Insulin management and metabolic control of type 1 diabetes mellitus in childhood and adolescence in 18 countries. Hvid?re Study Group on Childhood Diabetes

Insulin regimens and metabolic control in children and adolescents with Type 1 diabetes mellitus were evaluated in a cross-sectional, non-population-based investigation, involving 22 paediatric departments, from 18 countries in Europe, Japan, and North America. Blood samples and information were collected from 2873 children from March to August 1995. HbA1c was determined once and analysed centrally (normal range 4.4-6.3%, mean 5.4%). Year of birth, sex, duration of diabetes, height, body weight, number of daily insulin injections, types and doses of insulin were recorded. Average HbA1c in children under 11 years was 8.3 +/- 1.3% (mean +/- SD) compared with 8.9 +/- 1.8% in those aged 12-18 years. The average insulin dose per kg body weight was almost constant (0.65 U kg(-1) 24 h(-1)) in children aged 2-9 years for both sexes, but there was a sharp increase during the pubertal years, particularly in girls. The increase in BMI of children with diabetes was much faster during adolescence compared to healthy children, especially in females. Sixty per cent of the children (n = 1707) used two daily insulin injections while 37% (n = 1071) used three or more. Of those on two or three injections daily, 37% used pre-mixed insulins, either alone or in combination with short- and intermediate-acting insulin. Pre-adolescent children on pre-mixed insulin showed similar HbA1c levels to those on a combination of short- and long-acting insulins, whereas in adolescents significantly better HbA1c values were achieved with individual combinations. Very young children were treated with a higher proportion of long-acting insulin. Among adolescent boys, lower HbA1c was related to use of more short-acting insulin. This association was not found in girls. We conclude that numerous insulin injection regimens are currently used in paediatric diabetes centres around the world, with an increasing tendency towards intensive diabetes management, particularly in older adolescents. Nevertheless, the goal of near normoglycaemia is achieved in only a few.     

As judicial tolerance for appeals wanes,litigants are risking sanctions when seeking to vacate awards

Federal courts aren't hesitating in sanctioning parties who challenge arbitration awards when the moves are rooted in delay or dissatisfaction. Marisa Marinelli and Christelette Hoey, of New York, explain     

Vapor-phase synthesis of uniform silica spheres through two-stage hydrolysis of SiCl4

We report, for the first time, a vapor-phase synthesis of nearly monodispersed silica spheres 250-300 nm in size through a two-stage hydrolysis of SiCl₄. In the first stage, SiCl₄ vapor was partially hydrolyzed with water vapor in a batch reactor at 150 °C to form silicon oxychloride particles, nearly monodispersed and spherical. In the second stage, these oxychloride particles were converted into silica particles through further hydrolysis at 1000 °C in a tubular reactor, while the morphology and size after the first-stage reaction remained virtually unchanged.     

CD59 and CD48 expressed by rat retinal pigment epithelial cells are major ligands for the CD2-mediated alternative pathway of T cell activation

The alternative CD2-mediated pathway of T cell activation, which is independent of MHC/peptide recognition by the TCR/CD3 complex, is dependent upon two signals being received by the CD2 molecule. The natural ligand for CD2 is CD58, but controversy exists over alternative or additional ligands that could deliver the second signal in vivo. We have used rat retinal pigment epithelial cells (RPE), which lack temperature-insensitive ligands for CD2 adhesion, to study Ag-independent T cell activation. Rat RPE cells expressed high levels of CD59 and low levels of another potential CD2 ligand, CD48, both in vitro and in the in vivo model of experimental autoimmune uveoretinitis. When increasing numbers of syngeneic T cells were added to microwell cultures of rat RPE cells, the T cells, even in the absence of any exogenous stimulant in the cultures, underwent spontaneous proliferation. This effect required metabolically active RPE cells, and was IL-2 driven and enhanced in the presence of indomethacin. Proliferation was modulated by phosphatidylinositol-phospholipase C treatment of the RPE, and blocked by mAbs to CD59. Ab cross-linking of CD48 but not CD59 on the RPE was found to induce messenger RNA expression for IL-1 beta, which together with constitutively expressed IL-6 are required costimulatory factors for T cell activation through CD2. This is the first demonstration in a fully syngeneic system that bi-directional signaling involving CD59 and CD48 molecules expressed by physiologically normal, nonhematopoietic, cells can trigger T lymphocyte activation and proliferation through autocrine IL-2 production in the absence of Ag.     

Value-directed human behavior analysis from video using partially observable Markov decision processes

This paper presents a method for learning decision theoretic models of human behaviors from video data. Our system learns relationships between the movements of a person, the context in which they are acting, and a utility function. This learning makes explicit that the meaning of a behavior to an observer is contained in its relationship to actions and outcomes. An agent wishing to capitalize on these relationships must learn to distinguish the behaviors according to how they help the agent to maximize utility. The model we use is a partially observable Markov decision process, or POMDP. The video observations are integrated into the POMDP using a dynamic Bayesian network that creates spatial and temporal abstractions amenable to decision making at the high level. The parameters of the model are learned from training data using an a posteriori constrained optimization technique based on the expectation-maximization algorithm. The system automatically discovers classes of behaviors and determines which are important for choosing actions that optimize over the utility of possible outcomes. This type of learning obviates the need for labeled data from expert knowledge about which behaviors are significant and removes bias about what behaviors may be useful to recognize in a particular situation. We show results in three interactions: a single player imitation game, a gestural robotic control problem, and a card game played by two people.     

River-Management Issues in Scottish Rivers

During recent years, there has been an increase in the use of'alternative'or environmentally acceptable methods of river engineering and management. Most of the published information finds greatest application in lowland rivers where rates of fluvial process operation are slow; however, there is a lack of information relating to high-energy upland rivers.
The paper presents the results of a consultative review of river-management problems in Scottish upland rivers. In addition, suggestions for good environmental practice relating to bank protection, fish-habitat improvement, flood alleviation and confluence realignment are discussed. Where appropriate, design guidelines are presented.