Prescribing insulin in type 1 diabetes mellitus: an update for general practitioners

The pancreas in a non-diabetic patient constantly secretes a small amount of insulin (basal secretion). After meals, a larger amount of insulin is secreted (bolus secretion) to cope with the increased blood glucose that occurs following a meal. The goal of insulin therapy in diabetics is to mimic this secretion pattern to provide enough insulin throughout a 24-hour period to meet the basal requirements and to deliver higher boluses of insulin to meet the glycaemic effect of meals. To achieve good diabetes control, an individually tailored insulin treatment regimen is required.South African Family Practice Vol. 48 (10) 2006: pp. 30-3

Lyman break galaxies and the Ly alpha forest

We use hydrodynamic cosmological simulations to predict correlations between Lyα forest absorption and the galaxy distribution at redshift z 3. The probability distribution function (PDF) of Lyα flux decrements shifts systematically toward higher values in the vicinity of galaxies, reflecting the overdense environments in which these galaxies reside. The predicted signal remains strong in spectra smoothed over 50-200 km s-1, allowing tests with moderate-resolution quasar spectra. The strong bias of high-redshift galaxies toward high-density regions imprints a clear signature on the flux PDF, but the predictions are not sensitive to galaxy baryon mass or star formation rate, and they are similar for galaxies and dark matter halos. The dependence of the flux PDF on galaxy proximity is sensitive to redshift determination errors, with rms errors of 150-300 km s-1 substantially weakening the predicted trends. On larger scales, the mean galaxy overdensity in a cube of 5 or 10 h-1 Mpc (comoving) is strongly correlated with the mean Lyα flux decrement on a line of sight through the cube center. The slope of the correlation is ~3 times steeper for galaxies than for dark matter as a result of galaxy bias. The predicted large-scale correlation is in qualitative agreement with recently reported observational results. However, observations also show a drop in the average absorption in the immediate vicinity of galaxies, which our models do not predict even if we allow the galaxies or active galactic nuclei within them to be ionizing sources. This decreased absorption could be a signature of galaxy feedback on the surrounding intergalactic medium, perhaps via galactic winds. We find that a simplified wind model that eliminates neutral hydrogen in spheres around the galaxies can marginally explain the data. However, because peculiar velocities allow gas at large distances to produce saturated absorption at the galaxy redshift, these winds (or any other feedback mechanism) must extend to comoving radii of ~1.5 h-1 Mpc to reproduce the observations. We also discuss the possibility that extended Lyα emission from the target galaxies fills in the expected Lyα forest absorption at small angular separations

SEMDSA/ACE-SA Guideline for the Management of Hypothyroidism in Adults

Background: Hypothyroidism is a common clinical condition confronting all healthcare practitioners yet there remains uncertainty about the optimal medication and optimum treatment targets. In addition, many patients remain symptomatic despite using recommended medications and attaining recommended treatment targets.Methods: All endocrinologists in South Africa who consented to be part of the guideline process were assigned various aspects of the management of patients with thyroid disease. In each section the current literature was reviewed and the level of evidence was graded. This information was then presented at a guideline meeting. Where evidence was lacking a consensus among participants was adopted.Results: This guideline provides 11 recommendations for the management of primary hypothyroidism, secondary hypothyroidism and subclinical hypothyroidism in adults.Conclusions: This is the first South African guideline for the management of hypothyroidism in adults and represents a comprehensive review of the current literature in an attempt to provide evidence-based guidance for all healthcare practitioners regarding the many clinical aspects encountered when managing patients with hypothyroidism

Continuous subcutaneous insulin infusion therapy in type 1 diabetes: 2013 clinical guidelines and recommendations from the Association of Clinical Endocrinologists of South Africa (ACE-SA)

No Abstract

Optimising use of electronic health records to describe the presentation of rheumatoid arthritis in primary care: a strategy for developing code lists

Background Research using electronic health records (EHRs) relies heavily on coded clinical data. Due to variation in coding practices, it can be difficult to aggregate the codes for a condition in order to define cases. This paper describes a methodology to develop ‘indicator markers’ found in patients with early rheumatoid arthritis (RA); these are a broader range of codes which may allow a probabilistic case definition to use in cases where no diagnostic code is yet recorded. Methods We examined EHRs of 5,843 patients in the General Practice Research Database, aged ≥30y, with a first coded diagnosis of RA between 2005 and 2008. Lists of indicator markers for RA were developed initially by panels of clinicians drawing up code-lists and then modified based on scrutiny of available data. The prevalence of indicator markers, and their temporal relationship to RA codes, was examined in patients from 3y before to 14d after recorded RA diagnosis. Findings Indicator markers were common throughout EHRs of RA patients, with 83.5% having 2 or more markers. 34% of patients received a disease-specific prescription before RA was coded; 42% had a referral to rheumatology, and 63% had a test for rheumatoid factor. 65% had at least one joint symptom or sign recorded and in 44% this was at least 6-months before recorded RA diagnosis. Conclusion Indicator markers of RA may be valuable for case definition in cases which do not yet have a diagnostic code. The clinical diagnosis of RA is likely to occur some months before it is coded, shown by markers frequently occurring ≥6 months before recorded diagnosis. It is difficult to differentiate delay in diagnosis from delay in recording. Information concealed in free text may be required for the accurate identification of patients and to assess the quality of care in general practice

