Diabetes mellitus: a study with special reference to its diagnosis and treatment by general practitioners

In this thesis an attempt has been made to show how the general practitioner may diagnose and treat his diabetic patient in the most efficient manner. In the writer's experience no other condition met with in practice demands the same degree of knowledge and patience, offers the same degree of success and earns the same degree of gratitude from the patient as does the treatment of diabetes. The co-operation of the patient is required more in this disease than in any other, and, as the diabetic is almost invariably an intelligent one, this is obtained in most cases in a whole- hearted manner.The conclusions arrived at from the study of current medical literature on diabetics and from observations made in practice may be summarised as follows: -1. A study of diabetes emphasises the fact that the greatest single factor in the promotion and maintenance of good health is a proper diet both from the quantitative and the qualitative points of view.2. In the production of diabetes mellitus it is suggested that two factors are always present. It is thought that obesity, an infection, heredity or any other recognised associated condition merely acts as a predisposing or exciting factor and that a "specific factor" is also present in every case of the disease. It is further suggested that this "specific factor" may be an ultramicroscopic virus with a special affinity for the islet tissue of the pancreas.3. The early recognition of diabetes, as of all other diseases, is of great importance, and for this reason the early manifestations of the disease should be familiar to all practitioners.4. A yearly medical overhaul of each of his patient is advocated. It is felt that, amongst other conditions many cases of early diabetes would be detected in this way, and consequently a much better prognosis would result.5. Every case of glycosuria met with in practice demands a careful systematic search for the type of sugar present and the cause.6. Only the suspicious case of diabetes requires the performance of the sugar tolerance test. It is generally accepted that a fasting blood-sugar of .13% or over; or a blood-sugar figure of .2% or over one hour after a meal (except in the aged or in the presence of such organic diseases as hyperthyroidism; hyperpituitarism, etc.) denotes true diabetes mellitus, and sugar tolerance tests should not be performed in these cases.7. The prognosis of diabetes more than that of any other disease depends on the treatment and the success of the treatment depends on the zeal of the doctor and the perseverance of the patient.8. It is thought that the term "arrested" instead of "cured" might be used with advantage in those cases becoming sugar -free under treatment.9. It is considered that the optimum diet for the diabetic is the minimum one which will sustain his strength, at the same time keeping his blood- sugar level within normal limits, to which end insulin may have to be employed and if employed then a minimum amount of insulin to achieve this purpose should be administered.10. The careful regulation of the food intake still ! remains the most important factor in the treatment of the diabetic.11. The aim and ideal of diabetic treatment is to keep the blood-sugar within normal limits and the urine sugar -free at all times, thus allowing the pancreas to regenerate and also preventing the occurrence of complications.12. Every patient who is having insulin should receive in the process of determining his insulin dosage an overdose of insulin for two purposes. Firstly to establish his insulin level, and secondly to familiarise him with the symptoms of hypoglycaemia.13. The early clinical manifestations of ketosis are of great importance to the practitioner; firstly as a means of preventing the onset of coma in a known case and secondly as a means of recognising the presence of severe diabetes in an undetected case.14. Coma demands immediate treatment. Experience shows that the longer the patient remains in coma untreated, the more difficult it is to revive him.15. As it appears that the administration of alkalis hinders carbohydrate metabolism, their use in cases of ketosis is discountenanced.16. The importance of every general practitioner carrying a 5 c.c. bottle of double strength insulin in his emergency bag along with his Benedict and ferric chloride reagents is emphasised.17. Expert opinion in this country and in America considers that insulin is the only successful drug in the treatment of those cases of diabetes which do not resnond to dietetic measures alone and in all cases of ketosis. Without exception insulin substitutes are inefficient.18. In spite of the increasing incidence of diabetes mellitus, dietetic measures and insulin are controlling the disease; and, by restoring health to the mild and medium case and by saving the life of the severe case, the lives of many useful citizens are annually preserved

Optimizing the fine lock performance of the Hubble Space Telescope fine guidance sensors

