bluuebunny/crossref_metadata_2025 huggingface dataset:
EFL Reading Anxiety Inventory (EFLRAI)
Authors: Zoghi Masoud , Alivandivafa Marziyeh
Published: January 2014

This study was designed to examine the factor structure and psychometric properties of the English as a Foreign Language Reading Anxiety Inventory (EFLRAI). A total of 939 non-English major students responded to the EFLRAI. Exploratory and confirmatory factor analyses were performed using a principal component analysis and structural equation modeling. Reliability analysis was also conducted to provide an indication of the internal consistency (reliability) of the measurement instrument. The findings of the study confirmed the adequacy of the three-factor model for the EFLRAI and also indicated decent reliability through internal consistency for the measure. The results not only support the EFLRAI’s multidimensionality, but also indicate the usefulness of the EFLRAI in reading anxiety research among non-English major students. The limitations of the study are discussed and recommendations for further research are provided.
Hemophagocytic Syndrome and Critical Illness
Authors: Tothova Zuzana , Berliner Nancy
Published: January 2014

Hemophagocytic lymphohistiocytosis (HLH) comprises a heterogeneous group of diseases that are characterized by a hyperinflammatory state due to uncontrolled T cell, macrophage, and histiocyte activation, accompanied by excessive cytokine production. This rare condition is almost uniformly fatal unless promptly recognized and treated. Much progress has been made in the last two decades in our understanding of the mechanisms underlying familial, and to a lesser extent, acquired cases of HLH. Recurrent mutations in more than 10 different genes have now been identified, involving biological pathways converging on intracellular vesicle trafficking and cytolytic granule exocytosis. Mechanisms underlying the majority of patients with acquired HLH, however, remain elusive, hampering both diagnostic evaluation and therapeutic management of these patients. Given that the majority of intensive care unit (ICU) patients with sepsis or multiorgan failure share many features of HLH, it is especially critical for pediatric and adult intensivists to be able to recognize patients with bona fide HLH and initiate treatment without delay. In this article, we review our current understanding of the pathophysiology, clinical testing, diagnosis, and treatment of patients with HLH, especially as it pertains to the care of critically ill patients in pediatric and medical ICUs.
Economic Necessity or Noble Cause? A Qualitative Study Exploring Motivations for Gestational Surrogacy in Gujarat, India
Authors: Karandikar Sharvari , Gezinski Lindsay B. , Carter James R. , Kaloga Marissa
Published: January 2014

In this qualitative study, in-depth interviews were conducted with 15 surrogates from India. Two themes are discussed: (1) motivations for becoming surrogates and (2) role of family and community in surrogacy. The respondents were illiterate women aged 21–30 years and had been surrogate mothers an average of 2 times. Motivations for surrogacy were financial in nature. Surrogates reported stigma from extended family and community forcing them to leave their homes and relocate after surrogacy. This study recommends counseling and psychosocial support services to women and change in policy to execute a stringent law to protect the rights of surrogates.
Assessment of defect detection in wood–plastic composites via shearography method
Authors: Barmouz Mohsen , Behravesh Amir Hosein , Reshadi Farshid , Soltani Naser
Published: January 2014

In this research work, the possibility of defect detection in wood–plastic composites (WPCs) by shearography method has been assessed. Shearography is one of the practical nondestructive test methods that has been commonly used for detecting defects in polymer-based composites. In this experimental work, first, a defect (hole) was intentionally drilled on one side of the extruded WPC and then the shearography test and analysis was performed on it. This preliminary step was performed to evaluate the application of the test and calibration. Subsequently, the injection-molded WPCs with different volume fraction of wood content were assessed via shearography test for detection of the probable defects in their structures. The results indicated that shearography method can be effectively used for defect revelation in wood–plastic composites.
The Rise of School Choice in Education Funding Reform
Authors: Windle Joel
Published: January 2014

This article contributes to the analysis of the global spread of support for school choice and to the understanding of how a particular form of policy development reflects and cements this support. It maps the growing dominance of school choice within a reconfiguration of politics, policy making, and research. To establish the nature of this reconfiguration, a comparison is made between the Karmel Review, which established systematic federal government intervention in Australian schooling, and the Gonski Review. The analysis traces a move away from a social-democratic model built around an autonomous and representative government authority in which educational research was broadly writ, to a neoliberal model under direct government control, drawing selectively on a cast of corporate consultants and technocrats. I conclude with a consideration of the wider implications of the dominance of school choice as a paradigm for funding reform.
Surviving the Peace
Authors: Cannon Sheila M. , Donnelly-Cox Gemma
Published: January 2014

