Association of kidney disease measures with risk of renal function worsening in patients with type 1 diabetes

Background: Albuminuria has been classically considered a marker of kidney damage progression in diabetic patients and it is routinely assessed to monitor kidney function. However, the role of a mild GFR reduction on the development of stage 653 CKD has been less explored in type 1 diabetes mellitus (T1DM) patients. Aim of the present study was to evaluate the prognostic role of kidney disease measures, namely albuminuria and reduced GFR, on the development of stage 653 CKD in a large cohort of patients affected by T1DM. Methods: A total of 4284 patients affected by T1DM followed-up at 76 diabetes centers participating to the Italian Association of Clinical Diabetologists (Associazione Medici Diabetologi, AMD) initiative constitutes the study population. Urinary albumin excretion (ACR) and estimated GFR (eGFR) were retrieved and analyzed. The incidence of stage 653 CKD (eGFR < 60 mL/min/1.73 m2) or eGFR reduction > 30% from baseline was evaluated. Results: The mean estimated GFR was 98 \ub1 17 mL/min/1.73m2 and the proportion of patients with albuminuria was 15.3% (n = 654) at baseline. About 8% (n = 337) of patients developed one of the two renal endpoints during the 4-year follow-up period. Age, albuminuria (micro or macro) and baseline eGFR < 90 ml/min/m2 were independent risk factors for stage 653 CKD and renal function worsening. When compared to patients with eGFR > 90 ml/min/1.73m2 and normoalbuminuria, those with albuminuria at baseline had a 1.69 greater risk of reaching stage 3 CKD, while patients with mild eGFR reduction (i.e. eGFR between 90 and 60 mL/min/1.73 m2) show a 3.81 greater risk that rose to 8.24 for those patients with albuminuria and mild eGFR reduction at baseline. Conclusions: Albuminuria and eGFR reduction represent independent risk factors for incident stage 653 CKD in T1DM patients. The simultaneous occurrence of reduced eGFR and albuminuria have a synergistic effect on renal function worsening

Enhanced optical and electrical gas sensing response of sol\u2013gel based NiO\u2013Au and ZnO\u2013Au nanostructured thin films

NiO and ZnO thin films of about 40\u201350 nm thickness with embedded Au nanoparticles have been synthesized with a simple and reliable sol\u2013gel procedure. The nanocomposites films are crystalline and porous and they show optical absorptions in the visible range according to Au nanoparticles concentration. These films have been tested as optical and electrical sensors for pollutant gases detection. A fast and reversible response has been detected for hydrogen, CO and NO2. Au nanoparticles have been found to improve the optical sensing properties of both NiO and ZnO films over the Au surface plasmon resonance peak wavelength range, but also to enhance the ZnO optical response in the near UV range, where Au nanoparticles are optically inactive. Moreover, combining the observed shift in the surface plasmon resonance peak and the different semiconductive type of the two oxides, it has been proved that reducing gases inject electrons into the oxide and then afterward the charge variation is detected by Au nanoparticles. Electrical tests confirm the n-type behavior of ZnO and p-type behavior of NiO, and show good performances at lower temperatures. Moreover, an enhancing effect of Au nanoparticles in the overall sensing performances is observed also in electrical tests

Graphene oxide for gas detection under standard humidity conditions

Graphene oxide (GO) synthesis is the easiest way to functionalize graphene, preserving the high graphene surface to volume ratio. Therefore, GO is a promising candidate for gas sensing applications. In this paper, an easy-to-fabricate and high sensitivity GO-based gas sensor is proposed. The device is fabricated by drop-casting a solution of GO flakes dispersed in water on a prepatterned Si3N4 substrate with 30 mu m spaced Pt electrodes. The sensing material has been studied using scanning electron microscopy and x-ray photoelectron spectroscopy. The large lateral dimensions of the flakes (tens of microns) allow single GO flake to bridge adjacent electrodes. The high quality of the synthesized flakes results in the gas sensor high sensitivity to and low detection limit (20 ppb) of NO2. The gas sensor response to NO2 has been studied in various relative humidity environments and it is demonstrated not to be affected by the presence of water vapor. Finally, the gas sensor responses to acetone, toluene, ethanol, and ammonia are reported

