Miracle-dz/UniFAR-FTUs huggingface dataset:
A Psychoeducational Program to Restore Hypoglycemia Awareness: The DAFNE-HART Pilot Study

OBJECTIVE To develop and pilot a novel intervention addressing motivational and cognitive barriers to avoiding hypoglycemia in people with type 1 diabetes and persistent impaired awareness of hypoglycemia (IAH) despite training in flexible insulin therapy. RESEARCH DESIGN AND METHODS A 6-week intervention using motivational interviewing and cognitive behavioral techniques was designed. Diabetes educators were trained and supported in its delivery to 23 people with IAH (Gold score ≥4). RESULTS Twelve months postcourse, hypoglycemia awareness had improved (P < 0.001). Median (range) rates of severe hypoglycemia (SH) fell from 3 (0–104) to 0 (0–3) per person per year (P < 0.0001) and moderate from 14 (0–100) to 0 (0–18) per person per 6 weeks (P < 0.001). Worry and behavior around hyperglycemia improved. HbA1c was unchanged. CONCLUSIONS A pilot intervention targeting motivation and cognitions around hypoglycemia engaged patients with resistant IAH and recurrent SH and was associated with significant improvement, supporting the hypothesis that these factors underpin problematic hypoglycemia.
Outcome of Chemotherapy Counseling in Oncology Patients by Pharmacist

Cancer is a disease that requires long term treatment and intensive monitoring. There are several methods to manage cancer but most cases are treated with chemotherapy. Patients who receive chemotherapy should receive advice on side effect management and proper self-care to properly cope with drug related problems and ultimately obtain the maximum benefits from the treatment. The prospective descriptive study was designed to evaluate the outcome of chemotherapy counseling utilizing standard questionnaires by a pharmacist who participated in an oncology care team during December 2004 to March 2005. The study setting was a medical oncology patient care unit (5E ward), Srinagarind Hospital, Khon Kaen University, Thailand. Ninety-one cancer patients were assessed for eligibility and 82 (90.1%) were recruited in this study. The counseling by pharmacist took place three times before and after patient received chemotherapy at each visit. The patients were evaluated in terms of knowledge, satisfaction and frequency of side effects. The results demonstrated that patients had an improved knowledge score based on disease and chemotherapy, possible side effect of chemotherapy and self care behavior after receiving chemotherapy counseling by a pharmacist following three evaluation periods (p
Dietary Sugar and Body Weight: Have We Reached a Crisis in the Epidemic of Obesity and Diabetes?

Sugar-sweetened drinks have been associated with several health problems. In the point narrative as presented below, we provide our opinion and review of the data to date that we need to reconsider consumption of dietary sugar based on the growing concern of obesity and type 2 diabetes. In the counterpoint narrative following our contribution, Drs. Kahn and Sievenpiper provide a defense and suggest that dietary sugar is not the culprit. Data from the National Health and Nutrition Examination Survey and U.S. Department of Agriculture dietary surveys along with commercial Homescan data on household purchases were used to understand changes in sugar and fructose consumption. Meta-analyses and randomized clinical trials were used to evaluate outcomes of beverage and fructose intake. About 75% of all foods and beverages contain added sugar in a large array of forms. Consumption of soft drinks has increased fivefold since 1950. Meta-analyses suggest that consumption of sugar-sweetened beverages (SSBs) is related to the risk of diabetes, the metabolic syndrome, and cardiovascular disease. Drinking two 16-ounce SSBs per day for 6 months induced features of the metabolic syndrome and fatty liver. Randomized controlled trials in children and adults lasting 6 months to 2 years have shown that lowering the intake of soft drinks reduced weight gain. Recent studies suggest a gene-SSB potential relationship. Consumption of calorie-sweetened beverages has continued to increase and plays a role in the epidemic of obesity, the metabolic syndrome, and fatty liver disease. Reducing intake of soft drinks is associated with less weight gain.
Association of Functional Decline With Subsequent Diabetes Incidence in U.S. Adults Aged 51 Years and Older: The Health and Retirement Study 1998–2010

