175 research outputs found
Globalisation, labour standards and economic development
In recent years a few advanced countries have been advocating multilateral rules permitting punitive trade measures to be taken against countries not upholding core labour standards. The mainly developing target countries have rebutted these initiatives which they argue are protectionist, in intent and in effect. Whilst closely examining the economic arguments in this controversy, this paper is also concerned with the broader political and moral dimensions. The authors suggest that developing countries are committed to improving core and other labour standards; the reason why they are unable to implement many of these forthwith is not because of the wickedness of their governments, but essentially their economic circumstances and the structure of their economies. The paper concludes that core ILO Conventions 87 and 98 should be re-drafted to take into account the economic conditions of developing countries.Globalisation, Labour Standards, Economic Development
Hypoglycaemia in type 1 diabetes: risk factors, symptoms and recovery
Hypoglycaemia is the commonest side-effect of insulin treatment for diabetes mellitus.
Appreciation of the risk factors for hypoglycaemia and early recognition of its symptoms can
help the affected individual with prompt self-treatment of hypoglycaemia, preventing
progression to severe hypoglycaemia. The proposed MD project will consist of three major
studies to investigate the risks for, symptoms of, and rate of recovery from, hypoglycaemia.STUDY ONE:
This study will examine the alleged association between severe hypoglycaemia and serum
angiotensin converting enzyme (ACE) levels. While many patients rarely experience severe
hypoglycaemia, a small subgroup experiences recurrent episodes. These are very disruptive
to daily life and may be dangerous, for example if they occur when the individual is driving.
It is therefore of clinical importance to identify risk factors for severe hypoglycaemia.Scandinavian studies have reported an association between elevated serum ACE activity and
an increased risk of severe hypoglycaemia in type 1 diabetes. A hypothetical explanation for
these findings is that lower ACE activity confers increased ability for cerebral function to be
maintained despite metabolic substrate deprivation. It is possible that in diabetes, this could
manifest as greater impairment of mental ability during hypoglycaemia in people with high
ACE activity. This would explain their increased risk of severe hypoglycaemia for a given
level of blood glucose as they would be more incapacitated, and therefore less able to self-treat.
However these studies have methodological limitations and these findings have not yet
been reproduced outside Scandinavia.In this study, it is proposed to examine the relationship between serum ACE levels and the
incidence of severe hypoglycaemia. Blood will be sampled for serum ACE activity and the
self-estimated frequency of severe hypoglycaemia will be recorded in 300 people with type 1
diabetes attending diabetes clinics at the Royal Infirmary of Edinburgh.STUDY TWO:
This study will examine the variability of hypoglycaemia symptom reporting. It is known
that the symptoms of hypoglycaemia are idiosyncratic and age-specific. However, no studies
have assessed the extent of any intra-individual variability in symptom reporting.A cohort of 350 people with type 1 and type 2 diabetes, with different disease durations and
varying treatment modalities, will be recruited and the symptoms associated with each
hypoglycaemic episode will be recorded prospectively over a 12 month period. The reported
symptom clusters will be analysed to assess the consistency of symptom reporting for each
individual. Regression analysis will be used to assess whether an individual's consistency
coefficient is related to any other factors such as disease duration or treatment modality. The
ability to predict which individuals will report a consistent group of symptoms and which
individuals will experience an erratic pattern of symptoms would assist patient education and
allow clinicians to inform patients about how to anticipate and recognise hypoglycaemia.STUDY THREE:
This study will examine the time taken for full cognitive recovery from hypoglycaemia and
the possible effect of the clinical syndrome of impaired awareness of hypoglycaemia on this
process. The effects of acute insulin-induced hypoglycaemia on cognitive function have been
investigated extensively but the recovery period after hypoglycaemia has not been rigorously
assessed. Previous studies examining recovery have had multiple limitations.The objective of this third study is to measure the recovery time for various domains of
cognitive function in a large group of patients with type 1 diabetes who have either normal
(n=20) or impaired (n=l 6) awareness of hypoglycaemia. A hyperinsulinaemic glucose clamp
technique will be used to induce controlled hypoglycaemia and a battery of cognitive tests
will be applied at baseline, at the beginning and end of a one hour period of hypoglycaemia,
then at ten minute intervals during a 90 minute recovery period. Each subject will act as their
own control by undergoing a euglycaemic clamp on a separate occasion. Test scores will be