This qualitative study explores the deinstitutionalization of peacebuilding in Ireland and how the core population of peacebuilding organizations are responding. We document organizational responses to the understudied phenomenon of deinstitutionalization—the weakening and dissipating of an institutionalized set of practices and beliefs. We rigorously map the field and population under study, illustrating the challenge and necessity of delineating a field of actors involved in a complex social process. This research contributes to understanding deinstitutionalization in two ways. First, we illustrate how organizations both adapt to and resist the challenge of deinstitutionalization. Second, organizations can act as custodians of outgoing traditions, turning to their communities and engaging in defensive institutional work, which seems to enhance their organizational survival.
Prediction of machining accuracy based on a geometric error model in five-axis peripheral milling process
Authors: Ding Guofu , Zhu Shaowei , Yahya Elssawi , Jiang Lei , Ma Shuwen , Yan Kaiyin
Published: January 2014

Machining accuracy is the most critical indicator to evaluate the machining quality of parts in metal cutting industry. However, it is difficult to be identified before real cutting, because of a variety of error sources presented in a machining process system, such as assembly inaccuracy of machine tool, deformation caused by temperature variation and dynamic cutting force, tool wear, servo lag and so on. Consequently, it is difficult to determine whether a new machining process can satisfy accuracy requirements beforehand. Traditionally, a machining process is validated through the “trial and error” approach, which is time consuming and costly. If machining accuracy can be predicted to a large extent, a rational process can be planned to ensure the precision of parts and even to maximize resource utilization without trial cuts. For this purpose, this work focuses on machining accuracy prediction for five-axis peripheral milling based on the geometric errors. An error synthesis modeling method is proposed to integrate the geometric errors of the process system, including machine tool geometric error, workpiece locating error, cutting tool dimension error and setup error. From a multi-body system point of view, all these errors are synthesized to generate position error of the cutting contact point in the workpiece coordinate system. Then the machining error is obtained by projecting the position error to the workpiece normal vector, which can be measured by a coordinate measuring machine. The prediction model has been evaluated by a cutting test with our in-house-developed prototype software. The result shows that the proposed method is feasible and effective.
Selection and thermodynamic analysis of a turbocharger for a producer gas-fuelled multi-cylinder engine
Authors: Shivapuji Anand M , Dasappa S
Published: January 2014

The current work addresses the use of producer gas, a bio-derived gaseous alternative fuel, in engines designed for natural gas, derived from diesel engine frames. Impact of the use of producer gas on the general engine performance with specific focus on turbo-charging is addressed. The operation of a particular engine frame with diesel, natural gas and producer gas indicates that the peak load achieved is highest with diesel fuel (in compression ignition mode) followed by natural gas and producer gas (both in spark ignite mode). Detailed analysis of the engine power de-rating on fuelling with natural gas and producer gas indicates that the change in compression ratio (migration from compression to spark ignited mode), difference in mixture calorific value and turbocharger mismatch are the primary contributing factors. The largest de-rating occurs due to turbocharger mismatch. Turbocharger selection and optimization is identified as the strategy to recover the non-thermodynamic power loss, identified as the recovery potential (the loss due to mixture calorific value and turbocharger mismatch) on operating the engine with a fuel different from the base fuel. A turbocharged after-cooled six cylinder, 5.9 l, 90 kWe (diesel rating) engine (12.2 bar BMEP) is available commercially as a naturally aspirated natural gas engine delivering a peak load of 44.0 kWe (6.0 bar BMEP). The engine delivers a load of 27.3 kWe with producer gas under naturally aspirated mode. On charge boosting the engine with a turbocharger similar in configuration to the diesel engine turbocharger, the peak load delivered with producer gas is 36 kWe (4.8 bar BMEP) indicating a de-rating of about 60% over the baseline diesel mode. Estimation of knock limited peak load for producer gas-fuelled operation on the engine frame using a Wiebe function-based zero-dimensional code indicates a knock limited peak load of 76 kWe, indicating the potential to recover about 40 kWe. As a part of the recovery strategy, optimizing the ignition timing for maximum brake torque based on both spark sweep tests and established combustion descriptors and engine-turbocharger matching for producer gas-fuelled operation resulted in a knock limited peak load of 72.8 kWe (9.9 bar BMEP) at a compressor pressure ratio of 2.30. The de-rating of about 17.0 kWe compared to diesel rating is attributed to the reduction in compression ratio. With load recovery, the specific biomass consumption reduces from 1.2 kg/kWh to 1.0 kg/kWh, an improvement of over 16% while the engine thermal efficiency increases from 28% to 32%. The thermodynamic analysis of the compressor and the turbine indicates an isentropic efficiency of 74.5% and 73%, respectively.
The Problem of Complementary and Alternative Medicine Use Today
Authors: MacArtney John I. , Wahlberg Ayo
Published: January 2014

Commentators such as Goldacre, Dawkins, and Singh and Ernst are worried that the rise in complementary and alternative medicine (CAM) represents a flight from science propagated by enemies of reason. We outline what kind of problem CAM use is for these commentators, and find that users of CAM have been constituted as duped, ignorant, irrational, or immoral in explaining CAM use. However, this form of problematization can be described as a flight from social science. We explore CAM use in light of a rigorous and robust social scientific body of knowledge about how individuals engage with CAM. By pointing to the push and pull factors, CAM user’s experiences of their body, and the problem of patient choice in CAM use, we summarize some of the key findings made by social scientists and show how they trouble many of the reasoned assumptions about CAM use.
The Role of Parental Education in the Relation Between ADHD Symptoms and Executive Functions in Children
Authors: Tillman Carin , Granvald Viktor
Published: January 2014

