Quality of diabetes care: problem of patient or doctor adherence?

Current guidelines for treatment of type 2 diabetes mellitus include disease prevention and the control of blood pressure and lipids in addition to blood glucose management. However, physician compliance with treatment guidelines is relatively poor. In any given year, HbA1c and blood lipids are measured only in about half of patients and are below target in even less, while blood pressure is frequently measured but controlled in less than 50%. Some reasons for this unsatisfactory situation are providers' beliefs, frustration and lack of knowledge, patient barriers and the fact that the guidelines are not easy to access and implement. Patient non-adherence can be changed by improving education, perception, motivation and self-management. Strategies for improving disease management are discussed

How patients with insulin-treated type 1 and type 2 diabetes view their own and their physician's treatment goals.

To investigate the subjective treatment goals of insulin-treated diabetic patients. 297 type 1 and 205 type 2 diabetic patients, representative of the North-western Swiss population, filled out a self report questionnaire focusing on their own treatment goals using standardized measures wherever available. Factor analysis of the 16 items reflecting their treatment goals revealed four subscales (Crohnbach's alpha): High actual quality of life (0.73), weight reduction/maintenance and daily hassles (0.68), good medical care and knowledge (0.64) and good long term glucose control (0.71). Good long term glucose control was the single most important main treatment goal for most patients (type 1: 60.2%, type 2: 49.7%, p = 0.025). However, both type 1 and type 2 diabetic patients believed that this goal - especially the value of HbA1c - was overestimated (both p <0.0001), while high actual quality of life was underestimated (p = 0.003 and p = 0.05, respectively) by their physicians compared to their own assessment. Good long term glucose control (OR 1.63, p = 0.003) and high actual quality of life (OR 2.17, p <0.0001) were more important and weight reduction/maintenance and coping with daily hassles (OR 0.75, p = 0.07) were slightly less important treatment goals for type 1 than for type 2 diabetic patients. These differences in goals were best associated with the mode of insulin therapy, self-monitoring, and with the extent of diabetes education. Patients believe that physicians overestimate the importance of long term glucose control and underestimate the importance of actual quality of life. Diabetes education and self management have the largest impact on patients' own treatment goals

Wind-aided flame spread under oblique forced flow

he wind-aided flame spread process along a solid fuel rod under oblique forced flow is analyzed in absence of gravity or when the forced flow dominates the gravity-induced flow. The transverse velocity is large enough to ensure that mixing of the fuel vapors and air occurs in a thin boundary layer surrounding the fuel rod and we can use the boundary layer approximation to describe the gas-phase chemical reaction and downwind flame spread process. A global, second-order, Arrhenius expression is employed to describe the gas-phase reaction, while the solid surface gasification reaction is modeled in terms of a constant pyrolysis temperature. The solid is heated by the hot gases convected from the flame by the axial component of the velocity in the direction of the flame spread. The solid will be considered thermally thick, assuming the thickness of the heated layer in the solid to be small compared with the rod radius. The analysis determines the flame spread velocity and the flow structure in the flame front region. The analysis also shows that flame spread is not possible at large flow velocities due to finite rate effects, while at low velocities the gas-phase reaction is diffusion-controlled. By including radiation losses from the surface a flame spread limit, at low velocities, is also found in the present analysis. The wind-aided flame spread process along a solid fuel rod under oblique forced flow is analyzed in absence of gravity or when the forced flow dominates the gravity-induced flow. The transverse velocity is large enough to ensure that mixing of the fuel vapors and air occurs in a thin boundary layer surrounding the fuel rod and we can use the boundary layer approximation to describe the gas-phase chemical reaction and downwind flame spread process. A global, second-order, Arrhenius expression is employed to describe the gas-phase reaction, while the solid surface gasification reaction is modeled in terms of a constant pyrolysis temperature. The solid is heated by the hot gases convected from the flame by the axial component of the velocity in the direction of the flame spread. The solid will be considered thermally thick, assuming the thickness of the heated layer in the solid to be small compared with the rod radius. The analysis determines the flame spread velocity and the flow structure in the flame front region. The analysis also shows that flame spread is not possible at large flow velocities due to finite rate effects, while at low velocities the gas-phase reaction is diffusion-controlled. By including radiation losses from the surface a flame spread limit, at low velocities, is also found in the present analysis

