bluuebunny/crossref_metadata_2025 huggingface dataset:
Public Support of Community Corrections in China
Authors: Jiang Shanhe , Xiang Deping , Chen Qi , Goodlin-Fahncke Wendi , Huang Chengxiang , Yang Shengyong , Zhang Dawei , Zhao Anna
Published: January 2014

There are a variety of factors that have been associated with support for the use of community corrections in the West. However, little research has been completed to examine if these same factors are also associated with support for the use of community corrections in China. This exploratory study examined the degree of agreement and support of 764 Chinese citizens on the use of community corrections methods. Results indicated that most respondents supported the use of community corrections methods rather than traditional incarceration methods. In addition, five attitudes (the punishment perspective, the rehabilitation perspective, the humanitarian perception, cost-effectiveness, and risk) toward the use of community corrections methods were examined and all were found to be significantly associated with the support of community corrections in present-day China.
The Impact of Age Stereotypes on Older Adults’ Hazard Perception Performance and Driving Confidence
Authors: Chapman Lyn , Sargent-Cox Kerry , Horswill Mark S. , Anstey Kaarin J.
Published: January 2014

This study examined the effect of age-stereotype threat on older adults’ performance on a task measuring hazard perception performance in driving. The impact of age-stereotype threat in relation to the value participants placed on driving and pre- and post-task confidence in driving ability was also investigated. Eighty-six adults aged from 65 years of age completed a questionnaire measuring demographic information, driving experience, self-rated health, driving importance, and driving confidence. Prior to undertaking a timed hazard perception task, participants were exposed to either negative or positive age stereotypes. Results showed that age-stereotype threats, while not influencing hazard perception performance, significantly reduced post-driving confidence compared with pre-driving confidence for those in the negative prime condition. This finding builds on the literature that has found that stereotype-based influences cannot simply be understood in terms of performance outcomes alone and may be relevant to factors affected by confidence such as driving cessation decisions.
Evaluating the Adequacy of Social-Emotional Measures in Early Childhood
Authors: Gokiert Rebecca J. , Georgis Rebecca , Tremblay Melissa , Krishnan Vijaya , Vandenberghe Christine , Lee Clara
Published: January 2014

Technical adequacy and usability are important considerations in selecting early childhood social-emotional (SE) screening and assessment measures. As identification of difficulties can be tied to programming, intervention, accountability, and funding, it is imperative that practitioners and decision makers select appropriate and quality measures from the plethora of measures available. This study systematically reviewed and evaluated the technical adequacy and usability of 10 commonly used SE assessment and screening measures, using a framework for evaluating selected properties of measures (e.g., reliability, validity). Through this review, it was found that there are inadequacies in many commonly used SE measures, deserving the attention of both users and developers.
A Practical Guide to Concentrated Insulin for Pharmacists
Authors: Andres Jennifer , Clements Jennifer N.
Published: January 2014

Purpose: Insulin improves glycemic control in several ways, for example, by stimulating glucose uptake in the muscle and inhibiting hepatic glucose production. It has other mechanisms of action for correcting the abnormal metabolism of proteins, fats, and carbohydrates. The formulation of concentrated insulin (U-500) is a higher potency of insulin than the U-100 regular formulation. It is indicated for children and adults with type 1 and type 2 diabetes who have not achieved adequate glycemic control with exercise and proper dietary habits. However, the unique characteristics of concentrated insulin require that a patient be educated on its use. This article provides a practical guide for pharmacists on the use of concentrated insulin in both inpatient and outpatient settings and highlights specific concerns and management strategies. Conclusion: Concentrated insulin works in the same mechanism as U-100 insulin formulations for treating type 1 and type 2 diabetes. Pharmacists are knowledgeable about managing the disease and can identify patients who will benefit with treatment of concentrated insulin. They can provide recommendations to prevent and resolve situations, such as dosing errors, which arise in patients on concentrated insulin and can educate patients and health care professionals on dosing conversions and titration.
Piezoelectric-based non-destructive monitoring of contact pressures in fine-blanking process
Authors: Ding Ri-xian , Guo Cheng , Zhu Zi-cai , Zhang Ming-kai , Gao Rui-peng
Published: January 2014