OBJECTIVE We assessed whether functional decline and physical disability increase the subsequent risk of diabetes. RESEARCH DESIGN AND METHODS We used a subsample of adults aged 51 years and older with no diabetes at baseline who were followed up to 12 years (1998–2010) in the Health and Retirement Study, an observational study of a nationally representative survey. We assessed baseline disability status and incident disability with subsequent risk of diabetes, accounting for death as a competing risk and controlling for BMI, age, sex, race/ethnicity, net wealth, mother’s level of education, respondents’ level of education, and time of follow-up. Disability was defined as none, mild, moderate, and severe, based on a validated scale of mobility measures. Diabetes was identified by self-report of a diagnosis from a doctor. Population attributable fraction (PAF) was calculated to assess the percentage of diabetes cases that were attributable to mobility disability. RESULTS The sample included 22,878 adults with an average of 8.7 years of follow-up; 9,649 (41.2%) reported some level of disability at baseline, and 8,175 (35.7%) additional participants developed disability during follow-up; 3,546 (15.5%) participants developed diabetes; and 5,869 (25.6%) died. Regression analyses found a statistically significant dose–response relationship of increased risk of diabetes (28–95%) among those with any level of functional decline, prevalent or incident. Among the subanalytic sample, including incident disability only, the PAF was 6.9% (CI 4.2–9.5). CONCLUSIONS Our findings suggest those who become disabled, even mildly, are at increased risk of developing diabetes. This finding raises the possibility that approaches to prevent disability in older adults could also reduce diabetes incidence.
The Hippocratic Myth

How does American society address the vulnerability of the body? We rarely stop to think about how quickly a disease or accident can derail even the best of lives. For the hundreds of millions of people who live on a few dollars a day, medical care is rare and haphazard. The United States has gradually put in place a vast infrastructure of law and institutions designed to provide its citizens with quality, affordable, and accessible care. The proper limits of such care are hard to discern. Gregg Bloche’s book The Hippocratic Myth gives some excellent examples to reflect upon as the Affordable Care Act slowly begins to influence the health care delivery system. Not many policymakers or scholars can write with the authority of Gregg Bloche. Bloche is not only a law professor, but a physician, who knows his way around a hospital. Throughout The Hippocratic Myth, Bloche cements his authority in the mind of the reader by relating stories of his experience as a clinician. In each of these stories, his humane and insightful approach as psychiatrist shines through. I do not say this to imply that Bloche uses his book to brag about his own abilities. Rather, these fluently-written passages strike one as the work of one of those rare practitioners who manages to care deeply about the patient at hand while simultaneously contextualizing the encounter in a larger framework. Thus The Hippocratic Myth should take its
A Low–Glycemic Index Meal and Bedtime Snack Prevents Postprandial Hyperglycemia and Associated Rises in Inflammatory Markers, Providing Protection From Early but Not Late Nocturnal Hypoglycemia Following Evening Exercise in Type 1 Diabetes

OBJECTIVE To examine the influence of the glycemic index (GI) of foods consumed after evening exercise on postprandial glycemia, metabolic and inflammatory markers, and nocturnal glycemic control in type 1 diabetes. RESEARCH DESIGN AND METHODS On two evenings (∼1700 h), 10 male patients (27 ± 5 years of age, HbA1c 6.7 ± 0.7% [49.9 ± 8.1 mmol/mol]) were administered a 25% rapid-acting insulin dose with a carbohydrate bolus 60 min before 45 min of treadmill running. At 60 min postexercise, patients were administered a 50% rapid-acting insulin dose with one of two isoenergetic meals (1.0 g carbohdyrate/kg body mass [BM]) matched for macronutrient content but of either low GI (LGI) or high GI (HGI). At 180 min postmeal, the LGI group ingested an LGI snack and the HGI group an HGI snack (0.4 g carbohdyrate/kg BM) before returning home (∼2300 h). Interval samples were analyzed for blood glucose and lactate; plasma glucagon, epinephrine, interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α); and serum insulin, cortisol, nonesterified fatty acid, and β-hydroxybutyrate concentrations. Interstitial glucose was recorded for 20 h postlaboratory attendance through continuous glucose monitoring. RESULTS Following the postexercise meal, an HGI snack induced hyperglycemia in all patients (mean ± SD glucose 13.5 ± 3.3 mmol/L) and marked increases in TNF-α and IL-6, whereas relative euglycemia was maintained with an LGI snack (7.7 ± 2.5 mmol/L, P < 0.001) without inflammatory cytokine elevation. Both meal types protected all patients from early hypoglycemia. Overnight glycemia was comparable, with a similar incidence of nocturnal hypoglycemia (n = 5 for both HGI and LGI). CONCLUSIONS Consuming LGI food with a reduced rapid-acting insulin dose following evening exercise prevents postprandial hyperglycemia and inflammation and provides hypoglycemia protection for ∼8 h postexercise; however, the risk of late nocturnal hypoglycemia remains.
Mental health, risk communication and data quality in the electronic age

