Intensive glycemic treatment during Type 1 diabetes pregnancy: A story of (mostly) sweet success!

Studies from Scotland and Canada confirm large increases in the incidence of pregnancies complicated by pregestational type 1 diabetes (T1D). With this increased antenatal workload comes more specialization and staff expertise, which may be important as diabetes technology use increases. While euglycemia remains elusive and obstetrical intervention (earlier delivery, increased operative deliveries) is increasing, there have been some notable successes in the past 5–10 years. These include a decline in the rates of congenital anomaly (Canada) and stillbirths (U.K.) and substantial reductions in both maternal hypoglycemia (both moderate and severe) across many countries. However, pregnant women with T1D still spend ∼30–45% of the time (8–11 h/day) hyperglycemic during the second and third trimesters. The duration of maternal hyperglycemia appears unchanged in routine clinical care over the past decade. This ongoing fetal exposure to maternal hyperglycemia likely explains the persistent rates of large for gestational age (LGA), neonatal hypoglycemia, and neonatal intensive care unit (NICU) admissions in T1D offspring. The Continuous Glucose Monitoring in Women With Type 1 Diabetes in Pregnancy Trial (CONCEPTT) found that pregnant women using real-time continuous glucose monitoring (CGM) spent 5% less time (1.2 h/day) hyperglycemic during the third trimester, with clinically relevant reductions in LGA, neonatal hypoglycemia, and NICU admissions. This article will review the progress in our understanding of the intensive glycemic treatment of T1D pregnancy, focusing in particular on the recent technological advances in CGM and automated insulin delivery. It suggests that even with advanced diabetes technology, optimal maternal dietary intake is needed to minimize the neonatal complications attributed to postprandial hyperglycemia

Evolution of surface gravity waves over a submarine canyon

The effects of a submarine canyon on the propagation of ocean surface waves are examined with a three-dimensional coupled-mode model for wave propagation over steep topography. Whereas the classical geometrical optics approximation predicts an abrupt transition from complete transmission at small incidence angles to no transmission at large angles, the full model predicts a more gradual transition with partial reflection/transmission that is sensitive to the canyon geometry and controlled by evanescent modes for small incidence angles and relatively short waves. Model results for large incidence angles are compared with data from directional wave buoys deployed around the rim and over Scripps Canyon, near San Diego, California, during the Nearshore Canyon Experiment (NCEX). Wave heights are observed to decay across the canyon by about a factor 5 over a distance shorter than a wavelength. Yet, a spectral refraction model predicts an even larger reduction by about a factor 10, because low frequency components cannot cross the canyon in the geometrical optics approximation. The coupled-mode model yields accurate results over and behind the canyon. These results show that although most of the wave energy is refractively trapped on the offshore rim of the canyon, a small fraction of the wave energy 'tunnels' across the canyon. Simplifications of the model that reduce it to the standard and modified mild slope equations also yield good results, indicating that evanescent modes and high order bottom slope effects are of minor importance for the energy transformation of waves propagating across depth contours at large oblique angles

Modeling water waves beyond perturbations

In this chapter, we illustrate the advantage of variational principles for modeling water waves from an elementary practical viewpoint. The method is based on a `relaxed' variational principle, i.e., on a Lagrangian involving as many variables as possible, and imposing some suitable subordinate constraints. This approach allows the construction of approximations without necessarily relying on a small parameter. This is illustrated via simple examples, namely the Serre equations in shallow water, a generalization of the Klein-Gordon equation in deep water and how to unify these equations in arbitrary depth. The chapter ends with a discussion and caution on how this approach should be used in practice.Comment: 15 pages, 1 figure, 39 references. This document is a contributed chapter to an upcoming volume to be published by Springer in Lecture Notes in Physics Series. Other author's papers can be downloaded at http://www.denys-dutykh.com

Members of opposite sex mutually regulate gonadal recrudescence in the lizard Calotes versicolor (Agamidae)