Graphene Oxide as a Practical Solution to High Sensitivity Gas Sensing

Graphene and its related materials have attracted much interest in sensing applications because of their optimized ratio between active surface and bulk volume. In particular, several forms of oxidized graphene have been studied to optimize the sensing efficiency, sometimes moving away from practical solutions to boost performance. In this paper, we propose a practical, high-sensitivity, and easy to fabricate gas sensor based on high quality graphene oxide (GO), and we give the rationale to the high performance of the device. The device is fabricated by drop-casting water-dispersed single-layer GO flakes on standard 30 μm spaced interdigitated Pt electrodes. The exceptional size of the GO flakes (27 μm mean size and ∼500 μm maximum size) allows single GO flake to bridge adjacent electrodes. A typical p-type response is observed by testing the device in both reducing and oxidizing environments. The specific response to NO₂ is studied by varying the operating temperature and the gas concentration. Sensing activity is demonstrated to be mainly mediated by the oxygen functional groups. A 20 ppb detection limit is measured. Besides illustrating a simple and efficient approach to gas sensing, this work is an example of the versatility of graphene oxide, accomplishing tasks that are complementary to graphene

Graphene Oxide as a Practical Solution to High Sensitivity Gas Sensing

Graphene and its related materials have attracted much interest in sensing applications because of their optimized ratio between active surface and bulk volume. In particular, several forms of oxidized graphene have been studied to optimize the sensing efficiency, sometimes moving away from practical solutions to boost performance. In this paper, we propose a practical, high-sensitivity, and easy to fabricate gas sensor based on high quality graphene oxide (GO), and we give the rationale to the high performance of the device. The device is fabricated by drop-casting water-dispersed single-layer GO flakes on standard 30 mu m spaced interdigitated Pt electrodes. The exceptional size of the GO flakes (27 mu m mean size and similar to 500 mu m maximum size) allows single GO flake to bridge electrodes. A typical p-type response is observed by testing the device in both reducing and oxidizing environments. The specific response to NO2 is studied by varying the operating temperature and the gas concentration. Sensing activity is demonstrated to be mainly mediated by the oxygen functional groups. A 20 ppb detection limit is measured. Besides illustrating a simple and efficient approach to gas sensing, this work is an example of the versatility of graphene oxide, accomplishing tasks that are complementary to graphene. adjacen

[AMD Annals: a model of continuous monitoring and improvement of the quality of diabetes care].

OBJECTIVE: in recent years, several initiatives have been launched by the Associazione medici diabetologi (AMD) in the context of a national quality improvement program.These activities include: identification of specific indicators of quality of diabetes care, development of a software to calculate such indicators by using routine clinical data, creation of a network of diabetes clinics and analysis and publication of the results in ad hoc reports (AMD Annals). Through the best performer approach, each centre could compare its own performance not only with the theoretical targets suggested by existing guidelines, but also with the results achieved by the best centres operating within the same healthcare system.We evaluated whether the involvement of diabetes clinics into the AMD Annals initiative improved the quality of care over 4 years. DESIGN: a controlled before and after study was performed to compare data collected from 2004 to 2007 by two groups of centres: group A included centres that had been involved in the project since the first edition of AMD Annals; group B included centres only involved in the last edition. SETTING AND PARTICIPANTS: overall, 124 diabetes clinics provided data on over 100,000 type 2 diabetes patients/year seen from 2004 to 2007. MAIN OUTCOME MEASURES: process indicators included the proportion of patients with at least one measurement of HbA1c, blood pressure and lipid profile during the previous 12 months. Intermediate outcomes included percentages of patients with levels of HbA1c ≤ 7%, blood pressure ≤ 130/85 mmHg and LDL-cholesterol <100 mg/dl (favourable indicators), and the percentages of patients with levels of HbA1c ≥ 9%, blood pressure ≥ 140/90 mmHg and LDL-cholesterol ≥ 130 mg/dl (unfavourable indicators). Percentages of patients treated with insulin, two or more antihypertensive agents, and statins were also evaluated. A multilevel analysis adjusted for age, gender, diabetes duration, and clustering effect was applied to investigate the changes in the indicators between the two groups of centres during 4 years. RESULTS: lipid profile monitoring increased more in group A (+6.2% from 2004 to 2007) than in group B (+2.4%), while HbA1c and blood pressure monitoring did not change over time in both groups. As for the outcomes considered, the percentage of patients with HbA1c ≤ 7% increased by 6% in group A and by 1.3%in group B, while the proportion of patients achieving the blood pressure target increased in group A (+6.4%), but not in group B (-1.4%). A reduction in the percentage of patients with blood pressure ≥ 140/90 mmHg was found in group A (-7.3%) but not in group B (-0.9%). Marked improvements in the proportion of patients with LDL-cholesterol at target were documented in both groups (group A: +10.5%; group B: +12.2%.) The proportion of patients treated with insulin increased in group A only (+5.8%), while the use of statins grew by 20%in both groups.The proportion of individuals treated with two or more antihypertensive drugs increased by 3.6% in group A and by 1.6% in group B. CONCLUSION: the AMD Annals approach can be considered as a case model for quality improvement activities in chronic diseases and a tool to evaluate the level of adoption/acceptance of guidelines in clinical practice. The considerable success documented was obtained without allocation of extra resources or financial incentives but simply through a physician-led effort made possible by the commitment of the specialists involved

