Law vs. War: Competing Approaches to Fighting Terrorism

The authors address one of the fundamental assumptions underlying the conduct of the War on Terrorism - the nature of our enemy, whether perpetrators of terrorist activities are criminals or soldiers (combatants). Although the United States recognizes that terrorist acts are certainly illegal, it has chosen to treat perpetrators as combatants; but much of the world, including many of our traditional allies, have opted for a purely legalistic approach. Disagreement about assumptions is not the only basis for divergent policies for confronting terrorism, but certainly explains much of our inability to agree on strategies to overcome what we recognize as a serious common and persistent international problem. Their insights into how our respective cultures and histories influence our definitions, assumptions, and subsequent policy decisions can assist us to respect and learn from competing strategies. They correctly surmise that our current international struggle is too important for us to ignore assumptions underlying our own and competing ideas.https://press.armywarcollege.edu/monographs/1740/thumbnail.jp

By the way … self-confidence -the key to success?

Abstract In the past there has been an abundance of psychological theories suggesting women had an innate fear of success -that a lack of success was somehow inherent to their nature (Lips, 1997). These ideas have been totally discredited, but suspicion of woman's ability to achieve still seems to linger in some quarters -not least among women themselves. Women in a variety of educational and career situations continue to express a lack of confidence in their own abilities. Whether innate or constructed, the issues of women's selfbelief and self-confidence (and the closely related ability to easily move into or "fit"' an existing professional culture and to succeed within that culture) are visited in this paper in the area of women's education, and the professional domains of nursing, law and academe. This article has been peer-reviewed and accepted for publication in SLEID, an international journal of scholarship and research that supports emerging scholars and the development of evidence-based practice in education. © Copyright of articles is retained by authors. As an open access journal, articles are free to use, with proper attribution, in educational and other non-commercial settings

Incidence and progression of diabetic retinopathy within a private diabetes mellitus clinic in South Africa

Objective: The study objective was to examine the influence of glycaemic control and ethnic variations on the incidence and progression of diabetic retinopathy (DR).Design, subjects and setting: Eight hundred and ninety-two persons with type 1 diabetes mellitus, and 1 998 persons with type 2 diabetes mellitus, who were enrolled in a private diabetes mellitus management programme in South Africa, participated in the study. Survival analyses were conducted to assess the relationship between the risk factors and the incidence of DR and referable DR, and the progression of DR.Outcome measures: Cumulative incidence of diabetic retinopathy and referable diabetic retinopathy.Results: The seven-year cumulative incidence of DR and referable DR was 536 and 50 cases per 1 000 persons with type 1 diabetes mellitus without DR at baseline, and 351 and 47 cases per 1 000 persons with type 2 diabetes mellitus. The seven-year cumulative incidence of referable DR was 332 cases per 1 000 persons with type 1 diabetes mellitus with background DR at baseline, and 360 cases with type 2 diabetes mellitus, representing a seven- and eightfold increase compared to no DR at baseline. After controlling for known risk factors for DR, a high baseline haemoglobin A1c (HbA1c) and non-Caucasian ethnicity were associated with the incidence of referable DR in patients with type 1 and type 2 diabetes mellitus.Conclusion: It was revealed in the first study to report on the incidence and progression of DR in South Africa that a high baseline HbA1c, ethnicity, and the presence of background DR increased the risk of the development of referable DR.Keywords: diabetes mellitus, diabetic retinopathy, epidemiology, incidence, risk factors, South Afric

Nutrition Strategies for Triathlon

Contemporary sports nutrition guidelines recommend that each athlete develop a personalised, periodised and practical approach to eating that allows him or her to train hard, recover and adapt optimally, stay free of illness and injury and compete at their best at peak races. Competitive triathletes undertake a heavy training programme to prepare for three different sports while undertaking races varying in duration from 20 min to 10 h. The everyday diet should be adequate in energy availability, provide CHO in varying amounts and timing around workouts according to the benefits of training with low or high CHO availability and spread high-quality protein over the day to maximise the adaptive response to each session. Race nutrition requires a targeted and well-practised plan that maintains fuel and hydration goals over the duration of the specific event, according to the opportunities provided by the race and other challenges, such as a hot environment. Supplements and sports foods can make a small contribution to a sports nutrition plan, when medical supplements are used under supervision to prevent/treat nutrient deficiencies (e.g. iron or vitamin D) or when sports foods provide a convenient source of nutrients when it is impractical to eat whole foods. Finally, a few evidence-based performance supplements may contribute to optimal race performance when used according to best practice protocols to suit the triathlete’s goals and individual responsiveness

Comparative effectiveness of dipeptidyl peptidase-4 (DPP-4) inhibitors and human glucagon-like peptide-1 (GLP-1) analogue as add-on therapies to sulphonylurea among diabetes patients in the Asia-Pacific region: a systematic review

