The diabetic child in the emergency room

The WHO announced diabetes mellitus as one of the main threats to human health in the 21st century. In children and adolescents the prevalence of both the autoimmune type 1 and the obesity-related type 2 diabetes is increasing. Common to all types of diabetes is an absolute or relative lack of insulin to keep glucose homeostasis under control. Thus children and adolescents with newly diagnosed diabetes present with hyperglycemia which is often accompanied by ketoacidosis bearing the risk of cerebral edema. Children and adolescents with known diabetes treated with insulin or orale antidiabetic agents may also suffer from hyperglycemia or even ketoacidosis during times of non-compliance with diet and drugs or during concomitant illnesses. Hyperglycemia with ketoacidosis is an emergency situation for which patients need to be admitted to the next hospital for administration of insulin, fluids and potassium. In contrast, insulin treatment in diabetic patients may also lead to a hypoglycemia, the sudden drop in blood glucose, at any moment. Thus recognition and correction of mild hypoglycemia should be familiar to every diabetic child and their caretaker. Severe hypoglycemia with or without seizures may bring the diabetic child in a sudden emergency situation for which the administration of glucagon intramuscularly or glucose intravenously is mandatory. After every severe hypoglycemia the insulin and diet regimen of the diabetic child or adolescent must be reviewed with the diabetes specialist. For unexplained hypoglycemia or major treatment adjustments the diabetic child or adolescent may need to be readmitted to the diabetic ward of a hospital to avoid repeat, potentially life-threatening hypoglycemia.

Rough Waters: Life at Sea in the 19th Century

This talk consists of two parts - first part deals with what Jeffrey Bolster called “The Changing Nature of Maritime Insurrection”- and I will tie that into some research that I did on a New York clipper ship called the Contest. The second part of the talk will look at the rise of seafarer’s missions and that will tie Roald Kverndal’s magnum opus Seamen’s Missions: Their Origin and Early Growth into some research that I did on the earliest work done in New York among seafarers that pre-dated the American Seamen’s Friend Society.

Texas electronics waste management: A policy analysis for the 21st century

Electronic waste is a fairly new and largely unknown phenomenon. Accordingly, governments have only recently acknowledged electronic waste as a threat to the environment and public health. In attempting to mitigate the hazards associated with this rapidly growing toxic waste stream, governments at all levels have started to implement e-waste management programs. The legislation enacted to create these programs is based on extended producer responsibility or EPR policy. ^ EPR shifts the burden of final disposal of e-waste from the consumer or municipal solid waste system to the manufacturer of electronic equipment. Applying an EPR policy is intended to send signals up the production chain to the manufacturer. The desired outcome is to change the methods of production in order to reduce production outputs/inputs with the ultimate goal of changing product design. This thesis performs a policy analysis of the current e-waste policies at the federal and state level of government, focusing specifically on Texas e-waste policies. ^ The Texas e-waste law known, as HB 2714 or the Texas Computer TakeBack Law, requires manufacturers to provide individual consumers with a free and convenient method for returning their used computers to manufacturers. The law is based on individual producer responsibility and shared responsibility among consumer, retailers, recyclers, and the TCEQ. ^ Using a set of evaluation criteria created by the Organization for Economic Co-operation and Development, the Texas e-waste law was examined to determine its effectiveness at reducing the threat of e-waste in Texas. Based on the outcomes of the analysis certain recommendations were made for the legislature to incorporate into HB 2714. ^ The results of the policy analysis show that HB 2714 is a poorly constructed law and does not provide the desired results seen in other states with EPR policies. The TakeBack Law does little to change the collection methods of manufacturers and even less to change their production habits. If the e-waste problem is to be taken seriously, HB 2714 must be amended to reflect the proposed changes in this thesis.^

Family to Family: Child Welfare for the 21st Century

Child welfare services have undergone many revisions and transformations since their initiation. Some scholars trace the beginning of child welfare in the United States to events such as a 1655 Massachusetts conviction for maltreatment leading to the death of a 12-year-old boy (Watkins, 1990). The predominant philosophy of child welfare has shifted over time from an early emphasis on child saving, to child protection, to family preservation. Building on family preservation, one of the current transformations in child welfare that is taking place in isolated pockets to whole states, is family-centered, neighborhood-based services. One force behind implementation of this transformation is the Family to Family Initiative of the Annie E. Casey Foundation. This paper places family-centered, neighborhood-based child welfare services within the historical context of development of child welfare and within the recent move to reinvent human services (Adams & Nelson, 1995). Against this backdrop, a locality-based implementation of the Family to Family Initiative is described.

Temperature, water level and bathymetry of thermokarst lakes in the continuous permafrost zone of northern Siberia - Lena River Delta, Siberia

Thermokarst lakes are typical features of the northern permafrost ecosystems, and play an important role in the thermal exchange between atmosphere and subsurface. The objective of this study is to describe the main thermal processes of the lakes and to quantify the heat exchange with the underlying sediments. The thermal regimes of five lakes located within the continuous permafrost zone of northern Siberia (Lena River Delta) were investigated using hourly water temperature and water level records covering a 3-year period (2009-2012), together with bathymetric survey data. The lakes included thermokarst lakes located on Holocene river terraces that may be connected to Lena River water during spring flooding, and a thermokarst lake located on deposits of the Pleistocene Ice Complex. Lakes were covered by ice up to 2 m thick that persisted for more than 7 months of the year, from October until about mid-June. Lake-bottom temperatures increased at the start of the ice-covered period due to upward-directed heat flux from the underlying thawed sediment. Prior to ice break-up, solar radiation effectively warmed the water beneath the ice cover and induced convective mixing. Ice break-up started at the beginning of June and lasted until the middle or end of June. Mixing occurred within the entire water column from the start of ice break-up and continued during the ice-free periods, as confirmed by the Wedderburn numbers, a quantitative measure of the balance between wind mixing and stratification that is important for describing the biogeochemical cycles of lakes. The lake thermal regime was modeled numerically using the FLake model. The model demonstrated good agreement with observations with regard to the mean lake temperature, with a good reproduction of the summer stratification during the ice-free period, but poor agreement during the ice-covered period. Modeled sensitivity to lake depth demonstrated that lakes in this climatic zone with mean depths > 5 m develop continuous stratification in summer for at least 1 month. The modeled vertical heat flux across the bottom sediment tends towards an annual mean of zero, with maximum downward fluxes of about 5 W/m**2 in summer and with heat released back into the water column at a rate of less than 1 W/m**2 during the ice-covered period. The lakes are shown to be efficient heat absorbers and effectively distribute the heat through mixing. Monthly bottom water temperatures during the ice-free period range up to 15 °C and are therefore higher than the associated monthly air or ground temperatures in the surrounding frozen permafrost landscape. The investigated lakes remain unfrozen at depth, with mean annual lake-bottom temperatures of between 2.7 and 4 °C.