have continuous production and fulfil large annual quotas. This is generally achieved through the use of the capital intensive, underground, longwall mining technique. This technique requires that the coal seam structure be accurately known ahead of the extraction coal face. Any unknown faulting, unstable roof conditions or gas accumulations encountered while mining can lead to equipment damage, down-time and injury to workers. Thus, the responsibility is on the mine geologist to ensure that the coal seam structure is accurately mapped ahead of mining, to provide a safe mine plan. Before the introduction of the seismic method in coal mining, all coal seam mapping was done using surface boreholes. This is an expensive method to use and provides only a low level of lateral resolution. Seismic methods are gradually replacing boreholes and becoming more common place in coal industry as an accurate and cost effective alternative method for imaging the seam structure. Burton Downs colliery in central Queensland, was one such mine to take advantage of this method as apart of an Underground Feasibility Study for their northern, Kerlong mine area. With no previous seismic work done in the area, reverse vertical seismic profiling (RVSP) and two-dimensional (2-D) surveys were initially shot. RVSP results showed that the seismic method was viable, imaging the coal seam of interest and provided acquisition parameters for the 2-D surveys. The 2-D lines gave high-resolution images of the coal seams within the mine area, and showed a complex faulting system which included low-angle reverse faulting and normal faulting. The success of the 2-D profiles prompted the acquisition of a three-dimensional (3-D) survey. After processing the 3-D depth volume, a much more complete structural interpretation and hence, mine plan could be made.

Objective To review the safety and efficacy of cyclosporine in the treatment of children with severe bilateral sight-threatening intermediate uveitis or panuveitis. Design/participants A retrospective chart review was performed on all children younger than 18 years of age with chronic bilateral sight-threatening uveitis who were treated with cyclosporine. Main outcome measures Assessment of the therapeutic efficacy and development of adverse effects of cyclosporine after 6 months, 2 years, and 4 years of therapy was performed. Results Between 1983 and 1992, 15 children and adolescents were treated with cyclosporine. After 6 months, visual acuity improved or stabilized in 82.1% of eyes, while median vitreous inflammation decreased from 2.0 to 0.5. After 2 and 4 years, visual acuity improved or stabilized in 64% and 75% of eyes, respectively. Median vitreous inflammation remained 0.5 after 2 and 4 years of therapy. Mean creatinine clearance and hemoglobin values decreased and serum creatinine increased after 6 months. After 2 years, only mean hemo- globin values remained decreased. After 4 years, no significant differences were noted in any of the laboratory studies. The most frequently noted side effects included transient increases in serum creatinine in 53%, gingival hyperplasia in 40%, and hirsutism in 20% of patients. Conclusions The authors' results suggest that cyclosporine is a safe and effective therapy for the treatment of children with severe bilateral sight-threatening intermediate uveitis or panuveitis.

Programming is a complex cognitive task for students, because of the difficulty of finding the appropriate elements (the “decomposition” problem) and integrating them correctly into a whole (the “composition” problem). Programming is also hard to learn, because so much of the thinking behind a program is implicit and the process of programming is long and complicated. Our approach is to integrate a computer-aided design tool (CAD) with scaffolding to create a single, cohesive, and coherent workbench for the entire process. Our workbench is called the GPCeditor. We have evaluated its use by high-school students. Our results suggest that students program well in the GPCeditor, they learn good programming practices, and that the learning is occurring through use of the GPCeditor.

Abstract —Syndromes of risk factor disturbance may contribute to the development of coronary heart disease and non–insulin-dependent diabetes mellitus, but their definition and quantification remain problematic. Using factor analysis, constellations of risk factor variables that could indicate distinct syndromes of metabolic disturbance were explored in the baseline data of the first follow-up cohort of 742 men from the Heart Disease and Diabetes Risk Indicators in a Screened Cohort (HDDRISC) study. The primary analysis considered 16 intercorrelated variables measured in more than 90% of cohort participants. A missing-values estimation routine was used to ensure inclusion of all participants in the analysis. Subanalyses were undertaken, including a repeat of the primary analysis on the 522 individuals who had received measurement of HDL cholesterol, an oblique rather than orthogonal factor rotation procedure performed on primary and HDL subset analyses, a repeat of these two primary and HDL subset analyses using only those participants with complete measurements, and a repeat of these six analyses including only the seven variables conventionally associated with the metabolic syndrome. The principal factor that emerged in all analyses undertaken comprised oral glucose tolerance test insulin and glucose response, serum uric acid, and body mass index. Fasting serum triglyceride concentration was included in this factor in 11 of the 12 analyses undertaken, fasting plasma insulin in 8, fasting plasma glucose in 5, and mean arterial pressure in 3. HDL cholesterol factored in isolation from insulin in all analyses undertaken. These findings provide strong support for a core metabolic cluster, which is unlikely to include blood pressure and does not include HDL. The factor scores relating to this cluster will provide a means of assessing its quantitative importance in prospective analysis of the development of CHD and diabetes in this cohort.

