Clinical utility of fixed combinations of sitagliptin–metformin in treatment of type 2 diabetes

Adequate glycemic control in type 2 diabetes remains a difficult but achievable goal. The development of new classes of glucose-lowering medications, including in particular the incretin-based therapies, provides an opportunity to utilize combinations of medications which target multiple physiologic abnormalities in type 2 diabetes. Complementary combination therapy with sitagliptin–metformin lowers glucose via enhancement of insulin secretion, suppression of glucagon secretion, and insulin sensitization. Use of this combination in diabetes management will provide a greater degree of glycosylated hemoglobin-lowering than that seen with the use of either drug as monotherapy, is unlikely to cause significant hypoglycemia, and is generally associated with weight loss. The effectiveness, tolerability, and potential cost savings associated with the use of sitagliptin–metformin combination therapy make this an attractive option in diabetes management. The possible beneficial effects of this therapy on beta cell function, as well as its cardiovascular impact, remain inadequately explored but are of significant interest

An investigation into using GIS in electrification and network planning in rural KwaZulu-Natal.

Thesis (M.Sc.)-University of KwaZulu-Natal, Pietermaritzburg, 2006.The South African Government has set a target of universal access to basic electricity by the year 2012. Free basic electricity is defined as the amount of electricity sufficient to provide basic lighting, media access, water heating and ironing with on-grid electricity; or basic lighting and media access for a non-grid system. Eskom Distribution, in conjunction with local municipalities, is responsible for the outstanding electrification predominantly in rural areas. In KwaZulu-Natal, mountainous terrain and scattered settlement patterns of communities complicate the achievement of this goal. This study was aimed at using GIS to address the urgent need to plan electrification, firstly by identifying areas that need electrification and secondly by prioritising those areas according to set principles. Electrification areas were effectively identified and prioritised from both a need and capability of supply aspect. The study then aimed at designing the shortest networks from the grid to those identified electrification areas. To determine electrification areas spatially, electoral areas (EAs) demarcated as rural during the run up to the 1994 elections were used to identify rural areas; and Ethekwini Metropolitan Municipality, current electrification projects, reserves and a buffer zone around existing transformers excluded. Household point data was used to polygonize the remaining area, and those polygons were aggregated on their calculated area to create future rural electrification areas (FREA). A points and weighting system; based on one initially used in Namibia and further developed in an electrification planning model by RAPS Consulting, CSIR and DME to prioritise villages for electrification; was applied to calculate point scores for each FREA and other criteria such as distance from a network with capacity considered to determine a prioritised list of FREA that can be electrified immediately. Roads, land cover, household positions and slope were used to design the shortest path from the grid to the three highest scoring FREA. Each layer was reclassified, ratings applied and the layers combined to successfully determine the final path in terms of the criteria used. Interest in using GIS for spatial planning has led to a GIS Initiative Group (GISIG) being formed at Eskom Distribution in Eastern Region to address data collection, co-ordination of planning, tools written previously but never implemented being re-evaluated and, more recently, new tools being designed. However, much is still needed in terms of research, resolving of data quality issues, testing of points and weighting systems, and for functionally independent sections to work together on making changes to age-old system structures and processes before any of the recommendations resulting from this study can be effectively implemented

The journey of the soul: the role of music in the Ludus super Anticlaudianum of Adam de la Bassee

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Integrated Prevention and Control of Seasonal Respiratory Infections in Aotearoa New Zealand: next steps for transformative change

Public health measures that successfully eliminated the spread of Covid-19 in Aotearoa New Zealand during 2020 also profoundly reduced the normally high seasonal burden of non-Covid infectious diseases. One outcome of this extraordinary year was that life expectancy in New Zealand actually increased during 2020, the first year of this global pandemic. We should not accept or allow a return to previous levels of illness and death during the winter months. Transformative change will require an integrated approach to infectious disease policy that builds on the knowledge and infrastructure developed during the first two years of the pandemic response. An effective strategy will include generic elements – notably, science-informed strategic leadership, a Tiriti and equity focus, and an upgraded alert level system. We will also need a specific plan for infectious respiratory diseases, including measures to improve indoor air quality, a national mask strategy, and an enhanced system to deliver vaccinations against seasonal respiratory infections. Such an approach can have immediate and long-term benefits, protecting New Zealanders from endemic, epidemic and pandemic infections. We face a potentially difficult winter in 2022, with multiple infectious disease threats. There is an urgent need for integrated policy and action to prevent and control both Covid-19 and more familiar winter season respiratory infections. In the future, 2020 should be seen as the watershed year that triggered a transformative improvement in New Zealand’s poor track record of infectious disease incidence and inequities

