By the most recent estimates, 34.2 million people in the U.S. have diabetes.<sup>1</sup> At the same time, 88 million people are at increased risk for developing type 2 diabetes. The U.S. also sees an increasing prevalence of both type 1 and type 2 diabetes in children and adolescents.<sup>2</sup> Thus, more than 122 million Americans are at risk of developing devastating complications associated with chronic hyperglycemia.<sup>1</sup> Diabetes self-management education and support (DSMES) is a critical element of care for all people with diabetes (PWD). “The purpose of DSMES is to give PWD the knowledge, skills, and confidence to accept responsibility for their self-management. This includes collaborating with their healthcare team, making informed decisions, solving problems, developing personal goals and action plans, and coping with emotions and life stresses.”<sup>3</sup> DSMES interventions include activities that support PWD to implement and sustain the self-management behaviors and strategies to improve diabetes and related cardiometabolic conditions and quality of life on an ongoing basis. Despite progress in diabetes treatment modalities, glycemic and cardiometabolic outcomes continue to decline in the U.S.<sup>4</sup> Now, more than ever, the provision of DSMES is a vital component of the full treatment for diabetes.
On 6 February 2015, Kampala city authorities alerted the Ugandan Ministry of Health of a “strange disease” that killed one person and sickened dozens. We conducted an epidemiologic investigation to identify the nature of the disease, mode of transmission, and risk factors to inform timely and effective control measures. We defined a suspected case as onset of fever (≥37.5 °C) for more than 3 days with abdominal pain, headache, negative malaria test or failed anti-malaria treatment, and at least 2 of the following: diarrhea, nausea or vomiting, constipation, fatigue. A probable case was defined as a suspected case with a positive TUBEX® TF test. A confirmed case had blood culture yielding Salmonella Typhi. We conducted a case-control study to compare exposures of 33 suspected case-patients and 78 controls, and tested water and juice samples. From 17 February–12 June, we identified 10,230 suspected, 1038 probable, and 51 confirmed cases. Approximately 22.58% (7/31) of case-patients and 2.56% (2/78) of controls drank water sold in small plastic bags (ORM-H = 8.90; 95%CI = 1.60–49.00); 54.54% (18/33) of case-patients and 19.23% (15/78) of controls consumed locally-made drinks (ORM-H = 4.60; 95%CI: 1.90–11.00). All isolates were susceptible to ciprofloxacin and ceftriaxone. Water and juice samples exhibited evidence of fecal contamination. Contaminated water and street-vended beverages were likely vehicles of this outbreak. At our recommendation authorities closed unsafe water sources and supplied safe water to affected areas.
In today’s financial crisis, the capital reserves held by banks have become the measure by which an organisation counts down to failure, rather than the system to proactively prevent it. Indeed, the bankruptcies and near-death experience of a number of financial institutions provide yet further evidence of risk management controls gone awry. The question then has to be asked, what is it that offers a financial institution its greatest protection against failure if it is not capital? Quite simply, it is the risk culture embedded in its people and processes. At the core of any risk culture are the incentives for individual reward that balance risk and return with short-term self-interest and long-term stakeholder goals. Furthermore, it is the embedded early warning systems that highlight growing exposures to risk. Here, the greatest hope for preventing such crisis in the future lies in the final piece of Basel II — the yet to be implemented operational risk framework — the first-ever truly global regulation intended to foster a risk-adjusted performance culture.
An algorithm is introduced that performs stereophonic acoustic echo cancellation (SAEC) for systems using pairwise panning of a single monophonic source to provide the effect of spatialisation. The technique exploits the inherent high correlation between the loudspeaker signals, unlike other general SAEC techniques, which try to utilise any small uncorrelated features in the signals. The algorithm maintains a single aggregate echo path estimate that is updated using normalised least mean square (NLMS) and the knowledge of any change in the spatialisation. Consequently, it achieves a computational complexity that is of the same order as a single channel NLMS algorithm.
Background: The August 2013 publication of a large historical cohort study in the New England Journal of Medicine has reignited interest in the potential teratogenic effects of fluconazole when used in pregnant females. Fluconazole is an effective and commonly-utilized antifungal medication. Thus, maternal and fetal exposure to fluconazole is expected in the general population, and pharmacists are expected to counsel patients regarding any risks to their prescribed treatment.