The prevalence of diabetes mellitus is rising globally, and it induces a substantial public health burden to the healthcare systems. Its optimal control is one of the most significant challenges faced by physicians and policy-makers. Whereas some of the established oral hypoglycaemic drug classes like biguanide, sulphonylureas, thiazolidinediones have been extensively used, the newer agents like dipeptidyl peptidase-4 (DPP-4) inhibitors and the human glucagon-like peptide-1 (GLP-1) analogues have recently emerged as suitable options due to their similar efficacy and favorable side effect profiles. These agents are widely recognized alternatives to the traditional oral hypoglycaemic agents or insulin, especially in conditions where they are contraindicated or unacceptable to patients. Many studies which evaluated their clinical effects, either alone or as add-on agents, were conducted in Western countries. There exist few reviews on their effectiveness in the Asia-Pacific region. The purpose of this systematic review is to address the comparative effectiveness of these new classes of medications as add-on therapies to sulphonylurea drugs among diabetic patients in the Asia-Pacific countries. We conducted a thorough literature search of the MEDLINE and EMBASE from the inception of these databases to August 2013, supplemented by an additional manual search using reference lists from research studies, meta-analyses and review articles as retrieved by the electronic databases. A total of nine randomized controlled trials were identified and described in this article. It was found that DPP-4 inhibitors and GLP-1 analogues were in general effective as add-on therapies to existing sulphonylurea therapies, achieving HbA1c reductions by a magnitude of 0.59–0.90% and 0.77–1.62%, respectively. Few adverse events including hypoglycaemic attacks were reported. Therefore, these two new drug classes represent novel therapies with great potential to be major therapeutic options. Future larger-scale research should be conducted among other Asia-Pacific region to evaluate their efficacy in other ethnic groups

Impact of age at type 2 diabetes mellitus diagnosis on mortality and vascular complications: systematic review and meta-analyses

AIMS/HYPOTHESIS: Few studies examine the association between age at diagnosis and subsequent complications from type 2 diabetes. This paper aims to summarise the risk of mortality, macrovascular complications and microvascular complications associated with age at diagnosis of type 2 diabetes. METHODS: Data were sourced from MEDLINE and All EBM (Evidence Based Medicine) databases from inception to July 2018. Observational studies, investigating the effect of age at diabetes diagnosis on macrovascular and microvascular diabetes complications in adults with type 2 diabetes were selected according to pre-specified criteria. Two investigators independently extracted data and evaluated all studies. If data were not reported in a comparable format, data were obtained from authors, presented as minimally adjusted ORs (and 95% CIs) per 1 year increase in age at diabetes diagnosis, adjusted for current age for each outcome of interest. The study protocol was recorded with PROSPERO International Prospective Register of Systematic Reviews (CRD42016043593). RESULTS: Data from 26 observational studies comprising 1,325,493 individuals from 30 countries were included. Random-effects meta-analyses with inverse variance weighting were used to obtain the pooled ORs. Age at diabetes diagnosis was inversely associated with risk of all-cause mortality and macrovascular and microvascular disease (all p < 0.001). Each 1 year increase in age at diabetes diagnosis was associated with a 4%, 3% and 5% decreased risk of all-cause mortality, macrovascular disease and microvascular disease, respectively, adjusted for current age. The effects were consistent for the individual components of the composite outcomes (all p < 0.001). CONCLUSIONS/INTERPRETATION: Younger, rather than older, age at diabetes diagnosis was associated with higher risk of mortality and vascular disease. Early and sustained interventions to delay type 2 diabetes onset and improve blood glucose levels and cardiovascular risk profiles of those already diagnosed are essential to reduce morbidity and mortality. Graphical abstract

Transdermal microconduits by microscission for drug delivery and sample acquisition

BACKGROUND: Painless, rapid, controlled, minimally invasive molecular transport across human skin for drug delivery and analyte acquisition is of widespread interest. Creation of microconduits through the stratum corneum and epidermis is achieved by stochastic scissioning events localized to typically 250 μm diameter areas of human skin in vivo. METHODS: Microscissioning is achieved by a limited flux of accelerated gas: 25 μm inert particles passing through the aperture in a mask held against the stratum corneum. The particles scize (cut) tissue, which is removed by the gas flow with the sensation of a gentle stream of air against the skin. The resulting microconduit is fully open and may be between 50 and 200 μm deep. RESULTS: In vivo adult human tests show that microconduits reduce the electrical impedance between two ECG electrodes from approximately 4,000 Ω to 500 Ω. Drug delivery has been demonstrated in vivo by applying lidocaine to a microconduit from a cotton swab. Sharp point probing demonstrated full anaesthesia around the site within three minutes. Topical application without the microconduit required approximately 1.5 hours. Approximately 180 μm deep microconduits in vivo yielded blood sample volumes of several μl, with a faint pricking sensation as blood enters tissue. Blood glucose measurements were taken with two commercial monitoring systems. Microconduits are invisible to the unaided eye, developing a slight erythematous macule that disappears over days. CONCLUSION: Microscissioned microconduits may provide a minimally invasive basis for delivery of any size molecule, and for extraction of interstitial fluid and blood samples. Such microconduits reduce through-skin electrical impedance, have controllable diameter and depth, are fully open and, after healing, no foreign bodies were visible using through-skin confocal microscopy. In subjects to date, microscissioning is painless and rapid