490 research outputs found

    Single temperature for Monte Carlo optimization on complex landscapes

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    We propose a new strategy for Monte Carlo (MC) optimization on rugged multidimensional landscapes. The strategy is based on querying the statistical properties of the landscape in order to find the temperature at which the mean first passage time across the current region of the landscape is minimized. Thus, in contrast to other algorithms such as simulated annealing (SA), we explicitly match the temperature schedule to the statistics of landscape irregularities. In cases where this statistics is approximately the same over the entire landscape, or where non-local moves couple distant parts of the landscape, single-temperature MC will outperform any other MC algorithm with the same move set. We also find that in strongly anisotropic Coulomb spin glass and traveling salesman problems, the only relevant statistics (which we use to assign a single MC temperature) is that of irregularities in low-energy funnels. Our results may explain why protein folding in nature is efficient at room temperatures.Comment: 5 pages, 3 figure

    Children's and youth’s perspectives and participation in park management : a case study of Swedish municipal park management units

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    Kommuner har ett viktigt uppdrag i att inkludera barns och ungas perspektiv och delaktighet i samhĂ€llsutvecklingen. I och med att Barnkonventionen blev svensk lag i januari 2020 har barns och ungas rĂ€tt att höras och vara delaktiga vid beslut som rör dem stĂ€rkts. Det hĂ€r medför en stor utmaning för bland annat de som ansvarar för förvaltningen av utemiljöer, dĂ„ deras arbete har en stark koppling till barns och ungas behov och direkt inverkan pĂ„ deras livsvillkor. Parkförvaltningar har identifierats som en viktig aktör för att förvalta och utveckla barnvĂ€nliga miljöer, dock finns det en osĂ€kerhet om hur detta ska tillĂ€mpas. Den hĂ€r studien har haft som syfte att studera hur parkförvaltningar arbetar med dessa frĂ„gor idag och identifiera viktiga faktorer. En fallstudie med parkförvaltningar frĂ„n tre olika kommuner genomfördes, de valdes baserat pĂ„ att de visat att de aktivt arbetat med barns och ungas delaktighet. Metoden inkluderade semistrukturerade intervjuer med totalt fyra informanter frĂ„n fyra olika avdelningar pĂ„ kommunernas parkförvaltningar, samtliga med erfarenhet av dialogprocesser med barn och unga. Resultaten visar att det finns etablerade arbetsmetoder och strategier pĂ„ förvaltningarna i de undersökta kommunerna. Studien tar upp ett antal exempel pĂ„ hur förvaltningarna arbetar strategiskt för att utveckla lösningar och möta barn och ungas behov. Förvaltningarna möter liknande utmaningar i sitt arbete som utgörs av: begrĂ€sningar i budget, tid, kunskap och personal. Resultaten indikerar att bristande resurser försĂ€mrar barns och ungas möjligheter att vara delaktiga vid förvaltningen och utvecklingen av utemiljön. Förvaltningarnas styrkor definierades som: korta ledtider, projekt som rör barn och unga och samarbeten med skolor, förskolor och fritidsgĂ„rdar för att nĂ„ barn och unga i kommunen. De har Ă€ven etablerade rutiner kring dialogprocesser av varierande form och storlek som inkluderar barns och ungas perspektiv under olika faser av byggprocessen. Behovet av Ă„terkoppling identifieras som en del av erfarenhetsöverföringen inom organisationerna men ocksĂ„ som en viktig aspekt av dialogen med barn och unga. Ett annat förbĂ€ttringsomrĂ„de Ă€r utvecklingen av anpassade kommunikationsvĂ€gar för barn och unga, mer delaktighet pĂ„ policy och operationell nivĂ„ samt implementera olika former av samstyrning frĂ€mjar delaktighet och skapa mer engagemang.Municipalities have an important mission in including children's and young people's perspectives and participation in urban planning. Since the Convention on the Rights of the Child became Swedish law in January 2020, the right of children and young people to be heard and involved in decisions concerning them has been strengthened. This poses a major challenge for, among others, those responsible for the management of outdoor environments, as their work is strongly linked to the needs of children and young people and has a direct impact on their living conditions. Park administrations have been identified as an important factor in managing and developing childïżœfriendly environments, but there is also uncertainty about how this will be applied among managers. This study aims to study how park administrations work with these issues today and identify important factors. A case study with park administrations from three different municipalities was conducted, selected based on the fact that they actively worked with the participation of children and young people. The method included semi-structured interviews with four informants from four different departments of municipal park administrations, all with experience in dialogue processes with children and young people. The results show that there are established work methods and strategies in the administrations of the municipalities examined. The study presents a number of examples of how the administrations work strategically to develop solutions and meet the needs of children and young people. Administrations face similar challenges in their work: budgetary, time and staff limitations. The results indicate that a lack of resources impairs the ability of children and young people to be involved in the management and development of the outdoor environment. However, short lead times and specific projects that concern childrenÂŽs and youthÂŽs places were seen as a possibility for involving children and youth in decision making. The park management reaches children and young people in the municipality mainly through existing collaborations with schools, preschools, and youth centers. They have established routines regarding dialogue processes of varying shape and size that include children's and young people's perspectives during different phases of the construction process. The need for feedback is identified as part of the transfer of experience within organizations but also as an important aspect of dialogue with children and young people in the municipality. Another area of improvement is the development of suitable channels of contact for children and youth to be able to make themselves heard in issues regarding the management of outdoor spaces. They also need to develop adapted communication paths for children and young people, enable more participation at the policy and operational level, and implement different forms of co-governance to promote participation and create more engagement among children and youth