This paper discusses the impact on mental health service users of the computerised healthcare programme currently being developed by the NHS that aims to make healthcare information available on a much wider basis than is currently the case. The potential benefits of electronic health records are considerable in terms of enhancing effective and safe healthcare. Yet electronic databases, whatever their purported aim, open up the potential for greater surveillance in a state where dissidence is becoming less easily tolerated and technological advances allow greater inroads into private lives. With a specific focus upon service users considered to pose a risk to other people, and drawing upon qualitative research jointly conducted by the author, this paper focuses upon the use of risk assessments in practice, the accuracy of information about risk, service users’ rights re access to information, their involvement in risk assessment and the objectivity of risk information. The paper concludes with a discussion of possible outcomes for mental health service users and professionals.
Trends in the Evidence Level for the American Diabetes Association's “Standards of Medical Care in Diabetes” From 2005 to 2014

In the January Supplement of Diabetes Care , the American Diabetes Association (ADA) has published the newest version of the “Standards of Medical Care in Diabetes” (1). These Standards provide guidelines to help clinicians in the management of their patients with diabetes or at risk for diabetes. Published in one form or another since 1989, the Standards cover multiple aspects of clinical care, such as screening and diagnosis, glycemic management, and cardiovascular risk reduction. Over the past decade, the ADA has made a concerted effort to be transparent and evidence-based in its guideline development as recommended by the Institute of Medicine for guideline-setting organizations (2). We reviewed the ADA recommendations from the past decade to assess trends in the quality of evidence cited to support these recommendations. Each year, the recommendations in the Standards are reviewed and revised in light of emerging and changing evidence. We examined the total number and evidence level for all bulleted recommendations made by the Standards of Care each year from 2005 to 2014. Recommendations are assigned ratings of A, B, C, or E depending on the quality of evidence (Table 1). For our analyses of trends over the past decade, we combined A- and B-level recommendations into a “higher-level evidence” category and combined C- and E-level recommendations into a “lower-level evidence” category. We then calculated the proportion of overall recommendations that were based on higher-level evidence each year. We also examined trends in the recommendations within …
Response to Comment on Tay et al. A Very Low-Carbohydrate, Low–Saturated Fat Diet for Type 2 Diabetes Management: A Randomized Trial. Diabetes Care 2014;37:2909–2918

Maiorino et al. (1) correctly identify that HbA1c was the primary outcome of our previously reported study (2) but may have misunderstood the statistical approach used to evaluate the diet effects on outcomes, including HbA1c, when they suggest a subgroup analysis was used as opposed to the whole-population analysis that was performed. The primary objective of our study was to compare the effects of a very low-carbohydrate (LC) diet to a high–unrefined carbohydrate (HC) diet on glycemic control and cardiovascular disease risk factors in obese adults with type 2 diabetes. The study used a randomized groups, pretest-posttest design and the planned analysis of the …
Sex, Conception Interval, Gestational Age, Apgar Score, and Anthropometric Surrogates in relation to Birth Weight of Bangladeshi Newborns: A Cross-Sectional Study

In developing countries, where about 75% of births occur at home or in the community, logistic problems prevent the weighing of every newborn child. Baby born with a weight less than 2,500 g is considered low birth weight, since below this value birth-specific infant mortality begins to rise rapidly. In Bangladesh, the prevalence of low birth weight is unacceptably high. Infant's sex differences, birth to conception interval, gestational age, and Apgar score are associated with infant birth weight. To screen low-birth-weight babies, simple anthropometric parameters can be used in rural areas where 80–90% of deliveries take place. A sample of 343 newborn singletons, 186 male and 157 female babies, were studied in Southwest region of Bangladesh to examine the birth weight status of newborns and to identify the relationship between birth weight and other anthropometric parameters of newborns. The mean birth weight was g, and 28.6% were low-birth-weight (<2,500 g) babies. All key anthropometric parameters of the newborns significantly correlated with infant birth weight . Mid upper arm circumference and chest circumference were identified as the optimal surrogate indicators of LBW babies. In the community where weighing of newborns is difficult, these measurements can be used to identify the LBW babies.
Impaired Awareness of Hypoglycemia in Adults With Type 1 Diabetes Is Not Associated With Autonomic Dysfunction or Peripheral Neuropathy