This paper summarizes the on-orbit performance to date of the three Hubble Space Telescope Fine Guidance Sensors (FGS's) in Fine Lock mode, with respect to acquisition success rate, ability to maintain lock, and star brightness range. The process of optimizing Fine Lock performance, including the reasoning underlying the adjustment of uplink parameters, and the effects of optimization are described. The Fine Lock optimization process has combined theoretical and experimental approaches. Computer models of the FGS have improved understanding of the effects of uplink parameters and fine error averaging on the ability of the FGS to acquire stars and maintain lock. Empirical data have determined the variation of the interferometric error characteristics (so-called 's-curves') between FGS's and over each FGS field of view, identified binary stars, and quantified the systematic error in Coarse Track (the mode preceding Fine Lock). On the basis of these empirical data, the values of the uplink parameters can be selected more precisely. Since launch, optimization efforts have improved FGS Fine Lock performance, particularly acquisition, which now enjoys a nearly 100 percent success rate. More recent work has been directed towards improving FGS tolerance of two conditions that exceed its original design requirements. First, large amplitude spacecraft jitter is induced by solar panel vibrations following day/night transitions. This jitter is generally much greater than the FGS's were designed to track, and while the tracking ability of the FGS's has been shown to exceed design requirements, losses of Fine Lock after day/night transitions are frequent. Computer simulations have demonstrated a potential improvement in Fine Lock tracking of vehicle jitter near terminator crossings. Second, telescope spherical aberration degrades the interferometric error signal in Fine Lock, but use of the FGS two-thirds aperture stop restores the transfer function with a corresponding loss of throughput. This loss requires the minimum brightness of acquired stars to be about one magnitude brighter than originally planned

Information and Communication Technology in Child Welfare: The Need for Culture-Centered Computing

This article discusses the introduction of information and communication technology (ICT) in the California child welfare system. Drawing from anthropological literature, the authors emphasize the role of work practice and context associated with new ICT implementation. This case study uses a documentary- historical approach to analyze interviews with 386 workers who used the Child Welfare Services/Case Management System (CWS/CMS) between 1997 and 2005. Data show the implementation of CWS/CMS impacted the work practice of the welfare system. The authors recommend culture-centered computing for future developments and upgrades of ICT in child welfare

A comparison of the fluency of oral, written and multiple-choice recall after silent reading of five grade levels

Thesis (Ed.M.)--Boston Universit

International Trade Law

This course examines the process and substance of international trade law, focusing primarily on the law of the World Trade Organization and secondarily on the law of regional trade organizations and the foreign trade law of the United States. We will begin with an overview of issues relating to the concept of free trade, the institutionalization of international trade, the relationship between U.S. and international trade law, and WTO dispute settlement. Next, we will cover the legal principles and rules of international trade. Throughout the course, we will refer to economic and political debates and use analytical methods in these disciplines to augment our understanding of international trade law. A major objective of the course is to learn how to engage international trade law in a variety of different practice-oriented settings. Towards that end, this course feature case studies and case-based advocacy

The Principle of Minimum Differentiation Reconsidered: Some New Developments in the Theory of Spatial Competition

The paper is divided into two parts: one-dimensional markets and two-dimensional markets. Also, we develop both one and two-dimensional models. Within each, we distinguish (a) bounded, (b) unbounded but finite, and (c) unbounded, infinite spaces. Among other things, we show: in one dimension, the nature of the space is not, as many investigators have thought, critical; in two dimensions, however, the very existence of equilibrium is seen to depend upon the nature of the space; the commonly-used rectangular customer density function yields results that do not generalize to any other density function; the existence of multiple equilibria in both one and two dimensions is a pervasive phenomenon in any of the spaces studied, and MD occurs only when the number of firms is restricted to two. Although the analysis and discussion are in terms of location theory and are concerned with the relationship between equilibrium configuration of firms and the transport-cost minimizing configuration, many of the results generalize to other forms of differenciation. The conditions under which the results generalize are considered in the concluding section of the paper.

Seasonality in the Surface Energy Balance of Tundra in the Lower Mackenzie River Basin

This study details seasonal characteristics in the annual surface energy balance of upland and lowland tundra during the 1998–99 water year (Y2). It contrasts the results with the 1997–98 water year (Y1) and relates the findings to the climatic normals for the lower Mackenzie River basin region. Both years were much warmer than the long-term average, with Y1 being both warmer and wetter than Y2. Six seasons are defined as early winter, midwinter, late winter, spring, summer, and fall. The most rapid changes in the surface energy balance occur in spring, fall, and late winter. Of these, spring is the most dynamic, and there is distinct asymmetry between rates of change in spring and those in fall. Rates of change of potential insolation (extraterrestrial solar radiation) in late winter, spring, and fall are within 10% of one another, being highest in late winter and smallest in spring. Rates of change in air temperature and ground temperature are twice as large in spring as in fall and late winter, when they are about the same. Rates of change in components of the energy balance in spring are twice and 4 times as large as in fall and late winter, respectively. The timing of snowpack ripening and snowmelt is the major agent determining the magnitude of asymmetry between fall and spring. This timing is a result of interaction between the solar cycle, air temperature, and snowpack longevity. Based on evidence from this study, potential surface responses to a 18C increase in air temperature are small to moderate in most seasons, but are large in spring when increases range from 7% to 10% of average surface energy fluxes