    PICA : a graphical program development tool

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    Kolmivuorotyön vaikutus työhyvinvointiin

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    OpinnÀytetyön tarkoituksena oli kuvata ja auttaa ymmÀrtÀmÀÀn sitÀ, millaisia kokemuksia hoitohenkilökunnalla on kolmivuorotyön vaikutuksesta työhyvinvointiin. OpinnÀytetyö toteutettiin HyvinkÀÀn sairaalan neurologisella osastolla. KohderyhmÀnÀ olivat neurologisen osaston hoitajat, joihin kuului niin sairaanhoitajia kuin perushoitajia. Tavoitteena oli saada tulosten perusteella henkilöstön työhyvinvointiin vaikuttavat tekijÀt kaikkien tietoon ja tÀmÀn pohjalta parantaa henkilöstön jaksamista ja luoda siihen mahdollisesti keinoja. Tutkimus toteutettiin kvalitatiivisena eli laadullisena tutkimuksena. TiedonkeruumenetelmÀnÀ kÀytettiin teemahaastattelua yksilöhaastatteluna. Teemahaastattelu sisÀlsi kuusi eri teemaa: haastateltavien taustoitus, työaikajÀrjestelmÀ, vuorotyö, osaston erityispiirteet, työssÀ jaksaminen ja työhyvinvointi. Teemat ohjasivat haastatteluiden kulkua. OpinnÀytetyön tuloksista kÀy ilmi, ettÀ työhyvinvointiin vaikuttavina tekijöinÀ pidettiin osaston ilmapiiriÀ ja työkavereita. Esimiestyöskentely, mahdollisuus koulutuksiin, oma asenne ja palautteen saaminen työstÀ koettiin myös tÀrkeiksi työhyvinvointia edistÀviksi tekijöiksi. Oman elÀmÀntilanteen koettiin vaikuttavan työssÀ jaksamiseen ja perheen tuki koettiin tÀrkeÀksi voimavaraksi. Työvuorosuunnittelu koettiin työhyvinvointia heikentÀvÀksi tekijÀksi, koska pidemmÀn aikavÀlin suunnitelmia on vaikea tehdÀ. Myös haastavat tilanteet potilastyössÀ, töiden jakautuminen epÀtasaisesti ja epÀkohdista puhuminen tavalla, joka ei tuota tulosta, koettiin työhyvinvointia heikentÀviksi tekijöiksi. Jatkotutkimusaiheena voisi olla esimiestyöskentelyn vaikutus toteutettavaan hoitotyöhön ja henkilöstön työmotivaatioon. Esimerkiksi voisi selvittÀÀ, miten esimiestyöskentely toimisi voimavarana ja mitÀ kehitettÀvÀÀ siinÀ olisi alaisten nÀkökulmasta. LisÀksi eri ammattiryhmien vÀlistÀ yhteistyötÀ ja sen toimivuutta voisi tarkastella lisÀÀ. Voitaisiin esimerkiksi tutkia, miten yhteistyöstÀ saataisiin sujuvaa ja potilaiden hoitoa edistÀvÀÀ.The purpose of this thesis was to describe and help understand the experiences of nursing staff relating to how working in three shifts affects well-being at work. The thesis was conducted at the neurology ward in HyvinkÀÀ Hospital. The target group consisted of the nursing staff at the neurology ward, including nurses, practical nurses and enrolled nurses. The goal was to bring out to everyone at the ward the things that affect well-being at work on the basis of the results, and furthermore, improve the way the nursing staff cope with the work load by possibly creating new means/ways of dealing with it. The study was implemented as a qualitative research. A theme interview as an individual interview was used as the method of data collection. The theme interview consisted of six themes; background information of the people interviewed, working time system, working in shifts, special characteristics of the ward, well-being at work, and coping with the work load. The themes determined how the interviews were conducted. The results of the study show that well-being at work was mostly affected by the atmosphere and the colleagues at the ward. Managerial work, possibility for trainings, the person's own attitude, and getting feedback related to your work were also considered important factors in improving well-being at work.The