Objective: Using a population-based sample of 9-year-old children, this study examined whether the relation between symptoms of ADHD and executive functions (EFs) depended on socioeconomic status (SES; indexed by parental education). Method: Parents and teachers rated the children’s ADHD symptoms, and parents also indicated their educational level in a questionnaire. The children performed a comprehensive set of EF tasks. Results: Whereas working memory was similarly related to ADHD symptoms in the lower and higher parental education group, the relations of inhibition and mental set-shifting with ADHD symptoms were generally stronger in the higher educational group, a pattern that was supported by several significant group differences in correlations. Conclusion: This suggests that the EF pathway in contemporary multiple pathway models of ADHD etiology may be particularly relevant in higher SES parts of the population.
When does America drop dictators?
Authors: Owen John M. , Poznansky Michael
Published: January 2014

The Obama administration’s initial ambivalence toward democratic revolutions in Tunisia and Egypt in 2011 points to a central puzzle in US foreign policy. In some countries, during some periods, America promotes liberal democracy; in other countries and periods, it tolerates or even supports authoritarianism. Why the variation? We focus on discrete decisions by a US President to retain a dictator or instead press for democracy in a client state S. Two conditions must be satisfied for a President to do the latter. (1) An exogenous domestic crisis must threaten S’s authoritarian regime. (2) The US domestic model of free-market liberal democracy must face no credible alternative in S’s region as a route to national development and security. A credible alternative model (e.g. communism or Islamism) threatens US interests by making dissenting elites in S more hostile to US hegemony and more accepting of the hegemony of America’s security rivals; that in turn makes free elections in S riskier for Washington. But when conditions (1) and (2) coincide, a new bargain emerges: S’s elites, now assenting to the US model, pledge to participate in the US-sponsored regional order, and Washington presses S’s regime into democratizing. We test our argument against two cases involving relations between the US and the Philippines, an authoritarian client until 1986. In a 1978 crisis, communism’s high credibility in Southeast Asia forced Jimmy Carter to continue supporting the Marcos dictatorship. In a 1985–86 crisis, communism’s lack of credibility allowed Ronald Reagan to drop Marcos and permit democracy.
Development and usability testing of a web-based cancer symptom and quality-of-life support intervention
Authors: Wolpin SE , Halpenny B , Whitman G , McReynolds J , Stewart M , Lober WB , Berry DL
Published: January 2014

The feasibility and acceptability of computerized screening and patient-reported outcome measures have been demonstrated in the literature. However, patient-centered management of health information entails two challenges: gathering and presenting data using “patient-tailored” methods and supporting “patient-control” of health information. The design and development of many symptom and quality-of-life information systems have not included opportunities for systematically collecting and analyzing user input. As part of a larger clinical trial, the Electronic Self-Report Assessment for Cancer–II project, participatory design approaches were used to build and test new features and interfaces for patient/caregiver users. The research questions centered on patient/caregiver preferences with regard to the following: (a) content, (b) user interface needs, (c) patient-oriented summary, and (d) patient-controlled sharing of information with family, caregivers, and clinicians. Mixed methods were used with an emphasis on qualitative approaches; focus groups and individual usability tests were the primary research methods. Focus group data were content analyzed, while individual usability sessions were assessed with both qualitative and quantitative methods. We identified 12 key patient/caregiver preferences through focus groups with 6 participants. We implemented seven of these preferences during the iterative design process. We deferred development for some of the preferences due to resource constraints. During individual usability testing (n = 8), we were able to identify 65 usability issues ranging from minor user confusion to critical errors that blocked task completion. The participatory development model that we used led to features and design revisions that were patient centered. We are currently evaluating new approaches for the application interface and for future research pathways. We encourage other researchers to adopt user-centered design approaches when building patient-centered technologies.
Sex always sells? Stripping the facade surrounding vice tourism in a recession
Authors: Moll Lisa , Kitterlin Miranda , Williams James A
Published: January 2014

A phenomenological study was employed to explore the lived experiences of select vice tourism service providers during times of economic recession. Specifically, this study focused on the viewpoints of exotic dancers, as their perspectives provided a greater understanding of contributing factors that impacted this population. This study also assessed economic recovery for workers in this facet of the vice tourism industry. Results dispute the commonly held belief that vice tourism services are recession-proof and provide practical implications for an understudied facet of the tourism industry.
Research on mechanical model for the J-lay method
Authors: Li Mingjie , Duan Menglan , Ye Mao , Zeng Xiaguang , Chen Jinghao , Xu Chongwei
Published: January 2014