The European Spine Phantom (ESP) has recently been developed as a universal standard for instruments measuring bone density. The ESP is composed of three semi-anthropomorphic hydroxyapatite vertebrae of varying densities surrounded by soft tissue equivalent plastic designed to resemble human bone and soft tissue when scanned on bone densitometers. In multi-centre studies it is particularly important to verify that each participating bone densitometer is performing in a stable and linear fashion. The aim of this study was to evaluate the ESP within the context of a multi-centre clinical trial. Eighteen centres in the UK and Canada with dual-energy X-ray absorptiometry (DXA) instruments (Lunar DPX, DPX-alpha and DPX-L) participated in the study. The ESP was scanned 10 times on each instrument without repositioning using standardized protocols. The precision of the bone mineral density (BMD) measurements (LI-3) expressed as a coefficient of variation ranged from 0.4% to 1.1% (mean 0.7%). The mean BMD of each instrument was expressed as a percentage difference from the overall mean and ranged from -1.33% to 1.33%. Linear regression analysis showed that all instruments behaved in a linear fashion across the range of densities with correlation coefficients allor = 0.999 and standard errors of the estimate1.5% of the mean BMD ESP value. The data from this study demonstrate that the ESP is a useful phantom for assessing the linearity, stability and differences between DXA instruments from one manufacturer.

Objectives. We attempted to assess insulin sensitivity in patients with chronic heart failure (CHF) and its relation to disease severity.Background. Peripheral muscular changes influence the progression of heart failure. This effect may be due to chronic disturbances of insulin and glucose metabolism that affect the energy status of skeletal and myocardial muscle.Methods. We investigated insulin sensitivity in 79 men—38 patients with CHF, 21 patients with angiographic evidence of coronary artery disease without CHF and 20 healthy control subjects—and assessed its relation to disease severity, etiology and hormonal status (all subjects had a similar age and body mass index). Insulin sensitivity was estimated by minimal modeling analysis of the glucose and insulin and profiles during a 0.5-g/kg body weight intravenous glucose tolerance test.Results. Compared with control subjects, patients with CHF had similar mean fasting glucose but increased insulin levels (67 vs. 29 pmol/liter, p < 0.002) and a 58% reduced mean insulin sensitivity (2.01 vs. 4.84 min−1/pmol/ml × 105, p < 0.0001). Peak oxygen consumption (Vo2) (r = 0.63), fasting triglycerides (r = −0.62) and age (r = −0.46, all p < 0.001) predicted insulin sensitivity independently. Rest norepinephrine and epinephrine levels, left ventricular ejection fraction and heart failure etiology were not related to insulin sensitivity. Patients with coronary artery disease but no CHF had an intermediate mean insulin sensitivity (3.30 min−1/pmol/ml × 105[−32%, p = 0.042 vs. control subjects; +113%, p = 0.0023 vs. patients with CHF due to ischemic heart disease]). In multivariate analyses of all 79 subjects, age (p = 0.0006), triglycerides (p = 0.0023), fasting insulin (p = 0.0037) and the presence of CHF (p = 0.018) were independent predictors of impaired insulin sensitivity (adjusted joint R2= 0.53, p < 0.0001).Conclusions. CHF is associated with marked insulin resistance, characterized by both fasting and stimulated hyperinsulinemia. Advanced heart failure (in terms of reduced peak Vo2) is related to increased insulin resistance, but this is not directly mediated through ventricular dysfunction or increased catecholamine levels.