personal life situation was considered to affect coping with the work load, and support from the family was seen as an important asset. Work shift planning was considered to decrease the well-being at work, because it is difficult to make long-term plans. Furthermore, challenging situations with patients, work load being divided unevenly, and speaking in an unconstructive manner about grievances were considered to decrease the well-being at work. One subject for further studies could be how the managerial work influences the patient care and the work motivation of the staff. One approach to this could be a study exploring how the managerial work works as an asset, and how the subordinates feel that the managerial work could be improved. Also the cooperation between different professions and how the cooperation works could be examined further. In such a study the main purpose could be how to make the cooperation smoother and at the same time improve the patient care

    Place Identity : Sustainability Performance Relationship among Rural Tourism Entrepreneurs

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    Place identity is the symbolic significance that an individual has for a specific place or locality. The term encompasses the ways in which physical and symbolic attributes of certain locations contribute to an individual's sense of identity. Place identity is also related to the concept of place attachment. At the individual level it has been proposed that an individual's positive place identity has a positive effect on pro-environment behavior. The place attachment may also explain an individual's attitudes to environmental concern and issues. Similarly, it has been found that there is a positive relationship between place identity and entrepreneurial performance. Therefore, an interesting question arises: Is there a relationship between place identity and sustainability performance? The objective of this study was to examine the concept of place identity in regarding the sustainability performance relationship of rural tourism enterprises. The theoretical framework is built from place identity and the concept of sustainable development. The material consists of interviews with 24 rural tourism entrepreneurs. The themes of the interviews comprise descriptions of the /countryside/scenery/and cultural heritage, the sense of communality, cooperation with stakeholders, sustainability actions and background information. The rural tourism entrepreneurs were aware of the features of the surrounding countryside and cultural environment and were /inspired/motivated/to protect them in different ways. Entrepreneurs were more aware of the cultural heritage of the place than of natural values. There were no differences as to where the entrepreneurs came from or whether they had a special relationship to the place. The enterprises utilized the historical and cultural elements of the area in their business and in so doing they preserved the heritage, which was a sign of the entrepreneur's place attachment. In most cases the sense of community was perceived as being positive, but the feelings of losing the communality was also expressed. It seems that the place identity has a positive relationship to the sustainability performance of the rural tourism entrepreneurs, but it is not the only reason for entrepreneurs' actions. The finding explains the importance of place identity in the sustainability development, but on the other hand, the study reveals the spectrum of other factors influencing it.Peer reviewe