The J-lay method is regarded as the most feasible way to lay pipeline in ultra-deep water; however, the time required to compute the forces generated is considerable. In this article, a new and simple mechanical model is developed in order to reduce the calculation time required. It comprises two parts: the first is a pipe–soil interaction model based on the linear beam theory and the Winkler foundation model, and the second is a nonlinear, large deflection beam theory to calculate the forces on the suspended segment. The accuracy of the numerical calculations has been verified against the output of commercial software with good results. Furthermore, high-order shear effect, which has been largely ignored in other publications, is discussed. The results show that computational accuracy can be improved by 3.1% by taking this effect into account. Therefore, the mechanical model proposed in this article is quicker and more accurate for determining the forces encountered during J-lay operations.
Policy and status of light pollution management in Korea
Authors: Cha JS , Lee JW , Lee WS , Jung JW , Lee KM , Han JS , Gu JH
Published: January 2014

Light pollution is emerging as one of the most rapidly increasing types of environmental degradation. Many localities have developed regulations to constrain the use of excessive light. Recently, the government of Korea has enacted and executed the ‘Light Pollution Prevention Act’ for the proper management of light pollution. This paper reviews the background and the main contents of the Act as well as the current status of light pollution in Korea. By this Act, a ‘Light Pollution Prevention Committee’ is established and the designation of environmental zones and the light emission standards for these zones are given. The contents of this study will be useful as a guideline for developing countries preparing light pollution management plans.
A microcontroller-based system for automated and continuous sky glow measurements with the use of digital single-lens reflex cameras
Authors: Lamphar HA Solano , Kundracik F
Published: January 2014

In recent years, the scientific community has shown an increased interest in sky glow research. This has revealed an increased need for automated technology that enables continuous evaluation of sky glow. As a result, a reliable low-cost platform has been developed and constructed for automating sky glow measurement. The core of the system is embedded software and hardware managed by a microcontroller with ARM architecture. A monolithic photodiode transimpedance amplifier is used to allow linear light measurement. Data from the diode are collected and used to arrange the exposure time of every image captured by the digital single-lens reflex camera. This proposal supports experimenters by providing a low-cost system to analyse sky glow variations overnight without a human interface.
Initial Irish light pollution measurements and a new Sky Quality Meter-based data logger
Authors: Espey B , McCauley J
Published: January 2014

In the Celtic Tiger years, Ireland underwent an explosive growth in housing and an increase in light pollution, nationally. We outline work undertaken towards the first ever ground-based survey of light pollution in the island of Ireland and illustrate this with some representative data taken between 2009 and the present. The aim of our work is to establish a database to serve as a reference to monitor future changes, to compare with in-orbit measurements, to study the potential impact on the environment and to permit the calculation of the effects of future changes in lighting usage and patterns. We also report the development of a microcontroller-based data-logging instrument based on a Unihedron Sky Quality Meter-LR detector, which can be used by amateurs or can serve as a stand-alone instrument for night-sky brightness surveys.
How to pay for public education
Authors: Reiff Mark R.
Published: January 2014

For years now, public education, and especially public higher education, has been under attack. Funding has been drastically reduced, fees increased, and the seemingly irresistible political force of ever-tightening austerity budgets threatens to cut it even more. But I am not going to take the standard line that government financial support for public higher education should be increased. I view that battle as already lost. What I am going to propose is that we stop arguing about the allocation or reallocation of ever more scarce public resources and think of another way to fund public higher education. It is time for a new approach, one that satisfies the left’s claim that higher education should be affordable for all, yet one that does not involve increasing the expenditure of public funds or committing the government to entitlement programs that it cannot now or at least cannot long afford. What we need is a new proposal that is acceptable to both sides if we are to bring public education into the twenty-first century. And this is what this article is devoted to providing.
The Impact of Exercise, Cognitive Activities, and Socialization on Cognitive Function
Authors: Jedrziewski M. Kathryn , Ewbank Douglas C. , Wang Haidong , Trojanowski John Q.
Published: January 2014

Currently, there are no effective treatments for Alzheimer’s disease and related disorders and age continues to be a robust risk factor. Thus, population aging in the United States may have catastrophic results if interventions are not found and implemented. This study examines possible associations between cognitive impairment and exercise, cognitive activities, and socialization. Cognitive activities, socialization, and exercise were assessed at baseline, and cognitive function was measured at baseline, 5-year, and 10-year follow-up. Controlling for baseline cognitive function, age, sex, education, diabetes, and hypertension, linear regression was performed. Engagement in cognitive activities was inversely associated with the onset of cognitive impairment at 5-year follow-up but was no longer significant at 10-year follow-up. Exercise was associated with a lower risk of cognitive impairment at 10-year follow-up but was not significant at 5-year follow-up. Associations with socialization were not statistically significant at either follow-up.
Quantification of food and nutrient intakes in Zambian children with and without malaria under controlled feeding conditions
Authors: Bresnahan Kara A , Chileshe Justin , Tanumihardjo Sherry A
Published: January 2014