A piezoelectric polyvinylidene fluoride film stress sensor was developed to measure the contact pressure on the sheet near the cutting edge in the fine-blanking process. Two cases with and without cracks in the fine-blanking surface were studied. The relationship between the contact pressure and crack width was investigated using the Kriging methodology at different punching speeds. The maximum contact pressure appeared at the beginning of sheet punching, but not at the end of V-ring indention. For the case with and without cracks in the fine-blanking surface, one and two fluctuations of contact pressure are observed, respectively. Using the Kriging model, a fine-blanked surface with a reduced crack width can be obtained using the optimal values of contact pressure and punching speed.
Modeling flux chemistry for submerged arc weldments of high-strength low-alloy steel
Authors: Jindal Sandeep , Chhibber Rahul , Mehta Narinder P
Published: January 2014

Chemical and mechanical properties of the welded joint are greatly affected by flux composition. The resulting chemical compositions of C, Si, Mn, P and S in the weld metal have been studied using formulated fluxes. The constrained mixture design, extreme vertices design, has been used to formulate fluxes to study the effect of flux constituents. Regression models were developed for weld metal content in terms of individual flux constituents and their binary mixtures for submerged arc welding of high-strength low-alloy steel. From the results, it is found that CaF2 is the most significant flux constituent and Al2O3 is the second most significant constituent among individual mixtures. CaO–MgO and CaO–Al2O3 binary mixtures are the most effective to change weld metal content. Regression mathematical models have been checked for adequacy using t-test and analysis of variance (F-test). Flux mixtures’ composition has been provided for optimum chemical composition of weld metal.
Improvement in Spatial Imagery Following Sight Onset Late in Childhood
Authors: Gandhi Tapan K. , Ganesh Suma , Sinha Pawan
Published: January 2014

The factors contributing to the development of spatial imagery skills are not well understood. Here, we consider whether visual experience shapes these skills. Although differences in spatial imagery between sighted and blind individuals have been reported, it is unclear whether these differences are truly due to visual deprivation or instead are due to extraneous factors, such as reduced opportunities for the blind to interact with their environment. A direct way of assessing vision’s contribution to the development of spatial imagery is to determine whether spatial imagery skills change soon after the onset of sight in congenitally blind individuals. We tested 10 children who gained sight after several years of congenital blindness and found significant improvements in their spatial imagery skills following sight-restoring surgeries. These results provide evidence of vision’s contribution to spatial imagery and also have implications for the nature of internal spatial representations.
Temporal Trends of Copper-Bearing Intrauterine Device Discontinuation
Authors: Zhou Jie , Tan Xiaodong , Song Xiangjing , Zhang Kaining , Fang Jing , Peng Lin , Qi Wencai , Nie Zonghui , Li Ming , Deng Rui , Yan Chaofang
Published: January 2014

Copper-bearing intrauterine device (IUD) insertion for long-term contraceptive use is high in China, but there has been evidence that first-year discontinuation rate of copper-bearing IUD has also increased rapidly in recent years especially among rural married women. To investigate long-term use of copper-bearing IUD, the authors examined the 7-year temporal trends of copper-bearing IUD discontinuation in a population-based birth-cohort study among 720 rural married women in China, from 2004 to 2012. Women requesting contraception were followed-up twice per year after the insertion of IUD. The gross cumulative life table discontinuation rates were calculated for each of the main reasons for discontinuation as well as for all reasons combined. By the end of 7 years, 384 discontinuations were observed. With a stepped-up trend, the gross cumulative life table rate for discontinuation increased from 10.06 (95% confidence interval = 7.86-12.27) per 100 women by the first year to 52.69 (95% confidence interval = 48.94-56.44) per 100 women by the end of 7 years, which increased rapidly in the first 2 years after copper-bearing IUD insertion, flattened out gradually in the following 2 years, then increased again in the last 3 years. Among reported method failure, expulsion and side effects were the main reasons for discontinuation of the copper-bearing IUD but not pregnancy. Personal reasons, such as renewal by personal will had influenced copper-bearing IUD use since the second year and should not be neglected. Based on this study, the temporal trends of copper-bearing IUD discontinuation was in a stepped-up trend in 7 years after insertion. Both reported method failure (expulsion and side effect) and personal reason had effect on the discontinuation of copper-bearing IUD, but pregnancy was no more the most important reason affecting the use of copper-bearing IUD.
A Comparative Study of Clinicopathological Features Between Simple Bone Cysts of the Calcaneus and the Long Bone
Authors: Takada Jun , Hoshi Manabu , Oebisu Naoto , Ieguchi Makoto , Kakehashi Anna , Wanibuchi Hideki , Nakamura Hiroaki
Published: January 2014

Background:

The potential unrevealed clinicopathological differences between simple bone cysts situated in the calcaneus (calcaneal bone cysts) and those situated in long bones (long bone cysts) were investigated in the present study.