    Sustainability of boreal and subarctic environment to nature-based tourism

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    Maquis as a vegetationsystem for indoor gardens : a fieldstudy in Lo Zingaro Nature Reserve, Siciliy

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    Inglasade miljöer blir allt vanligare idag, de har ofta ett medelhavsklimat och hyser medelhavsvÀxter (LINDAHL 1992). MÄnga av vÄra vanligaste trÀdgÄrdsvÀxter kommer frÄn medelhavsomrÄdet (PHILIPS 1998). MedelhavsvÀxterna tÄl torra och varma somrar och vill ha en lÄg temperatur vintertid. De övervintras bÀst i ett ljust och frostfritt utrymme vintertid. Inglasade miljöer förlÀnger sÀsongen och inreds gÀrna med vÀxter. Idag byggs stora miljöer med medelhavsklimat som inreds med stora exemplar av palmer, olivtrÀd och andra medelhavsvÀxter. Ett exempel Àr Bovieran (se bild 2), en stor inglasad tempererad vintertrÀdgÄrd med vÀxter för medelhavsklimat i anslutning till ett seniorboende (Bovieran 2017-03-07). Vi som formger gröna miljöer bör anvÀnda de vÀxter som Àr bÀst lÀmpade för vÀxtplatsen och dess egenskaper och kan lÄta naturen inspirera och lÀra oss om vi studerar vÀxternas naturstÄndort (KINGSBURY 2009). Syftet med kandidatarbetet var att studera medelhavsvÀxter som passar för inglasade miljöer i deras naturliga stÄndort. Litteraturstudierna ska ge en överblick och beskriva medelhavsklimatet, medelhavsvÀxternas anpassningar och egenskaper, olika vÀxtsamhÀllen med fördjupning inom macchian och dess arter. En fÀltstudie har utförts i Lo Zingaro naturreservat pÄ Sicilien för att undersöka och beskriva vegetationstypen macchia. FÀltstudien hade som syfte att komplettera litteraturstudien med egna observationer och vÀxterna som ingÄr i macchian. FrÄgestÀllningar som studien syftade till att besvara var hur artfördelningen i de olika skikten sÄg ut, samt vilka arter som ingick och slutligen hur detta kan kopplas till inglasade miljöer. DÄ terrÀngen och vegetationen visade sig vara svÄrframkomlig i Lo Zingaro naturreservat var det tvunget att lÀmna de kvantitativa metoderna och istÀllet göra fria observationer av vegetationen samt dokumentera med hjÀlp av foto. Resultatet blev ett antal fotopunkter med identifierade arter. Fotopunkterna visar pÄ nÄgra exempel frÄn macchian i reservatet och nÄgra av de arter som ingick och hur de var placerade i förhÄllande till varann. En av fotopunkterna har legat till grund för en övergripande beskrivning av vegetationstypernas utbredning pÄ en av bergssidorna i reservatet. Fotopunkterna har visat att macchian i Lo Zingaro naturreservat mestadels bestÄr av en lÄg macchia som domineras av trÀdtörel (Euphorbia dendroides) och dvÀrgpalm (Chamaerops humilis). Den lÄga macchian tÀcker stora ytor i reservatet och bildar en ogenomtrÀnglig massa i den svÄrtillgÀngliga terrÀngen. Det finns fÄ trÀd i omrÄdet och de befinner sig pÄ stora avstÄnd till varandra. Endast ett mindre bestÄnd av korkek (Quercus suber) finns kvar av den stÀdsegröna skogen efter brÀnder har hÀrjat och mÀnniska har hÄllit boskap i omrÄdet under lÄng tid. Macchian i reservatet Àr fortfarande ung, omrÄdet har varit skyddat sedan 1981, och den utvecklas sakta mot en högre macchia. Oliv (Olea europea) Àr ett Äterkommande inslag i macchian. HÀr finns ocksÄ mÄnga andra arter som kan vara av intresse för inglasade miljöer med medelhavsklimat