Adult males and females of the seasonally breeding lizard Calotes versicolor were subjected to various social situations under semi-natural conditions to explain the role of socio-sexual factors in gonadal recrudescence. They were grouped as: (i) males and females, (ii) males and females separated by a wire mesh, (iii) same sex groups of males or females, (iv) castrated males with intact females and (v) ovariectomized (OvX) females with intact males from postbreeding to breeding phase. Specimens collected from the wild during breeding season served as the control group. Plasma sex steroid levels (testosterone in male and 17β-estradiol in female), spermatogenetic activity and vitellogenesis were the criteria to judge gonadal recrudescence. In intact males and females that were kept together, gonadal recrudescence and plasma sex steroids levels were comparable to those in wild-caught individuals. Gonadal recrudescence was at its least in all male and all female groups, and plasma sex steroids were at basal levels. Association with OvX females initiated testicular recrudescence but spermatogenetic activity progressed only up to the spermatid stage while males separated from females by wire mesh showed spermatogenetic activity for a shorter period. Females grouped with castrated males and those separated from males by wire mesh produced vitellogenic follicles. However, the total number and diameter of vitellogenic follicles, and plasma estradiol levels were lower than in the females grouped with intact males. The findings indicate that association with members of the opposite sex with progressively rising titers of sex steroids is crucial in both initiating and sustaining gonadal recrudescence in the lizard. Thus, members of the opposite sex mutually regulate gonadal recrudescence in the C. versicolor

Emerging technologies for the management of Type 1 diabetes in pregnancy

Purpose of Review: The purpose of the study is to discuss emerging technologies available in the management of type 1 diabetes in pregnancy. Recent Findings: The latest evidence suggests that continuous glucose monitoring (CGM) should be offered to all women on intensive insulin therapy in early pregnancy. Studies have additionally demonstrated the ability of CGM to help gain insight into specific glucose profiles as they relate to glycaemic targets and pregnancy outcomes. Despite new studies comparing insulin pump therapy to multiple daily injections, its effectiveness in improving glucose and pregnancy outcomes remains unclear. Sensor-integrated insulin delivery (also called artificial pancreas or closed-loop insulin delivery) in pregnancy has been demonstrated to improve time in target and performs well despite the changing insulin demands of pregnancy. Summary: Emerging technologies show promise in the management of type 1 diabetes in pregnancy; however, research must continue to keep up as technology advances. Further research is needed to clarify the role technology can play in optimising glucose control before and during pregnancy as well as to understand which women are candidates for sensor-integrated insulin delivery

Remifentanil patient controlled analgesia versus epidural analgesia in labour. A multicentre randomized controlled trial

Contains fulltext : 109349.pdf (publisher's version ) (Open Access)ABSTRACT: BACKGROUND: Pain relief during labour is a topic of major interest in the Netherlands. Epidural analgesia is considered to be the most effective method of pain relief and recommended as first choice. However its uptake by pregnant women is limited compared to other western countries, partly as a result of non-availability due to logistic problems. Remifentanil, a synthetic opioid, is very suitable for patient controlled analgesia. Recent studies show that epidural analgesia is superior to remifentanil patient controlled analgesia in terms of pain intensity score; however there was no difference in satisfaction with pain relief between both treatments. METHODS/DESIGN: The proposed study is a multicentre randomized controlled study that assesses the cost-effectiveness of remifentanil patient controlled analgesia compared to epidural analgesia. We hypothesize that remifentanil patient controlled analgesia is as effective in improving pain appreciation scores as epidural analgesia, with lower costs and easier achievement of 24 hours availability of pain relief for women in labour and efficient pain relief for those with a contraindication for epidural analgesia.Eligible women will be informed about the study and randomized before active labour has started. Women will be randomly allocated to a strategy based on epidural analgesia or on remifentanil patient controlled analgesia when they request pain relief during labour. Primary outcome is the pain appreciation score, i.e. satisfaction with pain relief.Secondary outcome parameters are costs, patient satisfaction, pain scores (pain-intensity), mode of delivery and maternal and neonatal side effects.The economic analysis will be performed from a short-term healthcare perspective. For both strategies the cost of perinatal care for mother and child, starting at the onset of labour and ending ten days after delivery, will be registered and compared. DISCUSSION: This study, considering cost effectiveness of remifentanil as first choice analgesia versus epidural analgesia, could strongly improve the care for 180.000 women, giving birth in the Netherlands yearly by giving them access to pain relief during labour, 24 hours a day. TRIAL REGISTRATION NUMBER: Dutch Trial Register NTR2551, http://www.trialregister.nl

