Therapeutic inertia amongst general practitioners with interest in diabetes

Introduction As the therapeutic options in the management of type 2 diabetes increase, there is an increase confusion among health care professionals, thus leading to the phenomenon of therapeutic inertia. This is the failure to escalate or de-escalate treatment when the clinical need for this is required. It has been studied extensively in various settings, however, it has never been reported in any studies focusing solely on primary care physicians with an interest in diabetes. This group is increasingly becoming the focus of managing complex diabetes care in the community, albeit with the support from specialists. Methods In this retrospective audit, we assessed the prevalence of the phenomenon of therapeutic inertia amongst primary care physicians with an interest in diabetes in UK. We also assessed the predictive abilities of various patient level characteristics on therapeutic inertia amongst this group of clinicians. Results Out of the 240 patients reported on, therapeutic inertia was judged to have occurred in 53 (22.1%) of patients. The full model containing all the selected variables was not statistically significant, p = 0.59. So the model was not able to distinguish between situations in which therapeutic inertia occurred and when it did not occur. None of the patient level characteristics on its own was predictive of therapeutic inertia. Conclusion Therapeutic inertia was present only in about a fifth of patient patients with diabetes being managed by primary care physicians with an interest in diabetes

2D bio-based nanomaterial as a green route to amplify the formation of hydrate phases of cement composites:Atomistic simulations and analytical characterization

Ordinary Portland cement (OPC) is the binding element in concrete materials and, CO2 emissions associated with its manufacturing and use is about 8% of the world's CO2 emissions. The engineering properties of hardened concrete depend on the amount of the hydrate phases in OPC. If the growth of the hydrate phases could be increased, the performance of concrete would be significantly improved, and the consumption of OPC will be decreased, and its environmental footprint will be reduced. In this paper, we present a new green approach for controlling the growth of the hydrate phases in OPC using bio flakes composed of staked carrot-based two-dimensional (2D) nanosheets (CNSs) synthesized from carrot waste. Density-functional theory and reactive molecular dynamics (DFT-MD) simulations were carried out in conjunction with analytical characterization to examine the interfacial interaction between CNS with tricalcium silicate Ca3SiO5 (C3S), the main constituent of OPC and understand how they influence the growth of the hydrate phases in OPC. The DFT-MD simulations results show the 2D CNS dissolves due to its interfacial interaction with the highly reactive C3S, leading to a series of fast proton exchange in C3S. This in return accelerates the dissolution rate of C3S thereby amplifying the growth of the hydrate phases. The DFT-MD simulations also show that the dissolution of the 2D CNS creates new several organic compounds that enhance the mobility and dynamics of protons that further amplify the dissolution rate of C3S. The analytical results from scanning electron microscope (SEM), X-ray diffraction (XRD), transmission electron microscopy (TEM), and thermography analysis (TGA) and differential scanning calorimetry (DSC) show a significant growth of the hydrate products in OPC due to interfacial dissolution of C3S and some CNS thus, confirming the DFT-MD results. This work demonstrates that the growth of the hydrate products in OPC can be amplified by the addition of green and renewable 2D bio-based nanomaterials. This green approach provides a base for the design and development of low-carbon cementitious materials

BTS clinical statement for the assessment and management of respiratory problems in athletic individuals

No abstract available