    Tunteella ja tiedolla : kestÀvyydellÀ markkinointi maaseutumatkailuyrityksessÀ

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    Maaseutu tarjoaa luontaisia edellytyksiĂ€ kestĂ€vĂ€n matkailun toteuttamiseen kuten luonnon, maiseman, kulttuurin ja paikallisyhteisön. Useimmiten maaseutumatkailuyrittĂ€jĂ€t toimivat jo luonnostaan varsin kestĂ€vĂ€sti ja maaseutumatkailuun liitettĂ€vĂ€t mielikuvat tukevat hyvin yritysten kestĂ€vyysimagon muodostumista. Kuitenkaan yrittĂ€jĂ€t eivĂ€t vielĂ€ tunnista kaikkia kestĂ€vyyteen liittyviĂ€ seikkojaan toiminnassaan, eivĂ€tkĂ€ myöskÀÀn tuo kestĂ€vyysasioita riittĂ€vĂ€sti esiin tai hyödynnĂ€ markkinoinnissa. KestĂ€vyysmielikuvaa kannattaisikin tuoda huomattavasti enemmĂ€n esille, koska se voi tuoda yrityksille uudenlaista kilpailuetua muun muassa erottautumisella kilpailijoista. KestĂ€vyydellĂ€ markkinoinnissa sanat ”kestĂ€vĂ€â€ tai ”kestĂ€vĂ€ matkailu” sinĂ€nsĂ€ eivĂ€t ole toimivia markkinointitermejĂ€. KestĂ€vĂ€ matkailu on kĂ€sitteenĂ€ liian laaja ja mielletÀÀn hyvin erilaisiin asioihin viestin vastaanottajasta riippuen. TĂ€llĂ€ hetkellĂ€ maaseutumatkailuyrityksien pÀÀmarkkinointikanava on Internet. KestĂ€vyyttĂ€ tuodaan siellĂ€ esille usealla tavalla. Eniten yrityksien Internet markkinoinnissa nĂ€kyy ekologiseen kestĂ€vyyteen liittyvĂ€t asiat. Tilan historia tuodaan usein myös esille, sillĂ€ ovathan maaseutumatkailuyritykset useimmiten syntyneet maatilan yhteyteen. KestĂ€vyyttĂ€ viestivĂ€t myös Internet-sivujen kuvat ja vĂ€rit. Suomalaisten maaseutumatkailuyritysten sivuilla on pÀÀsÀÀntöisesti kuvia luonnosta, maisemista ja maatilan rakennuksista, esimerkiksi mökeistĂ€. Markkinoinnissa kĂ€ytetyt vĂ€rit ovat usein kytkettĂ€vissĂ€ luontoon tai maatilaan. KestĂ€vyydellĂ€ markkinoinnissa voidaan karkeasti erottaa kaksi erilaista strategiaa. Yritys voi kohdentaa markkinoinnin kestĂ€vyydestĂ€ kiinnostuneille kuluttajasegmenteille. TĂ€llöin lĂ€htökohtana on, ettĂ€ matkailutuote on lĂ€htökohtaisesti suunniteltu ekologisesti, kulttuurisesti tai sosiaalisesti kestĂ€vĂ€ksi. Toinen vaihtoehtoinen strategia on tunnistaa omista tuotteista ja/tai palveluista kestĂ€vyyden ominaisuudet ja tuoda nĂ€itĂ€ selvĂ€sti esille markkinoinnissa. Markkinointi voidaan kohdentaa tĂ€llöin myös muille kuin kestĂ€vistĂ€ matkailutuotteista kiinnostuneille, jolloin kohderyhmĂ€ on laajempi. Kummakin strategian lĂ€htökohtana on omien tuotteiden ja asiakkaiden tunteminen, jotta markkinointi voidaan suunnitella ja toteuttaa onnistuneesti. Matkaa suunniteltaessa ja varattaessa asiakkaalle merkitsevĂ€t useimmiten muut ominaisuudet enemmĂ€n kuin kestĂ€vyysominaisuudet. Kun tietÀÀ mitkĂ€ ovat asiakkaille tĂ€rkeitĂ€ kriteerejĂ€ ja