5 research outputs found
Recommended from our members
Asymmetric glottal jet deflection: differences of two- and three-dimensional models
Flow is studied through a channel with an oscillating orifice mimicking the motion of the glottal-gap during phonation. Simulations with prescribed flow and wall-motion are carried out for different orifice geometries, a 2D slit-like and a 3D lens-like one. Although the jet emerges from a symmetric orifice a significant deflection occurs in case of the slit-like geometry, contrary to the 3D lens-like one. The results demonstrate the dependency of jet entrainment and vortex dynamics on the orifice geometry and the interpretation of asymmetric jet deflection with regard to the relevance of the Coanda effect in the process of human phonation
SUGAR-DIP trial: Oral medication strategy versus insulin for diabetes in pregnancy, study protocol for a multicentre, open-label, non-inferiority, randomised controlled trial
Introduction In women with gestational diabetes mellitus (GDM) requiring pharmacotherapy, insulin was the established first-line treatment. More recently, oral glucose lowering drugs (OGLDs) have gained popularity as a patient-friendly, less expensive and safe alternative. Monotherapy with metformin or glibenclamide (glyburide) is incorporated in several international guidelines. In women who do not reach sufficient glucose control with OGLD monotherapy, usually insulin is added, either with or without continuation of OGLDs. No reliable data from clinical trials, however, are available on the effectiveness of a treatment strategy using all three agents, metformin, glibenclamide and insulin, in a stepwise approach, compared with insulin-only therapy for improving pregnancy outcomes. In this trial, we aim to assess the clinical effectiveness, cost-effectiveness and patient experience of a stepwise combined OGLD treatment protocol, compared with conventional insulin-based therapy for GDM. Methods The SUGAR-DIP trial is an open-label, multicentre randomised controlled non-inferiority trial. Participants are women with GDM who do not reach target glycaemic control with modification of diet, between 16 and 34 weeks of gestation. Participants will be randomised to either treatment with OGLDs, starting with metformin and supplemented as needed with glibenclamide, or randomised to treatment with insulin. In women who do not reach target glycaemic control with combined metformin and glibenclamide, glibenclamide will be substituted with insulin, while continuing metformin. The primary outcome will be the incidence of large-for-gestational-age infants (birth weight >90th percentile). Secondary outcome measures are maternal diabetes-related endpoints, obstetric complications, neonatal complications and cost-effectiveness analysis. Outcomes will be analysed according to the intention-to-treat principle. Ethics and dissemination The study protocol was approved by the Ethics Committee of the Utrecht University Medical Centre. Approval by the boards of management for all participating hospitals will be obtained. Trial results will be submitted for publication in peer-reviewed journals
Three years of measurements of light-absorbing aerosols over coastal Namibia: seasonality, origin, and transport
International audienceContinuous measurements between July 2012 and December 2015 at the Henties Bay Aerosol Observatory (HBAO; 22 • S, 14 • 05 E), Namibia, show that, during the austral wintertime, transport of light-absorbing black carbon aerosols occurs at low level into the marine boundary layer. The average of daily concentrations of equivalent black carbon (eBC) over the whole sampling period is 53 (±55) ng m −3. Peak values above 200 ng m −3 and up to 800 ng m −3 occur seasonally from May to August, ahead of the dry season peak of biomass burning in southern Africa (August to October). Analysis of 3-day air mass back-trajectories show that air masses from the South Atlantic Ocean south of Henties Bay are generally cleaner than air having originated over the ocean north of Henties Bay, influenced by the outflow of the major biomass burning plume, and from the continent, where wildfires occur. Additional episodic peak concentrations, even for oceanic transport, indicate that pollution from distant sources in South Africa and maritime traffic along the Atlantic ship tracks could be important. While we expect the direct radiative effect to be negligible, the indirect effect on the microphysical properties of the stratocumulus clouds and the deposition to the ocean could be significant and deserve further investigation, specifically ahead of the dry season
SUGAR-DIP trial:Oral medication strategy versus insulin for diabetes in pregnancy, study protocol for a multicentre, open-label, non-inferiority, randomised controlled trial
Introduction In women with gestational diabetes mellitus (GDM) requiring pharmacotherapy, insulin was the established first-line treatment. More recently, oral glucose lowering drugs (OGLDs) have gained popularity as a patient-friendly, less expensive and safe alternative. Monotherapy with metformin or glibenclamide (glyburide) is incorporated in several international guidelines. In women who do not reach sufficient glucose control with OGLD monotherapy, usually insulin is added, either with or without continuation of OGLDs. No reliable data from clinical trials, however, are available on the effectiveness of a treatment strategy using all three agents, metformin, glibenclamide and insulin, in a stepwise approach, compared with insulin-only therapy for improving pregnancy outcomes. In this trial, we aim to assess the clinical effectiveness, cost-effectiveness and patient experience of a stepwise combined OGLD treatment protocol, compared with conventional insulin-based therapy for GDM. Methods The SUGAR-DIP trial is an open-label, multicentre randomised controlled non-inferiority trial. Participants are women with GDM who do not reach target glycaemic control with modification of diet, between 16 and 34 weeks of gestation. Participants will be randomised to either treatment with OGLDs, starting with metformin and supplemented as needed with glibenclamide, or randomised to treatment with insulin. In women who do not reach target glycaemic control with combined metformin and glibenclamide, glibenclamide will be substituted with insulin, while continuing metformin. The primary outcome will be the incidence of large-for-gestational-age infants (birth weight >90th percentile). Secondary outcome measures are maternal diabetes-related endpoints, obstetric complications, neonatal complications and cost-effectiveness analysis. Outcomes will be analysed according to the intention-to-treat principle. Ethics and dissemination The study protocol was approved by the Ethics Committee of the Utrecht University Medical Centre. Approval by the boards of management for all participating hospitals will be obtained. Trial results will be submitted for publication in peer-reviewed journals