Methods:

A total of 41 cysts from 41 patients who underwent operative treatment were evaluated: 16 cysts in the calcaneus, 17 in the humerus, 7 in the femur, and 1 in the tibia. The clinical course, radiological findings, and histological features were retrospectively reviewed.

Results:

The mean patient age was 11.5 years (range, 3 to 25 years), and the mean follow-up was 33.0 months (range, 12 to 77 months). The mean patient age was significantly higher in patients with calcaneal bone cysts (13.5 years; long bone cysts, 10.2 years, P < .05). No treatment failure was seen for patients with calcaneal bone cysts, while 7 long bone cysts required reoperation. In H&E-stained specimens of the cyst wall, cholesterol clefts were identified in 10 of the 16 calcaneal bone cysts (62.5%), whereas none were identified in long bone cysts (0%; P < .0001).

Conclusion:

Our study elucidates the different clinicopathological features existing between calcaneal bone cysts and long bone cysts. Cholesterol clefting is most likely due to hemorrhaging and the subsequent breakdown of blood in the cyst. The significance of these differences between long bone and calcaneal cysts is still open to conjecture.

Level of Evidence:

Level III, retrospective comparative series.
Residency Programs for Home Health and Hospice Nurses
Authors: Pittman Patricia , Horton Katie , Terry Margaret , Bass Emily
Published: January 2014

The Institute of Medicine’s report, “The Future of Nursing: Leading Change, Advancing Health,” calls for “transition-to-practice” residencies for new nurses and nurses transferring to new types of settings. In this study, we examine the current residency landscape for home health and hospice nurses and compare it with responses from their peers in hospitals and nurse-led primary care clinics. We find that just 2% of surveyed home health and hospice settings offer residencies, while almost 49% of hospitals and 11% of nurse-led primary care clinics provide them. Major barriers cited include lack of available preceptors and financial costs. We discuss ways in which the federal government could help spur the development of residencies in this sector.
Gaming the system: Gender performance in Dance Central
Authors: Miller Kiri
Published: January 2014

This article investigates how the Dance Central game series (Harmonix Music Systems) invites and persuades players to experiment with gender performance. Dance Central uses the Xbox 360 Kinect, a motion-sensing interface, to teach players full-body dance routines set to popular club music. This study offers evidence that performative, constructivist gender theories informed the development process for these games, and explores what happens when designers enlist players in putting theory into practice. Dance Central stages visceral encounters with gendered choreography, generating both embodied gender work in the course of gameplay and reflective gender discourse in public-sphere social media. Grounded in qualitative ethnographic research that gives equal attention to interface affordances, game design, player experiences, and game-related discourse, this article offers a case study for understanding how digital media become enculturated as technologies of gender.
The role of different forms of bridging capital for immigrant adaptation and upward mobility. The case of Ukrainian and Vietnamese immigrants settled in Poland
Authors: Grzymała-Kazłowska Aleksandra
Published: January 2014

This paper analyses the adaptation strategies of Vietnamese and Ukrainian immigrants having permit for settlement in Poland and settled in Warsaw and its vicinity (namely in the Mazowieckie province), with an emphasis on the relationship between the cultural, social and economic dimensions of adaptation. The research showed that due to the large cultural distance between the Vietnamese and Polish societies as well as the specific socio-cultural characteristics of Vietnamese immigrants (e.g. strong ethnic identity and a high level of in-group ties) the concept of adaptation should be reconsidered and a more holistic approach should be taken. From an individualistic perspective, a strategy of separation was most visible among the Vietnamese, whereas from a group and culturally sensitive perspective a strategy of collective and intermediate integration was predominant in this group along with collective social mobility. Vietnamese immigrants who were integrated with Polish society, such as pioneer immigrants, Vietnamese leaders, the spouses of Poles and representatives of the 1.5 and 2nd generations played the role of cultural brokers. They mediated between their compatriots and Polish society. Thus the integration of the majority of immigrants took place through the agency of the representatives, who also had a key role in the formation of the Vietnamese enclave. In the case of Ukrainian migrants the close cultural distance between the Polish and Ukrainian societies as well as the volume and density of relations between Ukrainian immigrants and Poles (including very frequent mixed marriages) primarily led to assimilation and individual social mobility. Cases of migrants operating in transnational social spaces which encompass Ukrainians, Poles and migrants from other post-Soviet countries remained rare. Ukrainian immigrants mainly based their adaptation on bridging capital accumulated in strong ties (which was related to their Polish spouses and cultural assimilation), whereas the Vietnamese migrants predominantly used bridging capital generated in weak ties as a resource for adaptation.
The Potential Role of Chemokines in Alzheimer’s Disease Pathogenesis
Authors: Azizi Gholamreza , Khannazer Nikoo , Mirshafiey Abbas
Published: January 2014

