Training in flexible, intensive insulin management to enable dietary freedom in people with type 1 diabetes : dose adjustment for normal eating (DAFNE) randomised controlled trial

Objectives: To evaluate whether a course teaching flexible intensive insulin treatment combining dietary freedom and insulin adjustment can improve both glycaemic control and quality of life in type 1 diabetes.

Design: Randomised design with participants either attending training immediately (immediate DAFNE) or acting as waiting list controls and attending “delayed DAFNE” training 6 months later.
Setting: Secondary care diabetes clinics in three English health districts.

Participants: 169 adults with type 1 diabetes and moderate or poor glycaemic control.

Main outcome measures: Glycated haemoglobin (HbA1c), severe hypoglycaemia, impact of diabetes on quality of life (ADDQoL).

Results: At 6 months, HbA1c was significantly better in immediate DAFNE patients (mean 8.4%) than in delayed DAFNE patients (9.4%) (t=6.1, P<0.0001). The impact of diabetes on dietary freedom was significantly improved in immediate DAFNE patients compared with delayed DAFNE patients (t=−5.4, P<0.0001), as was the impact of diabetes on overall quality of life (t=2.9, P<0.01). General wellbeing and treatment satisfaction were also significantly improved, but severe hypoglycaemia, weight, and lipids remained unchanged. Improvements in “present quality of life” did not reach significance at 6 months but were significant by 1 year.

Conclusion: Skills training promoting dietary freedom improved quality of life and glycaemic control in people with type 1 diabetes without worsening severe hypoglycaemia or cardiovascular risk. This approach has the potential to enable more people to adopt intensive insulin treatment and is worthy of further investigation.

Rapid determination of carbohydrates in heroin drug seizures using capillary electrophoresis with short-end injection

A simple and rapid method for the analysis of carbohydrates in heroin samples by capillary electrophoresis utilizing a borate complexation method is described. Separations were performed using an uncoated fused silica capillary, 50 cm × 50 mm I.D. × 360 mm O.D. with an effective separation length of 9 cm. The system was run at 60°C with an applied voltage of -8 kilovolts. Injection of each sample was for 1 sec at -50 mbar. UV detection was employed with the wavelength set at 195 nm. The background electrolyte consisted of 65 mM borate, pH 12.0. Samples and standards were prepared in the run buffer containing 2 mg/mL of mannose as an internal standard. Under these conditions a test mixture containing glucose, sucrose, lactose, mannitol and mannose as an internal standard was resolved within 5 min. The method was used to determine the concentration of carbohydrates in heroin seizure samples and synthetic heroin samples. The results were in good agreement with the reported values.

The rapid analysis of heroin drug seizures using micellar electrokinetic chromatography with short-end injection

A simple and rapid method for the analysis of heroin seizures by micellar electrokinetic chromatography with short-end injection is described. Separations were performed using an uncoated fused silica capillary, 50 cm×50 mm I.D.×360 mm O.D. with an effective separation length of 8 cm. The system was run at 25°C with an applied negative voltage of –25 kilovolts. Injection of each sample was for 2 s at –50 mbar. UV detection was employed with the wavelength set at 210 nm. The background electrolyte consisted of 85:15 (water:acetonitrile, v/v) containing final concentrations of 25 mM SDS and 15 mM sodium borate, pH 9.5. Samples and standards were prepared in 0.1% v/v acetic acid and diluted in the run buffer containing 1 mg/ml of N,N-dimethyl-5-methoxytryptamine as an internal standard. Under these conditions a text mixture containing caffeine, paracetamol, morphine, codeine, heroin, and acetylcodeine was resolved within 1.5 min. The method was used to determine the concentration of heroin in heroin seizure samples, and the results were in good agreement with those obtained by a validated gas chromatographic method.

The several social constructions of James, Jenks, and Prout: A contribution to the sociological theorization of childhood

The article is intended to contribute to the ongoing debate over theorizations of childhood, especially in the terms articulated by Allison James, Chris Jenkins and Alan Prout. The article focuses on the notion of social construction as a theory of childhood. There are four valid approaches to theorizing childhood. The tribal approach treats childhood as a kind of exotic tribe with its own beliefs, practices and institutions. The social structural approach treats childhood as a structurally necessary stratum in any society. The minority group approach treats childhood as an oppressed minority group, able to some extent to represent themselves and exert quasi-political action. The socially constructed approach constitutes the sociological view of childhood. The key role played by the idea of social construction is made extremely clear in the earlier work, Constructing and Reconstructing Childhood by James and Prout. Social constructionism is said to be an interpretive approach, related historically to research on children's understanding of adult experimenters' intentions. The senses of social construction that emerge from critical psychology overlap a great deal with those articulated in the new sociology of childhood.

Preliminary investigations into tris(2,2'-bipyridyl) ruthenium (III) as a chemiluminescent reagent for the detection of 3,6-diacetylmorphine (heroin) on surfaces

The use of tris(2,2'-bipyridyl) ruthenium (III) as a chemiluminescent spray reagent spot-test for heroin is discussed. Two forms of the reagent are investigated an aqueous and an anhydrous where both were found to give vastly different results. The aqueous reagent giving slow, low intensity chemiluminescence whilst the anhydrous reagent gave a fast, bright response in the presence of 3,6-diacetylmorphine. The anhydrous reagent is less sensitive the slow, intensity response is characteristic of only two opiates tested 3,6-diacetylmorphine and 3-monoacetylmorphine.

Instructor's resource guide to accompany 'Management : core concepts & skills'

Prepared by Andrew Creed (Deakin University), this useful resource includes an introductory statement or question tp stimulate thought about topic, chapter learning objectives, chapter outline, chapter summary and teaching notes (including enhancements such as inserted activities for use in lectures/class). Responses for text questions including critical thinking, review, analysis and case study questions and additional class exercises.

Book review : Managing government property assets by Olga Kaganova and James McKellar (eds)

Managing Government Property Assets, edited by Olga Kaganova and James McKellar, is reviewed.