In this paper we consider a much-quoted phrase published by the essayist Charles Lamb (1775–1834) in the London Magazine in 1822 about a desirable quality in books: that they should be ‘strong-backed and neat-bound’. We identify meanings of modifier neat as evidenced by different communities of practice in early nineteenth-century newspapers, and in particular we present meanings of neat as used in certain Quaker writings known to have been read with approval by Lamb. By this method we assemble a series of nuanced meanings that the phrase neat-bound would have conveyed to contemporary readers – specifically, the readership of the London Magazine.
Left hand and wrist X-rays are conventionally used to assess skeletal maturity using methods such as Tanner-Whitehouse 3 (TW3). We noted a number were poor quality, caused by difficulty with hand placement. We introduced a simple radiolucent hand template to assist in hand positioning and assessed changes in X-ray quality and repeat X-ray rates.
The position of fingers, thumb and overall clarity of bone age X-rays were prospectively scored. In the absence of a validated tool to assess quality a 1–3 scale (poor, borderline, good) was devised. A radiolucent hand template was introduced for use in the intervention group. Need for repeat X-ray was determined by set criteria.
The intervention improved scores. More patients scored 3 (good) for positioning of fingers (89.29% and 85.33%, p=0.38), thumb (98.21% and 89.96%, p=0.06) and overall clarity (76.79% and 70.27%, p=0.41) for the intervention (n=56) and control groups (n=259), respectively. No patient required repeat X-ray from the intervention group, compared with 28 in the control group (p=0.007).
Achieving good quality bone age X-rays is more difficult than previously assumed. The use of a radiolucent hand template has been shown to improve hand position and significantly reduce the need for repeat X-ray.
A previously established method based on headspace solidphase microextraction (HS-SPME) and comprehensive two-dimensional gas chromatography (GC×GC) coupled to time-of-flight mass spectrometry (TOFMS) has been used to evaluate and compare the profiles of semi-volatile compounds present in mainstream tobacco smoke particulate matter trapped on glass fibre filters for two types of cigarettes differing only in filter design. In the first cigarette, the filter cavity contained approximately 60 mg of a weakly basic macroporous polystyrene resin cross-linked with divinyl benzene and with surface amine functionality (CR20), whereas in the second cigarette, it was empty.
Relative quantitative analysis, chemical identification, and chemical grouping allowed the use of both parametric and non-parametric analyses to identify differences in the chemical composition of the smokes from these cigarettes. The analysis demonstrated that in addition to the selective partial removal of volatile carbonyls and HCN demonstrated previously, CR20 selectively, but incompletely removed 316 compounds from the particulate phase of cigarette smoke, mainly aryl and aromatic hydrocarbons as well as other more volatile species. In contrast, the relative proportion of amines, hydroxylated aromatic compounds and less volatile species was increased in the smoke from the cigarette containing CR20 in the filter.
Our findings show that high resolution GC techniques combined with mass spectrometry and chemometric approaches are powerful tools for deconvoluting the complexity of combustion aerosols, as well as helping to identify changes in chemical composition resulting from modifications to cigarette designs. [Beitr. Tabakforsch. Int. 28 (2019) 231–249]
We previously showed, in patients with diabetes, that >50% of monitoring tests for glycated haemoglobin (HbA1c) are outside recommended intervals and that this is linked to diabetes control. Here, we examined the effect of tests/year on achievement of commonly utilised HbA1c targets and on HbA1c changes over time.
Data on 20,690 adults with diabetes with a baseline HbA1c of >53 mmol/mol (7%) were extracted from Clinical Biochemistry Laboratory records at three UK hospitals. We examined the effect of HbA1c tests/year on (i) the probability of achieving targets of ≤53 mmol/mol (7%) and ≤48 mmol/mol (6.5%) in a year using multi-state modelling and (ii) the changes in mean HbA1c using a linear mixed-effects model.
The probabilities of achieving ≤53 mmol/mol (7%) and ≤48 mmol/mol (6.5%) targets within 1 year were 0.20 (95% confidence interval: 0.19–0.21) and 0.10 (0.09–0.10), respectively. Compared with four tests/year, having one test or more than four tests/year were associated with lower likelihoods of achieving either target; two to three tests/year gave similar likelihoods to four tests/year. Mean HbA1c levels were higher in patients who had one test/year compared to those with four tests/year (mean difference: 2.64 mmol/mol [0.24%], p<0.001).
We showed that ≥80% of patients with suboptimal control are not achieving commonly recommended HbA1c targets within 1 year, highlighting the major challenge facing healthcare services. We also demonstrated that, although appropriate monitoring frequency is important, testing every 6 months is as effective as quarterly testing, supporting international recommendations. We suggest that the importance HbA1c monitoring frequency is being insufficiently recognised in diabetes management.