Insulin from the β-cells of the pancreatic islets of Langerhans controls energy homeostasis in vertebrates, and its deficiency causes diabetes mellitus. During embryonic development, the transcription factor Neurogenin3 initiates the differentiation of the β-cells and other islet cell types from pancreatic endoderm, but the genetic program that subsequently completes this differentiation remains incompletely understood. Here we show that the transcription factor Rfx6 directs islet cell differentiation downstream of Neurogenin3. Mice lacking Rfx6 failed to generate any of the normal islet cell types except for pancreatic-polypeptide-producing cells. In human infants with a similar autosomal recessive syndrome of neonatal diabetes, genetic mapping and subsequent sequencing identified mutations in the human RFX6 gene. These studies demonstrate a unique position for Rfx6 in the hierarchy of factors that coordinate pancreatic islet development in both mice and humans. Rfx6 could prove useful in efforts to generate β-cells for patients with diabetes.

This combination of multiple congenital abnormalities has not been previously described and probably represents a new autosomal recessive syndrome involving a genetic abnormality that interferes with normal islet development and whose aetiology is as yet unknown.

ABSTRACT. Objective. To describe findings of deep venous thrombosis (DVT) in association with femoral central venous catheter (CVC) placement for intensive fluid management in children with diabetic ketoacidosis (DKA) secondary to type 1 diabetes.Design. Retrospective cohort study. Setting. Pediatric intensive care unit (PICU) of a children's referral medical center.Patients. DKA patients from 1998 to 2002 of children with DKA with and without CVC placement. DKA patients were also compared with all PICU patients with CVC. CVC DVT was defined as ipsilateral leg swelling with CVC placement, confirmed by radiographic study, and persisting after CVC removal.Measurements and Main Results. Of 113 DKA PICU patients, 6 (5.3%) required femoral CVC for initial management. Three of these DKA/CVC patients developed ipsilateral DVT within 48 hours of CVC placement. All 3 patients required long-term therapy with low molecular weight heparin for persistent leg swelling. DKA/CVC patients with DVT were younger (median age: 10.5 months) than DKA/CVC patients without DVT. The number of DKA/CVC patients with DVT (1.4%) was significantly greater than for all femoral non-DKA/CVC patients. DKA/CVC patients were also significantly more likely to have DVT than age-matched shock/CVC patients. They also had significantly higher glucose, corrected sodium concentrations, and lower pH and serum bicarbonate than did age-matched shock/CVC patients.Conclusions. Femoral CVC placement is infrequently needed in pediatric DKA patients but can be associated with DVT. Femoral CVCs should be avoided in DKA patients or removed as soon as possible. DVT prophylaxis should be considered if a CVC is required. C entral venous catheter (CVC) placement can be essential for providing fluids and medications in the treatment of the child with hypoperfusion and difficulty obtaining adequate peripheral access. CVCs, however, are associated with a variety of infectious and noninfectious complications. 1,2 Both percutaneous and chronic indwelling CVCs are a significant risk factor for deep venous thrombosis (DVT) in children. 1,2 Pediatric venous thromboembolism registries have reported that 28% to 50% of DVT episodes in children occurred in the presence of an acute or chronic CVC. 3,4 The reported incidence of DVT in pediatric intensive care unit (PICU) patients with a CVC ranges widely depending on whether clinical or radiographic evidence of DVT is evaluated. 1,[5][6][7][8] One prospective study of acute CVC placement in PICU patients found a 7.5% incidence of symptomatic DVT but an incidence of 18.3% based on radiographic evidence. 1 Previous experience has demonstrated increased incidence of DVT in children with chronic conditions such as malignancy or congenital heart disease or with acute infection, surgery, trauma, or hypovolemia. 9,10 Diabetes mellitus has not been described as a specific isolated risk factor for DVT in children, although a propensity for hypercoagulability has been noted in diabetic adults. 11 Despite growing experience regarding CVC-relat...

Hyperglycemia is prevalent in pediatric intensive care units and may be effectively identified and managed using a protocolized approach.

This article addresses the importance of offenders’ perceived chances of anticipated desistance. The aim is to investigate to what extent anticipated desistance is associated with (objective) welfare deficiencies, perceived social status and personal agency as measured by the concept of perceived self-efficacy. Secondly, potential differences between men and women in the prediction of future chances of avoiding crime are investigated. Data derive from a survey of a nationwide representative sample of Norwegian prison inmates (225 men and 35 women). The results indicated the presence of severe welfare deficiencies among both male and female inmates. Despite this, a large majority among both genders anticipated their chances of abstaining from crime in the future as good or very good. Practical as well as theoretical implications of these findings are discussed.

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Several municipalities in Norway have tried the Housing First model to facilitate permanent housing for homeless people with substance abuse problems and/or mental illness. This article discusses users’ experiences from receiving social support as part of the Housing First programme. In particular, the article discusses the users’ experiences with the model’s emphasis on users’ choice and self-determination. The analysis shows that what the programs practise is not entirely freedom of choice for the participants but a greater respect of the users’ knowledge, perspectives, and opinions as a starting point for interventions. The analysis shows that participants and staff engage in joint reflection work to help the participants take more reflected decisions in their life. The article discusses how this method can contribute to overcome a diagnostic approach to marginalised and often stigmatised users and provide more personalised and effective services. The discussions draw on data from an evaluation of two trial projects of the Housing First model. The article is mainly based on an analysis of 16 qualitative interviews with users that participated in the projects.

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