Sibling interaction as a facilitator for talent development in sport

While current research has begun to address parental influences on talent development in sport, sibling interaction remains relatively under-examined. Therefore, this study aimed to explore the underpinning mechanisms through which sibling interaction impacts on talent development. Retrospective phenomenological interviews were conducted with four sets of siblings (N = 9), where at least one sibling had competed to an elite level. Findings revealed several higher-order themes that impacted positively on the talented athletes’ development: regularity of interaction in sport, emotional interpersonal skills, rivalry, resilience, co-operation and separation. Separation appeared as the athlete reached elite status, suggesting that these former mechanisms primarily impact during the development phase. Such findings support and extend the sibling, elite sport and talent development literature and provide valuable insight for both practitioners and academics. Importantly, coaches should consider a sibling’s role as an important mechanism outside of the formal coaching structure for talent development

Maternal psychological distress in primary care and association with child behavioural outcomes at age three

Observational studies indicate children whose mothers have poor mental health are at increased risk of socio-emotional behavioural difficulties, but it is unknown whether these outcomes vary by the mothers’ mental health recognition and treatment status. To examine this question, we analysed linked longitudinal primary care and research data from 1078 women enrolled in the Born in Bradford cohort. A latent class analysis of treatment status and self-reported distress broadly categorised women as (a) not having a common mental disorder (CMD) that persisted through pregnancy and the first 2 years after delivery (N = 756, 70.1 %), (b) treated for CMD (N = 67, 6.2 %), or (c) untreated (N = 255, 23.7 %). Compared to children of mothers without CMD, 3-year-old children with mothers classified as having untreated CMD had higher standardised factor scores on the Strengths and Difficulties Questionnaire (d = 0.32), as did children with mothers classified as having treated CMD (d = 0.27). Results were only slightly attenuated in adjusted analyses. Children of mothers with CMD may be at risk for socio-emotional and behavioural difficulties. The development of effective treatments for CMD needs to be balanced by greater attempts to identify and treat women. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s00787-015-0777-2) contains supplementary material, which is available to authorized users

Specific Human Astrocyte Subtype Revealed by Affinity Purified GFAP+1 Antibody; Unpurified Serum Cross-Reacts with Neurofilament-L in Alzheimer

The human GFAP splice variants GFAPΔ164 and GFAPΔexon6 both result in a GFAP protein isoform with a unique out-of-frame carboxy-terminus that can be detected by the GFAP+1 antibody. We previously reported that GFAP+1 was expressed in astrocytes and in degenerating neurons in Alzheimer's disease brains. In this study we aimed at further investigating the neuronal GFAP+1 expression and we started by affinity purifying the GFAP+1 antibody. The purified antibody resulted in a loss of neuronal GFAP+1 signal, although other antibodies directed against the amino- and carboxy-terminus of GFAPα still revealed GFAP-immunopositive neurons, as described before. With an in-depth analysis of a western blot, followed by mass spectrometry we discovered that the previously detected neuronal GFAP+1 expression was due to cross-reactivity of the antibody with neurofilament-L (NF-L). This was confirmed by double-label fluorescent immunohistochemistry and western blotting with the unpurified GFAP+1 antibody and an antibody against NF-L. Our data imply that NF-L can accumulate in some tangle-like structures in Alzheimer brains. More importantly, the purified GFAP+1 antibody clearly revealed a specific subtype of astrocytes in the adult human brain. These large astrocytes are present throughout the brain, e.g., along the subventricular zone, in the hippocampus, in the striatum and in the spinal cord of controls, Alzheimer, and Parkinson patients. The presence of a specific GFAP-isoform suggests a specialized function of these astrocytes

A Search for MeV to TeV Neutrinos from Fast Radio Bursts with IceCube

We present two searches for IceCube neutrino events coincident with 28 fast radio bursts (FRBs) and 1 repeating FRB. The first improves on a previous IceCube analysis - searching for spatial and temporal correlation of events with FRBs at energies greater than roughly 50 GeV - by increasing the effective area by an order of magnitude. The second is a search for temporal correlation of MeV neutrino events with FRBs. No significant correlation is found in either search; therefore, we set upper limits on the time-integrated neutrino flux emitted by FRBs for a range of emission timescales less than one day. These are the first limits on FRB neutrino emission at the MeV scale, and the limits set at higher energies are an order-of-magnitude improvement over those set by any neutrino telescope