Vitamin A supplementation improves status, which may protect against malarial infection. Provitamin A carotenoid biofortified staple crops may provide a more sustainable approach to alleviate vitamin A deficiency than supplementation, but the impact of febrile illness on food intake must be considered in malaria endemic regions. Morbidity data and food logs from a three-month efficacy trial on provitamin A biofortified (orange) maize in preschool Zambian children ( n = 181, age 3–5 years) were systematically analyzed over time to determine the impact of malaria on food intake. Nutrients examined included macronutrients, iron, zinc, and vitamin A. Comparisons based on individual intakes in healthy and malarial states over three-day intervals were made including children from both the orange and white maize groups ( n = 100). Malaria prevalence did not differ overall or between treatment groups over time (all P > 0.05). Lower nutrient intakes were observed for all variables during malaria outbreaks (food 289 ± 412 g; energy 248 ± 346 kcal; carbohydrate 42 ± 62 g; protein 8 ± 12 g; fat 5 ± 7 g; iron 1 ± 2 mg; zinc 1 ± 1 mg; vitamin A 58 ± 100 retinol activity equivalents; all P < 0.05). No differences were observed between nutrient decreases in orange and white maize groups ( P > 0.05). Considering the impact of malaria on food and nutrient intakes and increased vitamin A utilization and excretion due to the acute phase response, biofortification targets for provitamin A carotenoids may need to be elevated in malaria endemic regions.
Bumps and bridges on the road to responsible sharing of clinical trial data
Authors: Berlin Jesse A , Morris Sandra , Rockhold Frank , Askie Lisa , Ghersi Davina , Waldstreicher Joanne
Published: January 2014

Background

Sharing data from clinical trials could assist with the advancement of science and medicine, potentially providing a better understanding of both the benefits and risks of medicines and other treatments. Sharing data also allows for questions to be addressed at the meta-analysis level that cannot be addressed within individual studies.

Purpose

In this article, we offer some practical recommendations that will allow researchers to readily combine datasets from different studies and sources, thereby enabling meta-analyses that could have significant impact on advancing medicine.

Methods

The authors relied on their collective experience in the conduct and reporting of clinical trials to define the areas of potential concern related to responsible sharing of clinical trial data. We conducted a review of the literature and engaged in an iterative consensus-building process.

Results

To further the goal of responsible sharing of clinical trial data, collaboration on a consistent set of data standards and methods across both industry and academia is sorely needed. Protection of participant privacy is a paramount principle. The additional questions of who maintains, funds, and oversees databases of participant-level data will be important to resolve. Requiring researchers to register their requests for participant-level data and to provide details of their intended research would allow others to evaluate the proposed research plan, consistent with the principles of science and transparency.

Limitations

The recommendations represent the views of the individual authors. We recognize that other approaches to data sharing that have been advocated are also based on sound ethical and scientific principles.
Amniotic fluid embolism: Then and now
Authors: Rafael A , Benson MD
Published: January 2014

Background

The first case report to describe amniotic fluid embolism that appeared in 1926 in Basil-Medico is translated from Portuguese to English.

Case

A patient with a dead fetus for several weeks, presented in labor and died suddenly with fetal squames evident in the maternal pulmonary vasculature at autopsy.

Conclusion

As can be seen from the translation, this case report is remarkably similar in many of its features to some of the eight patients described 15 years later in the first English language discussion of the disease by Steiner and Luschbaugh in JAMA. An enigma presented by this first case remains today: fetal material in the maternal pulmonary vasculature appears specific for amniotic fluid embolism at autopsy but not in living patients.
Addressing the inverse care law: the role of community paediatric services
Authors: Rahman Fawzia R , Maharaj Veena , Yates Rowena , Beeley Chris , Moore Ian , Rose Alex , Counsell Andy
Published: January 2014

Background:

Children’s health suffers disproportionately from the effects of poverty. The inverse care law states that those who need care the most are the least likely to receive it. Community paediatricians are well placed to address health inequalities in children.

Aims:

To explore, using routinely collected data, whether we address health inequalities and the inverse care law, particularly for certain conditions targeted by our specialty.

Methods:

Five years of data were analysed, during which health equity audits have led to service changes in order to tackle inequities. The data include postcodes, allowing each child to be assigned to a deprivation quintile, and a range of diagnoses, including five sentinel conditions: attention deficit hyperactivity disorder (ADHD) on medication, autistic spectrum disorder (ASD), epilepsy, cerebral palsy and Down’s syndrome. This allowed analysis of the caseload by deprivation index for these conditions, comparison with the background population and exploration of time trends.

Results:

The number of children on the caseload and their distribution across the quintiles remained stable. The proportion of deprived children (i.e. in the lowest two quintiles) on the caseload over the last five years taken together is 56%, compared to 44% in the background population. The numbers of children with ADHD on medication has almost quadrupled in deprived quintiles and doubled in the least deprived quintile, while the numbers of children with this diagnosis in the most deprived is four times that in the least deprived. Numbers of children with ASD have also increased in each quintile. In contrast, the number of children with epilepsy and cerebral palsy did not show much variation, but those from deprived quintiles made up a greater proportion of the caseload.