ominaisuuksia matkassa (tuote tai palvelu), voidaan kestĂ€vyysviestintĂ€ sitoa juuri nĂ€ihin asiakkaalle olennaisiin asioihin. Maaseutumatkailun keskeisimmĂ€t tuotteet on erilaiset majoitus-, kokous- ja juhlapalvelut sekĂ€ ohjelmapalvelut. KESMA II-hankkeen markkinointikokeilut liittyivĂ€t nĂ€ihin kolmeen osa-alueeseen. Majoituspalveluiden tuottajien kannattaa viestiĂ€ kestĂ€vyysteoista. Teoista voi kertoa kuvin ja tekstein faktaperusteisesti kuvaamalla esimerkiksi kuinka yritys toimii ympĂ€ristöystĂ€vĂ€llisesti, kuinka se suojelee perinteistĂ€ rakennuskantaa tai kuinka yritys panostaa esteettömyyteen. Myös tunteisiin vetoavat kuvat esimerkiksi kauniista jĂ€rvimaisemasta luovat kuvan yrityksen teoista sĂ€ilyttÀÀ vesistöt puhtaana. KestĂ€vyysteoilla luodaan positiivinen yrityskuva. Ruokaan liittyvistĂ€ tuotteista ja palveluista voidaan todeta, ettĂ€ ruoka itsessÀÀn voi jo ilmentÀÀ kestĂ€vyyttĂ€, erityisesti jos kĂ€ytetÀÀn lĂ€hi- tai luomuruokaa. LĂ€hiruoan kestĂ€vyydestĂ€ voidaan viestiĂ€ paikalliseen ruokaan, ruokatuotantoon tai - kulttuuriin liittyvillĂ€ kuvilla ja tekstein. Myös elintarvikkeen pakkauksella voi vahvasti viestiĂ€ kestĂ€vyydestĂ€. Makunautinnoista viestimisessĂ€ kannattaa muistaa lĂ€mpimĂ€t, kirkkaat vĂ€rit ja itse tuotteet itsessÀÀn viestivĂ€t paremmin mausta. Ruoan alkuperĂ€stĂ€, perinteistĂ€ ja terveysvaikutuksista voidaan viestiĂ€ sekĂ€ faktojen ettĂ€ tarinoiden avulla. Matkailussa ruoan merkitys korostuu: se viestii paikallisuudesta ja aitoudesta. Ohjelmapalveluiden tuottajan kannattaa viestiĂ€ hyvinvointivaikutuksista ja paikalliskulttuurista.YhteisöllisyydestĂ€ ja hyvinvoinnista voidaan viestiĂ€ kuvilla, joissa esiintyy hyvĂ€ntuulisia ja hyvinvoivan nĂ€köisiĂ€ ihmisiĂ€. LĂ€mminhenkisillĂ€ ja rennoilla tilannekuvilla voi viestiĂ€ vieraanvaraisuudesta. TeksteissĂ€ kannattaa tuoda esille myös aktiviteettien hyvinvointivaikutuksia. Paikallista historiaa ja perinteitĂ€ voi tuoda esille kuvien ja tekstien kautta. Tarinoilla pystyy elĂ€vöittĂ€mÀÀn markkinointia ja ne lisÀÀvĂ€t aitouden tunnetta. Maaseutumatkailuyrityksen kannattaa rakentaa hyvinvointivaikutuksista ja yhteisöllisyydestĂ€ lisĂ€arvo ohjelmapalveluiden asiakkaalle ja viestiĂ€ niistĂ€. On tĂ€rkeĂ€ tietÀÀ, ettĂ€ asiakas kĂ€sittelee hĂ€nelle tulevaa tietoa joko jĂ€rkiperĂ€isesti tai tunnepohjaisesti tai pohjautuen kumpaankin. TĂ€stĂ€ syystĂ€ on hyvĂ€ pohtia, ettĂ€ viestintĂ€ on sellaista, ettĂ€ se sisĂ€ltÀÀ sekĂ€ jĂ€rkiperĂ€istĂ€ ettĂ€ tunnepohjaista tietoa. TiedetÀÀn, ettĂ€ tunneperĂ€inen viestintĂ€ vetoaa suurempaan osaan matkailijoista. Siksi onkin syytĂ€ panostaa enemmĂ€n tunneperĂ€iseen viestintÀÀn kuvissa ja tekstissĂ€ myös kestĂ€vyydellĂ€ markkinoitaessa