OBJECTIVE Impaired awareness of hypoglycemia (IAH) is a risk factor for severe hypoglycemia in people with insulin-treated diabetes; autonomic neuropathy has been suggested to underlie its development. The aim was to evaluate a putative association between IAH and autonomic dysfunction using novel and sensitive measures of autonomic neural function. RESEARCH DESIGN AND METHODS Sixty-six adults with type 1 diabetes were studied, 33 with IAH and 33 with normal awareness of hypoglycemia (NAH), confirmed by formal testing. Participants were matched for age, sex, and diabetes duration. Clinical and laboratory evaluations included extensive autonomic function testing, peripheral nerve conduction studies, and quantitative sensory testing. Composite abnormality Z scores were used for group comparisons. RESULTS The IAH and NAH group had similar median (interquartile range) age of 48 (14.5) vs. 47 (14.5) years, diabetes duration of 30 (13.5) vs. 31 (13.5) years, and mean ± SD HbA1c 7.8 ± 2.2% vs. 8.1 ± 1.9%, respectively. The autonomic composite Z score did not differ between the two groups (mean difference −0.15, 95% CI −0.46, 0.16; P = 0.33), nor did the thermal detection (mean difference 0.15, 95% CI −0.31, 0.61; P = 0.51) or nerve conduction scores (mean difference 0.03, 95% CI −0.43, 0.49; P = 0.89). CONCLUSIONS In adults with type 1 diabetes, IAH was not associated with autonomic dysfunction or peripheral neuropathy.
The fMRI correlates of psychological "complexes": Exploring the neurobiology of internal conflict

Objective: Internal conflict is a common feature of subjective life, but its neurobiology is poorly understood. A century ago, Jung discovered that subjects, asked to respond quickly to stimulus words presented serially from a standard list, would occasionally produce unusual associations with emotional and physiologically disturbances, at odds with their usual conscious stance. From such responses, "complexes" could be inferred. Complexes were thought to feature in psychosis, neurosis, deviant behaviors like criminality and the psychopathology of everyday life. Method: Jung's 100 Word Association Test adapted for fMRI conditions was performed in a 4 Tesla fMRI Unit with 12 normal subjects, yielding 14 scans. Words were presented at 20 second intervals. Two lots of 339 volumes (36 slices per volume) were acquired per subject. A "generic complex response" was mapped by contrasting all complexed responses against neutral. Results: SPM5 analysis of complexed responses revealed a pattern of bilaterally symmetrical activity, well above the FWE/FDR threshold (Z scores ranging from 4.77 to 5.58), in anterior insulae, medial prefrontal (SMA and middle cingulate), lateral prefrontal (Broca's), and mid -temporal regions. Conclusions: Internal conflict has a biological substrate. The pattern involves internal negotiations at three levels; cortico-limbic, antero-posterior (prefrontal versus post-frontal), and interhemispheric. Both insulae are involved. This pattern is similar to the "resonance circuitry" described by Siegel and colleagues as central to empathy and our sense of self and other.
Low–Blood Glucose Avoidance Training Improves Glycemic Variability in Adults With Type 1 Diabetes Complicated by Impaired Awareness of Hypoglycemia: HypoCOMPaSS Trial

The Comparison of Optimized MDI Versus Pumps With or Without Sensors in Severe Hypoglycemia (HypoCOMPaSS) trial was a prospective, multicenter, randomized controlled trial examining the restoration of impaired awareness of hypoglycemia (IAH) and the prevention of severe hypoglycemia (SH) in adults with type 1 diabetes using multiple daily injections (MDI) compared with continuous subcutaneous insulin infusion (CSII), with or without adjunctive real-time continuous glucose monitoring (RT-CGM), using a 2 × 2 factorial design (1). Few studies are currently available to compare the difference in glucose variability (GV) between MDI and CSII and between self-monitored blood glucose (SMBG) and RT-CGM (2–4). These studies showed an improvement in GV in favor of CSII and RT-CGM. However, none of them included participants with IAH or history of SH. The aim of this study is to compare the changes in GV between MDI and CSII and between SMBG and RT-CGM group in this specific patient group with type 1 diabetes with IAH or recurrent SH. A total of 96 participants were recruited for the study. Each participant undertook 7 days of blinded CGM using Medtronic iPro at baseline and prior to each of the four weekly visits during the 24-week randomized controlled trial period. GV was measured as glucose SD and coefficient of variation (%CV), calculated using available Excel formulas published online (5). Overall, there were decreases in GV between baseline and week …
Experimental Research on Damage Detection Based on Time Domain Data and Bayesian Fusion