The learner’s perspective in GP teaching practices with multi-level learners: a qualitative study

BACKGROUND Medical students, junior hospital doctors on rotation and general practice (GP) registrars are undertaking their training in clinical general practices in increasing numbers in Australia. Some practices have four levels of learner. This study aimed to explore how multi-level teaching (also called vertical integration of GP education and training) is occurring in clinical general practice and the impact of such teaching on the learner. METHODS A qualitative research methodology was used with face-to-face, semi-structured interviews of medical students, junior hospital doctors, GP registrars and GP teachers in eight training practices in the region that taught all levels of learners. Interviews were audio-recorded and transcribed. Qualitative analysis was conducted using thematic analysis techniques aided by the use of the software package N-Vivo 9. Primary themes were identified and categorised by the co-investigators. RESULTS 52 interviews were completed and analysed. Themes were identified relating to both the practice learning environment and teaching methods used.A practice environment where there is a strong teaching culture, enjoyment of learning, and flexible learning methods, as well as learning spaces and organised teaching arrangements, all contribute to positive learning from a learners' perspective.Learners identified a number of innovative teaching methods and viewed them as positive. These included multi-level learner group tutorials in the practice, being taught by a team of teachers, including GP registrars and other health professionals, and access to a supernumerary GP supervisor (also termed "GP consultant teacher"). Other teaching methods that were viewed positively were parallel consulting, informal learning and rural hospital context integrated learning. CONCLUSIONS Vertical integration of GP education and training generally impacted positively on all levels of learner. This research has provided further evidence about the learning culture, structures and teaching processes that have a positive impact on learners in the clinical general practice setting where there are multiple levels of learners. It has also identified some innovative teaching methods that will need further examination. The findings reinforce the importance of the environment for learning and learner centred approaches and will be important for training organisations developing vertically integrated practices and in their training of GP teachers.This project was supported by a grant from General Practice Education and Training through Coast City Country General Practice Training. This project was approved for conduct by the ANU Human Research Ethics Committee (protocol number 2011/415)

Pre-adolescent children’s experiences of receiving diabetes-related support from friends and peers: a qualitative study

BackgroundWhile pre�adolescent children with type 1 diabetes receive most support from their parents/caregivers, others also contribute to their care. This study explored pre�adolescent children's experiences of receiving diabetes�related support from friends and peers. The objective was to identify how children could be better supported by their friends and peers to undertake diabetes self�management.MethodsIn�depth interviews with 24 children (aged 9�12 years) with type 1 diabetes. Data were analysed using an inductive, thematic approach.ResultsChildren gave mixed accounts of their experiences of speaking to their school/class about diabetes with some indicating that this had resulted in unwanted attention. Most individuals reported that other children had a limited understanding of diabetes and sometimes acted in insensitive ways or said things they found upsetting. Virtually all children described having a small number of close friends who were interested in learning about diabetes and provided them with support. These friends provided support in three overlapping ways, as �monitors and prompters,� �helpers� and �normalizers.� While some children described benefiting from meeting peers with type 1 diabetes, most indicated that they would prefer to develop friendships based on shared interests rather than a common disease status.Discussion and conclusionsFriends and peers provide several kinds of support to pre�adolescent children with diabetes. Health professionals could consider ways to assist small friendship groups to undertake monitoring and prompting, helping and normalizing roles. Parents, schools and health professionals could explore ways to normalize self�management practices to better support children with diabetes in school settings.</p