Conclusions:

Routine data collection demonstrates that inequalities are addressed using all four quality domains of service provision and sentinel conditions more likely to affect deprived children are targeted. We believe it is possible for all services to collect and analyse data thus with minimal effort, thereby providing a foundation from which to address the inverse care law.
A Prospective Evaluation of Insulin Dosing Recommendations in Patients with Type 1 Diabetes at near Normal Glucose Control: Bolus Dosing
Authors: King Allen B. , Armstrong Dana U.
Published: January 2014

Background:

Current bolus insulin dosing recommendations are based on retrospective studies of patients with Type 1 diabetes in whom the glucose control was not intensely established. Using continuous glucose monitoring (CGM), we prospectively studied these recommendations in patients treated with continuous subcutaneous insulin infusion.

Methods:

Thirty subjects were studied over a mean of two weeks of continuous glucose monitoring with near daily insulin adjustments. First a basal glucose goal was achieved of <5% of values <70 mg/dL and <20%>, 170mg/dL. Then bolus dosing factors; Insulin to Carbohydrate Ratio (g of meal carbohydrates/unit of insulin, ICR) and Correction Factor (mg/dL fall in blood glucose/unit of insulin, CF); were established for each meal time to a goal of ± 20% of premeal glucose (ICR) or 80–120 mg/dL (CF) by the fourth post bolus hour.

Results:

All treatment goals were achieved in each subject. Modification of formulas from ICR = 450/Total Daily Dose (TDD) to ICR = (217/TDD) + 3 and from CF = 1700/TDD to CF = (1076/TDD) + 12 more closely matched observed results than published formulas. There was no significant difference in each factor with time of day. There was a highly significant relationship between ICR and CF, ICR*4.44 = CF (r = 0.9, p < 0.0005), total basal dose (TBD) and TDD.

Conclusions:

Current formulas need to be modified to provide higher insulin bolus doses. The interrelationships between ICR, CF, TBD and TDD suggest that any change in one may require a change in the others.
Optimizing Display, Analysis, Interpretation and Utility of Self-Monitoring of Blood Glucose (SMBG) Data for Management of Patients with Diabetes
Authors: Rodbard David
Published: January 2014

Background:

Self-monitoring of blood glucose (SMBG) data have not been used to fullest advantage. Few physicians routinely download data from memory-equipped glucose meters and perform systematic analyses and interpretation of the data. There is need for improved methods for display and analysis of SMBG data, for a systematic approach for identification and prioritization of clinical problems revealed by SMBG, for characterization of blood glucose variability, and for clinical decision support.

Methods:

We have developed a systematic approach to the analysis and interpretation of SMBG data to assist in the management of patients with diabetes. This approach utilizes the following criteria: 1) Overall quality of glycemic control; 2) Hypoglycemia (frequency, severity, timing); 3) Hyperglycemia; 4) Variability; 5) Pattern analysis; and 6) Adequacy of monitoring. The “Pattern analysis” includes assessment of: Trends by date and by time of day; relationship of blood glucose to meals; post-prandial excursions; the effects of day of the week, and interactions between time of day and day of the week.

Results:

The asymmetrical distribution of blood glucose values makes it difficult to interpret the mean and standard deviation. Use of the median (50th percentile) and Inter-Quartile Range (IQR) overcomes these difficulties: IQR is the difference between the 75th and 25th percentiles. SMBG data can be used to predict the A1c level and indices of the risks of hyperglycemia and hypoglycemia.

Conclusion:

Given reliable measures of glucose variability, one can apply a strategy to progressively reduce glucose variability and then increase the intensity of therapy so as to reduce median blood glucose and hence A1c, while minimizing the risk of hypoglycemia.
The Need for Performance Standards for Continuous Glucose Monitors
Authors: Nichols James H. , Klonoff David C.
Published: January 2014

Self-monitoring blood glucose (SMBG) devices or glucose meters currently provide a means for patients to manage insulin dosing through intermittent monitoring of blood glucose levels several times a day, but newer continuous glucose monitor devices (CGM) offer the potential of real-time glucose monitoring with less pain and lower cost. Unlike SMBG devices that sample glucose levels in circulating blood, CGM samples from the interstitial fluid. CGM devices generate not only a single level, but through averaging with past glucose results, can predict future trends. While consensus guidelines exist for evaluating the agreement of SMBG devices to other glucose and laboratory methods, no guidelines currently exists for CGM devices. Standards are needed to define the performance of CGM devices, both in terms of spot accuracy and trend information, as well as the level of performance required for clinical management. The Diabetes Technology Society (DTS) has been in close communication on the development of CGM guidelines with the Food and Drug Administration (FDA) and the Clinical and Laboratory Standards Institute (CLSI). Development of standards for CGM devices if adopted by the FDA would set minimum requirements of performance for manufacturers to meet in producing CGM devices and define common terminology for the display and clinical utilization of CGM data. It is expected that CGM performance standards will advance over time as technology improves and consumer demands change. The development of CGM standards will also play an important role in accelerating the development of an artificial pancreas, which relies on CGM technology.
Teaching Diabetes to Middle-School Students with the www.2aida.net AIDA Online Diabetes Software Simulator
Authors: Palacio Andres , Lehmann Eldon D. , Olson Darin E.
Published: January 2014

Introduction:

The lifetime risk of developing diabetes for students born in the new millennium in the United States is estimated to be 27% to 52%. Many students need to learn about diabetes for their personal care, or desire to learn about diabetes to develop a career in healthcare. Most teenagers are adept at learning through Web-based computer tools.