Methods: A literature review of all published literature indexed to PubMed (January 1966 to October 2013) and International Pharmaceutical Abstracts (January 1975 to October 2013) including fluconazole and teratogenic effects and published in the English language was conducted.
Results: Fourteen publications were included for analysis including case reports (n=7), cross-sectional research (n=2), and historical cohort studies (n=5).
Conclusion: There appears to be little to no fetal risk resulting from a single dose or short duration antifungal therapy with fluconazole. However, prolonged high-dose fluconazole therapy has increased potential to confer teratogenic effects. In those cases, the risks of such therapy should be weighed against potential benefits.
Type: Student Project
Observations are presented on habitat, population, feeding and breeding behaviour, voice and territory of the Black-breasted Button-quail Tumix melanogaster near Gympie in south-east Queensland. The species appears dependent on vine scrub with a moist , deep leaf-litter layer, and occurs in adjacent unburnt forest wilh a deep litter layer. The population has increased since cessation of frequent burning; female territory size is c. 1.5 ha . Food appears to be litter invertebrates. Females appear to have a role in the care of feathered juveniles.
Chlorofluorocarbons (CFCS) have been used as blowing agents in foam insulation, as the working fluids in cooling and refrigeration equipment, and as solvents in general and precision cleaning applications since their introduction in the 1930s. The number of applications and volumes of CFCs used grew at a tremendous pace during the 1960s and 1970s, but in the mid-1980s it was confirmed that these extremely useful chemicals contribute to the destruction of stratospheric zone and that they are the primary cause of the CFCs have also been found to be second only to carbon dioxide as a factor causing increased greenhouse warming. These chemicals are being phased out of use rapidly to protect the ozone layer and it is very important that the replacements for CFCs do not result in a net increase in global warming by introducing less efficient processes that lead to higher energy use and increased carbon dioxide emissions. A study was conducted to identify those alternative chemicals and technologies that could replace CFCs in energy related applications before the year 2000, and to assess the total potential impact of those alternatives on global warming. The analysis for this project included an estimate of the direct effects frommore » the release of blowing agents, refrigerants, and solvents into the atmosphere and the indirect effects of carbon dioxide emissions resulting from energy use for commercial and residential building insulation, household and commercial refrigeration, building and automobile air conditioning, and general metal and electronics solvent cleaning. This paper focuses on those aspects of the study relevant to building insulation. In general the hydrofluorocarbon (HFC) and hydrochlorofluorocarbon alternatives for CFCs lead to large and sometimes dramatic reductions in total equivalent warming impact, lifetime equivalent C0{sub 2} emissions (TEWI). Most of the reductions result from decreased direct effects without significant changes in energy use.« less
Fractional thermal runaway calorimetry (FTRC) techniques were introduced to examine thermal runaway (TR) behavior of lithium-ion (Li-ion) cells. Specifically, FTRC considers the total energy released vs. the fraction of the total energy that is released through the cell casing vs. through the ejecta material. This device has been expanded to universally support FTRC testing of additional cell types including 21700-format, D-Cell format, and large prismatic format Li-ion cells. The TR behavior as influenced by cell format, manufacturer, chemistry, capacity, and in situ safety features are described in this presentation.
A new method of signal analysis for automated fluorescence-based DNA sequencing is presented. Signal resolution is a limiting factor in obtaining accurate sequence information beyond 400-450 nucleotides per gel lane. We have developed a computer program for the imaging of DNA bands in sequencing gels. The image analysis shows that distortions in the shapes of the bands decrease resolution of peaks observed served in the standard data plots. Reconstruction of the undistorted band shape prior to signal analysis substantially improves the resolution of peaks and may improve the accuracy and length of the contiguous sequence read. Image analysis identified other factors limiting the accuracy and length of automated DNA sequence analysis and provided a tool for evaluating various remedies. Our techniques should also be applicable in other systems, for example, in gel electrophoresis of proteins and DNA restriction fragments, and in scranning densitometry.
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