    Comparison of Measurements of Autoantibodies to Glutamic Acid Decarboxylase and Islet Antigen-2 in Whole Blood Eluates from Dried Blood Spots Using the RSR-Enzyme Linked Immunosorbent Assay Kits and In-House Radioimmunoassays

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    To evaluate the performance of dried blood spots (DBSs) with subsequent analyses of glutamic acid decarboxylase (GADA) and islet antigen-2 (IA-2A) with the RSR-ELISAs, we selected 80 children newly diagnosed with type 1 diabetes and 120 healthy women. DBSs from patients and controls were used for RSR-ELISAs while patients samples were analysed also with in-house RIAs. The RSR-ELISA-GADA performed well with a specificity of 100%, albeit sensitivity (46%) was lower compared to in RIA (56%; P = .008). No prozone effect was observed after dilution of discrepant samples. RSR-ELISA-IA-2A achieved specificity of 69% and sensitivity was lower (59%) compared with RIA (66%; P < .001). Negative or low positive patients and control samples in the RSR-ELISA-IA-2A increased after dilution. Eluates from DBS can readily be used to analyse GADA with the RSR-ELISA, even if low levels of autoantibodies were not detected. Some factor could disturb RSR-ELISA-IA-2A analyses

    ÎČ-cell function and metabolic control in latent autoimmune diabetes in adults with early insulin versus conventional treatment: a 3-year follow-up

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    Objectives: The optimal treatment of latent autoimmune diabetes in adults (LADA) is not established. We explored whether early insulin treatment, which has shown beneficial effects in rodents and in human pilot studies, would result in better preservation of beta-cell function or metabolic control, compared with conventional treatment. Subjects and methods: Glucagon-stimulated C-peptide and HbAlc were evaluated at baseline and after 12, 24 and 36 months in 37 patients recently diagnosed with diabetes, aged >= 30 years, non-insulin-requiring and GADAb and/or ICA positive. Twenty patients received early insulin and 17 received conventional treatment (diet +/- oral hypoglycaemic agents (OHA), metformin, some and/or sulfonylurea) and insulin when necessary. Results: Level of metabolic control, HbAlc, was preserved in the early insulin treated, while it significantly deteriorated in the conventionally treated. There was no significant difference between the groups in C-peptide after 12, 24 or 36 months, or in the decline of C-peptide. Only baseline C-peptide predicted a C-peptide of >= 0.5 nmol/l at 36 months. Gender, body mass index, antibody titres or HbAlc did not influence the levels of C-peptide or HbAlc at baseline or end-of-study, or the decline in C-peptide. Among the diet +/- OHA-treated, 5/17 (30%) developed insulin dependency during the follow-up. No major hypoglycaemic events occurred. Conclusions: Early insulin treatment in LADA leads to better preservation of metabolic control and was safe. Superior preservation of C-peptide could not be significantly demonstrated. Only baseline level of C-peptide significantly influenced C-peptide level after 3 years. Further studies exploring the best treatment in LADA are warranted. European Journal of Endocrinology 164 239-24
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