Methods:

Twenty-one students entering 8th and 9th grades (aged 12 to 14 years old) enrolled in a Biotechnology Summer Camp focused on diabetes. Lectures on pathophysiology and clinical aspects of diabetes were followed by simulated cases using the AIDA online diabetes software simulator accessed via the internet at www.2aida.net . Two cases demonstrated glycemic effects and pharmacokinetics of insulin administration, diet, and exercise in insulin-dependent (Type 1) diabetes and non-insulin-dependent (Type 2) diabetes. Students filled out standardized evaluations at the end of the session to assess receptiveness to this type of learning; opinions on the utility, information, and ease of use; and perceived risks of using the online simulator to understand diabetes.

Results:

All students were receptive to this educational tool. The majority found AIDA online useful (17/21 [81%]), educational (21/21 [100%]), worthy of wider distribution (20/21 [95%]), and would recommend the program to others with diabetes or wanting to learn about diabetes (18/21 [86%]). A minority (2/21 [9.5%]) found the program risky regarding the information given to the students. Positive comments included the ability to visualize concepts being taught in earlier lectures, and recognized the rigors required to manage diabetes. Fewer negative comments reflected frustration with the web-based user interface, the course materials, or difficulty in achieving good simulated glycemic control.

Discussion:

Teaching pathophysiology of diabetes and pharmacology of insulin to middle school students is enhanced with the AIDA online diabetes simulator. Future versions of this program, and development of similar programs, could be useful in teaching adolescents who have diabetes, and might help stimulate interested students to learn more about the care of people with diabetes.
Quality Control of Self-Monitoring of Blood Glucose: Why and How?
Authors: Solnica Bogdan , Naskalski Jerzy W.
Published: January 2014

The control of analytical quality of self-monitoring of blood glucose (SMBG) is recommended as a routine procedure in diabetes management. This control procedure should be easily accessible to patients, convenient, not time-consuming, and provide a reliable assessment of glucose meter performance. Optimally it should be located in the diabetes outpatient clinic. Presently there are two approaches to carrying out SMBG quality control. The first is based on the comparison of results obtained by a controlled glucose meter and use of the laboratory method or point-of-care testing device as a surrogate reference analyzer. The second one is a traditionally organized external quality assessment scheme with use of a dedicated control material, which is distributed to all participants. The recommended allowable meter error in SMBG can be realistically set at 10%.
Impact of Treatment with Rosiglitazone or Metformin on Biomarkers for Insulin Resistance and Metabolic Syndrome in Patients with Polycystic Ovary Syndrome
Authors: Steiner Charles A. , Janez Andrej , Jensterle Mojca , Reisinger Katrin , Forst Thomas , Pfützner Andreas
Published: January 2014

Background:

There is increasing evidence that insulin resistance (IR) has an important implication in the pathogenesis of polycystic ovary syndrome (PCOS), a common endocrinopathy in women. This study was performed to investigate the impact of different treatments for IR on five currently discussed markers for insulin resistance: Intact proinsulin, adiponectin, retinol-binding protein 4 (RBP4), resistin, and visfatin in patients with PCOS.

Methods:

Thirty-five women with clinically confirmed PCOS diagnosis were included in the study [age (mean±SD): 24.7±4.8 years; body mass index: 27.4+6.0 kg/m2]. They were randomized to receive either metformin (850 mg twice a day) or rosiglitazone (4 mg once a day). Blood samples for measurement of the HOMAIR score, visfatin, RBP4, intact proinsulin, resisitin, and adiponectin were taken at baseline and after 6 months of treatment.

Results:

Both drugs improved ovulation, and an increase in insulin sensitivity was observed, especially in the rosiglitazone arm. Adiponectin levels increased in both treatment arms (metformin: 8.6±3.3 to 16.7±7.2 mg/liter, p < 0.001; rosiglitazone: 8.2±3.5 to 26.2±9.5 mg/liter, p < 0.001), but the increase was more pronounced with rosiglitazone (p < 0.001). While no changes of visfatin concentrations were observed during rosiglitazone therapy (15.4±6.9 ng/ml vs 17.4±4.8 ng/ml, n.s.), there was an increase in the metformin treatment arm (11.9±4.0 to 21.8±8.3 ng/ml, p < 0.001). Significant increases demonstrated for RBP4 in both treatment arms were more pronounced in the metformin group (metformin: +66%, rosiglitazone: +33%). All patients were in stage I or II of ß-cell dysfunction and none of them showed increased intact proinsulin levels or changes in resisitin at baseline or end point.