AMD Annals: a model of continuous monitoring and improvement of the quality of diabetes care

OBJECTIVE: in recent years, several initiatives have been launched by the Associazione medici diabetologi (AMD) in the context of a national quality improvement program.These activities include: identification of specific indicators of quality of diabetes care, development of a software to calculate such indicators by using routine clinical data, creation of a network of diabetes clinics and analysis and publication of the results in ad hoc reports (AMD Annals). Through the best performer approach, each centre could compare its own performance not only with the theoretical targets suggested by existing guidelines, but also with the results achieved by the best centres operating within the same healthcare system.We evaluated whether the involvement of diabetes clinics into the AMD Annals initiative improved the quality of care over 4 years. DESIGN: a controlled before and after study was performed to compare data collected from 2004 to 2007 by two groups of centres: group A included centres that had been involved in the project since the first edition of AMD Annals; group B included centres only involved in the last edition. SETTING AND PARTICIPANTS: overall, 124 diabetes clinics provided data on over 100,000 type 2 diabetes patients/year seen from 2004 to 2007. MAIN OUTCOME MEASURES: process indicators included the proportion of patients with at least one measurement of HbA1c, blood pressure and lipid profile during the previous 12 months. Intermediate outcomes included percentages of patients with levels of HbA1c ≤ 7%, blood pressure ≤ 130/85 mmHg and LDL-cholesterol <100 mg/dl (favourable indicators), and the percentages of patients with levels of HbA1c ≥ 9%, blood pressure ≥ 140/90 mmHg and LDL-cholesterol ≥ 130 mg/dl (unfavourable indicators). Percentages of patients treated with insulin, two or more antihypertensive agents, and statins were also evaluated. A multilevel analysis adjusted for age, gender, diabetes duration, and clustering effect was applied to investigate the changes in the indicators between the two groups of centres during 4 years. RESULTS: lipid profile monitoring increased more in group A (+6.2% from 2004 to 2007) than in group B (+2.4%), while HbA1c and blood pressure monitoring did not change over time in both groups. As for the outcomes considered, the percentage of patients with HbA1c ≤ 7% increased by 6% in group A and by 1.3%in group B, while the proportion of patients achieving the blood pressure target increased in group A (+6.4%), but not in group B (-1.4%). A reduction in the percentage of patients with blood pressure ≥ 140/90 mmHg was found in group A (-7.3%) but not in group B (-0.9%). Marked improvements in the proportion of patients with LDL-cholesterol at target were documented in both groups (group A: +10.5%; group B: +12.2%.) The proportion of patients treated with insulin increased in group A only (+5.8%), while the use of statins grew by 20%in both groups.The proportion of individuals treated with two or more antihypertensive drugs increased by 3.6% in group A and by 1.6% in group B. CONCLUSION: the AMD Annals approach can be considered as a case model for quality improvement activities in chronic diseases and a tool to evaluate the level of adoption/acceptance of guidelines in clinical practice. The considerable success documented was obtained without allocation of extra resources or financial incentives but simply through a physician-led effort made possible by the commitment of the specialists involved