Traumatic Bladder Ruptures: A Ten-Year Review at a Level 1 Trauma Center

Abstract Bladder rupture occurs in only 1.6% of blunt abdominopelvic trauma cases. Although rare, bladder rupture can result in significant morbidity if undiagnosed or inappropriately managed. AUA Urotrauma Guidelines suggest that urethral catheter drainage is a standard of care for both extraperitoneal and intraperitoneal bladder rupture regardless of the need for surgical repair. However, no specific guidance is given regarding the length of catheterization. The present study seeks to summarize contemporary management of bladder trauma at our tertiary care center, assess the impact of length of catheterization on bladder injuries and complications, and develop a protocol for management of bladder injuries from time of injury to catheter removal. A retrospective review was performed on 34,413 blunt trauma cases to identify traumatic bladder ruptures over the past 10 years (January 2008–January 2018) at our tertiary care facility. Patient data were collected including age, gender, BMI, mechanism of injury, and type of injury. The primary treatment modality (surgical repair vs. catheter drainage only), length of catheterization, and post-injury complications were also assessed. Review of our institutional trauma database identified 44 patients with bladder trauma. Mean age was 41 years, mean BMI was 24.8 kg/m2, 95% were Caucasian, and 55% were female. Motor vehicle collision (MVC) was the most common mechanism, representing 45% of total injuries. Other mechanisms included falls (20%) and all-terrain vehicle (ATV) accidents (13.6%). 31 patients had extraperitoneal injury, and 13 were intraperitoneal. Pelvic fractures were present in 93%, and 39% had additional solid organ injuries. Formal cystogram was performed in 59% on presentation, and mean time to cystogram was 4 hours. Gross hematuria was noted in 95% of cases. Operative management was performed for all intraperitoneal injuries and 35.5% of extraperitoneal cases. Bladder closure in operative cases was typically performed in 2 layers with absorbable suture in a running fashion. The intraperitoneal and extraperitoneal injuries managed operatively were compared, and length of catheterization (28 d vs. 22 d, ), time from injury to normal fluorocystogram (19.8 d vs. 20.7 d, ), and time from injury to repair (4.3 vs. 60.5 h, ) were not statistically different between cohorts. Patients whose catheter remained in place for greater than 14 days had prolonged time to initial cystogram (26.6 d vs. 11.5 d) compared with those whose foley catheter was removed within 14 days. The complication rate was 21% for catheters left more than 14 days while patients whose catheter remained less than 14 days experienced no complications. The present study provides a 10-year retrospective review characterizing the presentation, management, and follow-up of bladder trauma patients at our level 1 trauma center. Based on our findings, we have developed an institutional protocol which now includes recommendations regarding length of catheterization after traumatic bladder rupture. By providing specific guidelines for initial follow-up cystogram and foley removal, we hope to decrease patient morbidity from prolonged catheterization. Further study will seek to allow multidisciplinary trauma teams to standardize management, streamline care, and minimize complications for patients presenting with traumatic bladder injuries

Improving rice sustainability through digital tools

To provide a platform for dialogue among the stakeholders on the challenges of reaching Vietnamese smallholder farmers with digital tools, the International Rice Research Institute (IRRI) organized a webinar titled ‘Improving Rice Sustainability through Digital Tools’. Part of the Agro-ecological transformation for inclusive and sustainable agriculture and food systems (TRANSITIONS) project, funded by the European Union through its DeSIRA initiative and managed by the International Fund for Agricultural Development (IFAD), the webinar identified the opportunities for improving access and use of digital tools and tailoring the services to meet the needs of farmers through inclusive co-production of digital tools

Best practice guidance for inclusive digital tool development for sustainable rice in Vietnam

This brief summarizes findings of the project “Agroecological transitions for building resilient and inclusive agricultural and food systems” (TRANSITIONS), which is funded by the European Commission through its DeSIRA initiative and managed by the International Fund for Agricultural Development (IFAD). The Digital Tools regional work in Vietnam focused on research and engagement with digital tools for technical advice and performance assessment in sustainable rice production in the Mekong River Delta. This best practice guidance was developed based on findings from a review of existing digital tools for the rice value chain in Vietnam, a baseline survey with rice farmers and extension workers and a participatory dialogue with relevant stakeholders on the challenges of reaching Vietnamese smallholder rice farmers with digital tools

Systematic review of digital resources for climate-informed agroecological transitions in rice in the Mekong Delta

This report summarizes findings from the review of digital resources for climate-informed agroecological transitions in rice in the Mekong Delta in Vietnam. The project “Agroecological transitions for building resilient and inclusive agricultural and food systems” (TRANSITIONS) is funded by the European Commission through its DeSIRA initiative and managed by the International Fund for Agricultural Development (IFAD). The Digital Tools regional work in Vietnam focused on research and engagement with digital tools for technical advice and performance assessment in sustainable rice production in the Mekong Delta due to the high environmental impacts, climate change mitigation potentials and sustainability challenges. The Sustainable Rice Platform (SRP) is the world’s only sustainability standard for rice and is the focus for the digital tool review in Vietnam