Conclusions:

Both drugs slightly improved ovulation in our PCOS patient population during 6 months of therapy, which was accompanied by improved insulin sensitivity and an increase in adiponectin levels. Metformin increased visfatin concentrations. Despite improved insulin resistance, an increase in RBP4 concentration was seen for both drugs. Rosiglitazone seems to be the more favorable drug under these circumstances. However, our results regarding visfatin and RBP4 contradict other reports and further research is required to clarify their value as diagnostic markers for the metabolic syndrome. In this study, adiponectin appeared to be the most promising indicator of both metabolic status and therapeutic success.
GIM, Simulation Software of Meal Glucose—Insulin Model
Authors: Dalla Man Chiara , Raimondo Davide M. , Rizza Robert A. , Cobelli Claudio
Published: January 2014

Background:

A simulation model of the glucose—insulin system in normal life conditions can be very useful in diabetes research, e.g., testing insulin infusion algorithms and decision support systems and assessing glucose sensor performance and patient and student training. A new meal simulation model has been proposed that incorporates state-of-the-art quantitative knowledge on glucose metabolism and its control by insulin at both organ/tissue and whole-body levels. This article presents the interactive simulation software GIM (glucose insulin model), which implements this model.

Methods:

The model is implemented in MATLAB, version 7.0.1, and is designed with a windows interface that allows the user to easily simulate a 24-hour daily life of a normal, type 2, or type 1 diabetic subject. A Simulink version is also available. Three meals a day are considered. Both open- and closed-loop controls are available for simulating a type 1 diabetic subject.

Results:

Software options are described in detail. Case studies are presented to illustrate the potential of the software, e.g., compare a normal subject vs an insulin-resistant subject or open-loop vs closed-loop insulin infusion in type 1 diabetes treatment.

Conclusions:

User-friendly software that implements a state-of-the-art physiological model of the glucose-insulin system during a meal has been presented. The GIM graphical interface makes its use extremely easy for investigators without specific expertise in modeling.
Assessing Quality of Life for New Diabetes Treatments and Technologies: A Simple Patient-Centered Score
Authors: Pickup John C. , Harris Anna
Published: January 2014

Background:

A simple quality of life measure is needed for use in diabetes, particularly for the assessment of new treatments and technologies. We devised and validated a patient-centered quality of life (PCQoL) measure that should be applicable to routine clinical practice or trial of therapies.

Methods:

People with diabetes completed a two-part, PCQoL questionnaire where they nominated five aspects of generaland diabetes-related life judged most important for their overall quality of life and rated each for current level of satisfaction. Scores derived from the questionnaire were compared with a reference measure—the Diabetes Control and Complications Trial diabetes quality of life (DQoL) score. Both were repeated after 1 month. The participants were 72 diabetic patients (60% with type 1 diabetes); 29 people with type 1 diabetes were treated by continuous subcutaneous insulin infusion (CSII) and 14 were treated by multiple daily insulin injections (MDI).

Results:

Patients most often cited family and relationships or fear of complications and hypoglycemia as important facets of quality of life for them. The PCQoL measure was highly correlated with the reference DQoL measure (r = 0.73, p < 0.0001), had high repeatability (r = 91, p < 0.0001), and could be completed in less than 5 minutes. The test was sensitive enough to detect a better quality of life in CSII-treated patients vs MDI-treated patients.

Conclusion:

The PCQoL measure is simple, quick, valid, and suitable for routine use in diabetes or trials of new treatments.
Advances in Hemoglobin A1c Point of Care Technology
Authors: Bode Bruce W. , Irvin Benjamin R. , Pierce Jeffrey A. , Allen Michael , Clark Annette L.
Published: January 2014

Measurement of hemoglobin A1c (A1C) has long been accepted as the best indicator of glucose control over time. Assays for A1C use technologies based on either charge differences (high-pressure liquid chromatography) or structure (boronate affinity or immunoassay combined with general chemistry). These technologies are generally employed in expensive laboratory instruments. More recently, A1C technology has been incorporated into point of care (POC) devices, allowing for immediate availability of A1C measurements, greatly facilitating diabetes care in both specialist and general practices. POC A1C tests should have acceptable performance, standardization to national reference, National Glycohemoglobin Standardization Program (NGSP) certification, simple operation without need for costly instrumentation, and Clinical Laboratory Improvement Amendments (CLIA) waiver. CLIA-waived POC technology includes Bio-Rad MicroMat™ II (distributed by Cholestech as GDX™) and the Axis-Shield Afinion,™ both of which utilize boronate affinity. The DCA 2000®+ utilizes combined immunoassay and general chemistry. These instruments cost $1000 to $3000 and require regular maintenance, making them appropriate only for high-volume physician offices. The newly improved A1CNow+™ also utilizes combined immunoassay and general chemistry, but the small, inexpensive, disposable monitor can be used by patients as well as by health care professionals. The new version of A1CNow+ has improved performance through recent introduction of automated solid state chemistry manufacturing, improved fluidics and automated assembly of the test cartridge, error-correcting software, and unitary meter calibration with factory calibration directly to the NGSP reference standard.