Damages such as cracks often occur in engineering structures, and such damages often have the characteristics of time-domain variable stiffness. To effectively identify this kind of damage, a damage detection method based on time domain data and Bayesian fusion is presented in this paper. First, a hybrid model of the AR/ARCH model is used to identify structural nonlinear damage, and a damage indicator is also used: the second-order-variance indicator (SOVI). Although most of the nonlinear damage information is extracted by the indicator SOVI and ARCH model, some nonlinear information is still filtered out by the AR model part. Therefore, a linear cepstral metric indicator (CMI) based on the AR model is introduced to extract the remained nonlinear damage information, and further, the Bayesian fusion theory is applied to combine the results of SOVI and CMI to obtain complete nonlinear damage information and achieve better identification results. Finally, a three-story frame experimental model is used to demonstrate the effectiveness of the Bayesian fusion. Experimental results show that the Bayesian fusion method is superior to SOVI and CMI.
Aminoglykoside bei Patienten mit Mukoviszidose und pulmonaler Exazerbation : Vergleich von Einmal- und Dreimalgabe

Twenty-six patients with cystic fibrosis and pulmonary exacerbations were enrolled in a prospective randomized study to compare the efficacy of aminoglycosides (tobramycin or netilmicin) administered once daily (21 episodes, 5 with netilmicin, 16 with tobramycin) and thrice daily (23 episodes, 2 with netilmicin, 21 with tobramycin), respectively. In addition, the patients received an anti-pseudomonal beta-lactam antibiotic. In the single-dose group the total daily dosage was 4.97 +/- 1.12 mg/kg (total dosage per exacerbation: 74.55 mg/kg), compared to 9.60 +/- 2.70 mg/kg in the triple-dose group (total dosage per exacerbation: 165.12 mg/kg). The mean peak and trough serum levels of the aminoglycoside were 8.31 +/- 1.76 mg/l and 0.18 +/- 0.10 mg/l, respectively in the single dose group compared to 6.12 +/- 1.30 mg/l and 0.58 +/- 0.31 mg/l in the triple dose group. Success of treatment, defined as decrease in leucocyte counts, normalization of elevated CRP-values, number of days in hospital and interval until next admission to hospital, was not different between both groups. We conclude that single daily dose of aminoglycosides was as efficacious as triple dose in our patients.
Orthopedic implant-associated infections caused by Cutibacterium spp. – A remaining diagnostic challenge

Background The definition criteria and clinical characteristics of implant-associated infection (IAI) caused by Cutibacterium (formerly Propionibacterium) spp. are poorly known. We analyzed microbiologically proven Cutibacterium orthopedic IAI in a prospective cohort. Methods Patients with periprosthetic joint infections (PJI) and fixation device–associated infections (FDAI) caused by Cutibacterium spp. were prospectively included. IAI was defined by significant growth of Cutibacterium spp. and presence of at least one non-microbiological criterion for infection. The McNemar’s chi-squared or binomial test was used to compare the performance of diagnostic tests. Results Of 121 patients with Cutibacterium IAI, 62 patients (51%) had PJI and 59 (49%) had FDAI. 109 infections (90%) were caused by C. acnes and 12 (10%) by C. avidum. The median time from implantation until diagnosis of infection was 15.7 months (interquartile range, 5–46.5 months). Clinical local signs were present in 30 patients (28%) and radiological implant loosening in 64 patients (63%). Culture sensitivity of sonication fluid was 84%, of peri-implant tissue 84% and of synovial or peri-implant fluid 56% after 14 days of incubation. Conclusion Cutibacterium IAI was diagnosed late in the disease course and presented with subtle signs. Prolonged culture incubation and implant sonication improved the poor performance of conventional microbiological tests. Due to lack of reliable diagnostic tests, Cutibacterium remains difficult to detect making the diagnosis challenging.