26 research outputs found

    Is the ADA/EASD algorithm for the management of type 2 diabetes (January 2009) based on evidence or opinion? A critical analysis

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    The ADA and the EASD recently published a consensus statement for the medical management of hyperglycaemia in patients with type 2 diabetes. The authors advocate initial treatment with metformin monotherapy and lifestyle modification, followed by addition of basal insulin or a sulfonylurea if glycaemic goals are not met (tier 1 recommendations). All other glucose-lowering therapies are relegated to a secondary (tier 2) status and only recommended for selected clinical settings. In our view, this algorithm does not offer physicians and patients the appropriate selection of options to individualise and optimise care with a view to sustained control of blood glucose and reduction both of diabetes complications and cardiovascular risk. This paper critically assesses the basis of the ADA/EASD algorithm and the resulting tiers of treatment options

    High-resolution optical dating of Late Holocene storm surge deposits – a showcase from Schokland (Noordoostpolder, the Netherlands)

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    Storm surges have a major impact on land use and human habitation in coastal regions. Our knowledge of this impact can be improved by correlating long-term historical storm records with sedimentary evidence of storm surges, but so far few studies have applied such an approach. Here we apply, for the first time, state-of-the-art optically stimulating luminescence (OSL) methods to obtain high-resolution age information on a sequence of Late Holocene storm surge deposits. By combining this chronological framework of storm surges with other reconstruction methods, we investigate the storm surge impact on the former island Schokland, located in a former inlet of the North Sea (central Netherlands). During the Late Holocene, Schokland transformed from a peat area that gradually inundated (~800 CE) via an island in a marginal marine environment (~1600 CE) to a land-locked island in the reclaimed Province of Flevoland (1942 CE). These transitions are recorded in the sediment archive of the island, consisting of silty clay with sandy intervals deposited during storm surges. A series of ten quartz OSL ages, obtained using best-practice methods to deal with incomplete resetting of the OSL signal and dose rate heterogeneity, reveal two periods of storm surge deposition, around 1600 CE and between 1742 and 1822 CE. Historical sources indicate that major storm surges hit Schokland during these periods. Laboratory analyses (thermogravimetry, grain-size, foraminifera, bivalves and ostracods) corroborates the existence of the two sets of storm surge deposits within the clay sequence. Our study sets a benchmark for obtaining robust depositional age constraints from storm surge sediments, and demonstrates the great potential of modern OSL methods to contribute to improved assessment of storm surge risk. © 2018 John Wiley & Sons, Ltd
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