Implementation of a community-based exercise program for Parkinson patients: using boxing as an example

Background: Persons with Parkinson’s disease (PD) benefit from continuous exercise through participation in community-based exercise programs. However, community programs often lack PD-specific knowledge needed to provide safe and adequately dosed exercise.Objective: To evaluate the acceptability and safety of a PD-specific boxing program in the community.Methods:We developed specific educational resources to facilitate the boxing instructors.We also organized an educational and practicalworkshop for patients (n = 26) and instructors (n = 10), and assessed: (a) participants’ satisfaction; (b) instructors’ appreciation of the educational resources; and (c) numbers of patients interested in participating in the boxing program. After 18 months, patients and instructors completed a questionnaire evaluating: (a) participants’ satisfaction; (b) adverse events; (c) facilitators and barriers; and (d) proportion of participants at follow-up.Results: Twenty-six persons with PD (62% men) and 10 boxing instructors participated in the workshop. 81% of patients and 80% of instructors were very satisfied. Instructors found the educational materials “very helpful” (60%) or “helpful” (40%). Patients expressed a clear interest (54%) or possible interest (46%) in the program.We initiated classes with 10 participants. At 18-months follow-up, the program consisted of four boxing sessions/week, led by three instructors, with 40 participants. Seventeen patients responded to the questionnaire at follow-up. Participants were “very satisfied” (53%), “satisfied” (35%) and neither satisfied nor unsatisfied (12%) with the program. Adverse effects were mild (e.g., muscle aches). Transportation and physical disability were the main barriers for participation.Conclusions: The boxing program was well-received, with increasing numbers of participants at 18 months. The educational resources can support boxing instructors participating in current and future boxing classes being delivered in the community.info:eu-repo/semantics/publishedVersio

Post-Operative Carbonate-Apatite Formation in PEO/PBT Copolymers (Polyactive®)

Previous studies have stressed the importance of calcification of the polyethylene oxide (PEO) I polybutylene terephthalate (PBT) copolymer surface by establishing a direct relation with the occurrence of bone-bonding. Here, we characterized the morphology as well as the composition of this post-operative reaction product in PEOIPBT copolymers. X-ray · photoelectron spectroscopical results demonstrated the ability of PEOIPBT copolymers to rapidly adsorb calcium ions from fluids. After subcutaneous implantation in rats, it was shown that polymer calcification comprised plate-shaped crystals, whereas an electron-dense layer was frequently encountered at the interface. Cells with a characteristic morphology were directly apposed to abundantly calcified surfaces, indicating the biocompatible nature of the material. Subcutaneous calcification was composed of a carbonate-apatite structure with a crystallinity comparable to bone mineral as demonstrated by Fourier transformed infrared spectroscopy and X-ray diffraction. It was concluded that the post-operative reaction product in PEOIPBT copolymers is, in morphology and composition, highly comparable to the carbonate-containing apatitic surface layer generated on acknowledged bioactive substrates and similar to the inorganic phase of bone apatite. This may, partially, explain the bone-bonding behaviour of PEOIPBT copolymers

Multidisciplinary care for people with Parkinson’s disease:the new kids on the block!

INTRODUCTION: Parkinson's disease (PD) is a chronic multisystem disorder that causes a wide variety of motor and non-motor symptoms. Over time, the progressive nature of the disease increases the risk of complications such as falls and loss of independence, having a profound impact on quality of life. The complexity and heterogeneity of symptoms therefore warrant a holistic, multidisciplinary approach. Specific healthcare professionals, e.g. the movement disorders neurologist and the PD nurse specialist, are considered essential members of this multidisciplinary team. However, with our increasing knowledge about different aspects of the disease, other disciplines are also being recognized as important contributors to the healthcare team. Areas covered: The authors describe a selection of these relatively newly-recognized disciplines, including the specialist in vascular medicine, gastroenterologist, pulmonologist, neuro-ophthalmologist, urologist, geriatrician/elderly care physician, palliative care specialist and the dentist. Furthermore, they share the view of a person with PD on how patients and caregivers should be involved in the multidisciplinary team. Finally, they have included a perspective on the new role of the movement disorder neurologist, with care delivery via 'tele-neurology'. Expert commentary: Increased awareness about the potential role of these 'new' professionals will further improve disease management and quality of life of PD patients