Theoretical study of the absorption spectra of the sodium dimer

Absorption of radiation from the sodium dimer molecular states correlating to Na(3s)-Na(3s) is investigated theoretically. Vibrational bound and continuum transitions from the singlet X Sigma-g+ state to the first excited singlet A Sigma-u+ and singlet B Pi-u states and from the triplet a Sigma-u+ state to the first excited triplet b Sigma-g+ and triplet c Pi-g states are studied quantum-mechanically. Theoretical and experimental data are used to characterize the molecular properties taking advantage of knowledge recently obtained from ab initio calculations, spectroscopy, and ultra-cold atom collision studies. The quantum-mechanical calculations are carried out for temperatures in the range from 500 to 3000 K and are compared with previous calculations and measurements where available.Comment: 19 pages, 8 figures, revtex, eps

Comment on "Resolving the 180-deg Ambiguity in Solar Vector Magnetic Field Data: Evaluating the Effects of Noise, Spatial Resolution, and Method Assumptions"

In a recent paper, Leka at al. (Solar Phys. 260, 83, 2009)constructed a synthetic vector magnetogram representing a three-dimensional magnetic structure defined only within a fraction of an arcsec in height. They rebinned the magnetogram to simulate conditions of limited spatial resolution and then compared the results of various azimuth disambiguation methods on the resampled data. Methods relying on the physical calculation of potential and/or non-potential magnetic fields failed in nearly the same, extended parts of the field of view and Leka et al. (2009) attributed these failures to the limited spatial resolution. This study shows that the failure of these methods is not due to the limited spatial resolution but due to the narrowly defined test data. Such narrow magnetic structures are not realistic in the real Sun. Physics-based disambiguation methods, adapted for solar magnetic fields extending to infinity, are not designed to handle such data; hence, they could only fail this test. I demonstrate how an appropriate limited-resolution disambiguation test can be performed by constructing a synthetic vector magnetogram very similar to that of Leka et al. (2009) but representing a structure defined in the semi-infinite space above the solar photosphere. For this magnetogram I find that even a simple potential-field disambiguation method manages to resolve the ambiguity very successfully, regardless of limited spatial resolution. Therefore, despite the conclusions of Leka et al. (2009), a proper limited-spatial-resolution test of azimuth disambiguation methods is yet to be performed in order to identify the best ideas and algorithms.Comment: Solar Physics, in press (19 pp., 5 figures, 2 tables

Clinical Application and Potential of Fecal Microbiota Transplantation

Molecular basis of bacterial pathogenesis, virulence factors and antibiotic resistanc

Fecal microbiota transplantation for Parkinson's disease using levodopa-carbidopa intestinal gel percutaneous endoscopic gastro-jejunal tube

We report a patient with a 5-year diagnosis of akinetic-rigid Parkinson's disease under treatment with Levodopa-Carbidopa Intestinal Gel therapy through a PEG-J tube due to motor complications, in which, in the context of a clinical study, we successfully and safely administered fecal microbiota transplant through a PEG-J.Cellular mechanisms in basic and clinical gastroenterology and hepatolog

All-Optical Broadband Excitation of the Motional State of Trapped Ions

We have developed a novel all-optical broadband scheme for exciting, amplifying and measuring the secular motion of ions in a radio frequency trap. Oscillation induced by optical excitation has been coherently amplified to precisely control and measure the ion's secular motion. Requiring only laser line-of-sight, we have shown that the ion's oscillation amplitude can be precisely controlled. Our excitation scheme can generate coherent motion which is robust against variations in the secular frequency. Therefore, our scheme is ideal to excite the desired level of oscillatory motion under conditions where the secular frequency is evolving in time. Measuring the oscillation amplitude through Doppler velocimetry, we have characterized the experimental parameters and compared them with a molecular dynamics simulation which provides a complete description of the system.Comment: 8 pages, 10 figure