compared using general linear modelling with awareness of hypoglycaemia as a betweensubjects
factor. The findings of this study will have important clinical implications and help
to advise patients how long to wait after restoration of euglycaemia before resuming activities
such as driving
Shareholder value maximisation, stock market and new technology: should the US corporate model be the universal standard
In 1992 a blue-ribbon group of US economists led by Michael Porter concluded that the US stock market-based corporate model was misallocating resources and jeopardising US competitiveness. The faster growth of US economy since then and the supposed US lead in the spread of information technology has brought new legitimacy to the stock market and the corporate model, which is being hailed as the universal standard. Two main conclusions of the analysis presented here are: (a) there is no warrant for revising the blue-ribbon groupÕs conclusion; and (b) even US corporations let alone developing country ones would be better off not having stock market valuation as a corporate goal.Shareholder wealth, Information technology, Stock-market efficiency
HbA1c response and hospital admissions following commencement of flash glucose monitoring in adults with type 1 diabetes
Introduction Our aim was to assess the effect of introducing flash monitoring in adults with type 1 diabetes with respect to change in hemoglobin A1c (HbA1c) and frequency of hospital admissions.Research design and methods Prospective observational study of adults with type 1 diabetes in our center, in whom a prescription for a flash monitoring sensor was collected. Primary outcome was change in HbA1c between 2016 and after flash monitoring. Rates of hospital admission were compared between the first year after flash monitoring and the corresponding 12-month period 2 years earlier.Results Approximately half of all adults with type 1 diabetes, attending our center, collected prescriptions for flash monitoring sensors (n=2216). Median fall in HbA1c was −1 (−0.1) mmol/mol (%) (p<0.001) and was greatest in those with baseline HbA1c >75 (9.0) mmol/mol (%): −10 (−0.9) mmol/mol (%), p<0.001. 43% of those with a baseline HbA1c >53 mmol/mol (7%) experienced a ≥5 mmol/mol (0.5%) fall in HbA1c. In addition to higher HbA1c, early commencement within 1 month of NHS-funded flash monitoring (p<0.001), and male gender (p=0.013) were associated with a fall in HbA1c of ≥5 (0.5) mmol/mol (%). Socioeconomic deprivation (p=0.009) and collecting fewer than 2 sensors per month (p=0.002) were associated with lack of response. Overall, hospital admissions did not change but an increase in admissions for hypoglycemia was observed (1.1% vs 0.3%, p=0.026).Conclusions Flash monitoring is associated with reduction in HbA1c in individuals with HbA1c >58 mmol/mol. Numerous clinical features are independently associated with HbA1c response. An increase in hypoglycemia admissions occurred following flash monitoring
Use of liothyronine (T3) in hypothyroidism: Joint British Thyroid Association/Society for endocrinology consensus statement
\ua9 2023 The Authors. Clinical Endocrinology published by John Wiley & Sons Ltd.Persistent symptoms in patients treated for hypothyroidism are common. Despite more than 20 years of debate, the use of liothyronine for this indication remains controversial, as numerous randomised trials have failed to show a benefit of treatment regimens that combine liothyronine (T3) with levothyroxine over levothyroxine monotherapy. This consensus statement attempts to provide practical guidance to clinicians faced with patients who have persistent symptoms during thyroid hormone replacement therapy. It applies to non-pregnant adults and is focussed on care delivered within the UK National Health Service, although it may be relevant in other healthcare environments. The statement emphasises several key clinical practice points for patients dissatisfied with treatment for hypothyroidism. Firstly, it is important to establish a diagnosis of overt hypothyroidism; patients with persistent symptoms during thyroid hormone replacement but with no clear biochemical evidence of overt hypothyroidism should first have a trial without thyroid hormone replacement. In those with established overt hypothyroidism, levothyroxine doses should be optimised aiming for a TSH in the 0.3–2.0 mU/L range for 3 to 6 months before a therapeutic response can be assessed. In some patients, it may be acceptable to have serum TSH below reference range (e.g. 0.1–0.3 mU/L), but not fully suppressed in the long term. We suggest that for some patients with confirmed overt hypothyroidism and persistent symptoms who have had adequate treatment with levothyroxine and in whom other comorbidities have been excluded, a trial of liothyronine/levothyroxine combined therapy may be warranted. The decision to start treatment with liothyronine should be a shared decision between patient and clinician. However, individual clinicians should not feel obliged to start liothyronine or to continue liothyronine medication provided by other health care practitioners or accessed without medical advice, if they judge this not to be in the patient\u27s best interest
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