Alzheimer’s disease (AD) is a neurodegenerative disorder and leading cause of dementia, which begins with impaired memory. The neuropathological hallmarks of AD include destructive alterations of neurons by neurofibrillary tangles, neuritic amyloid plaques, and neuroinflammatory process in the brain. Chemokines have a major role in inflammatory cell attraction and glial cell activation and/or modulation in the central nervous system. Moreover, the clinical and immunopathological evidence could show dual key role of chemokines in their pro- and anti-inflammatory properties in AD. However, their effects in neurodegeneration and/or neuroprotection remain an area of investigation. This review article provides an overview of characteristic, cellular source and activity of chemokines, and their roles in neuronal glial cell interaction in AD.
Successful Retrieval of an Irretrievable Jugular Tesio Catheter Using a Fogarty Arterial Embolectomy Catheter
Authors: Arnáiz-García María Elena , Gutiérrez-Diez Francisco , Arnáiz-García Ana María , Arnáiz Javier , Expósito Víctor , Nistal Juan Francisco , Rodríquez-Entem Felipe , Olalla Juan José , López-Rodríguez Javier , González-Santos José María
Published: January 2014

Long life expectancy and wide development of therapies have increased the number of patients under artificial treatment for lost kidney function or dialysis. Different options for vascular access are suitable for receiving this therapy. The use of tunneled catheters has consequently increased complications related to its use. A difficult retrieval of catheters caused by a hard fibrin sheath along its trajectory is a common drawback. Herein, we report a woman with suspicion of hemodialysis catheter infection and an irretrievable Tesio catheter. A novel technique using a Fogarty arterial catheter allowed a successful retrieval and avoided an aggressive management.
The Endovascular Treatment of a Ruptured Aneurysm of the Middle Colic Artery Combined With an Isolated Dissection of Superior Mesenteric Artery
Authors: Ham Eun Mi , Cho Byung Sun , Ye Jin Bong , Mun Yun Su , Choi Young Jin , Kwon Oh Sang
Published: January 2014

Background:

Ruptured aneurysm of the middle colic artery is very rare. Its concomitance with isolated dissection of the superior mesenteric artery (SMAD) has not yet been reported in the literature.

Case report:

A previously well 56-year-old man was referred to our hospital with acute-onset pain throughout the entire abdomen. A ruptured aneurysm of the middle colic artery and isolated SMAD were revealed using a computed tomography (CT) scan. Coil embolization was successfully performed for a ruptured aneurysm of the middle colic artery. During the immediate postprocedural period, the patient had ischemic colitis, but he recovered in a few days with conservative treatment. Close observation was elected to address the SMAD because the condition was not thought to be responsible for any symptoms. The CT scan followed after 2 years showed no change in SMAD.

Conclusions:

We successfully performed endovascular treatment for a ruptured aneurysm of the middle colic artery. For the incidentally detected SMAD, close observational management was chosen.
Endovascular Stent for Iatrogenic Penetrating Injury of the Thoracic Aorta
Authors: Vagefi Parsia A. , Patel Madhukar S. , LaMuraglia Glenn M.
Published: January 2014

Purpose:

This is a report of the endovascular management of an iatrogenic descending thoracic aortic injury with long-term follow-up.

Case Report:

A 74-year-old medically complex female underwent the inadvertent percutaneous placement of a 6F sheath directly into the descending thoracic aorta during an attempted pericardiocentesis at an outside hospital. Upon transfer, the patient underwent endovascular placement of a thoracic stent graft to cover the entry site and recovered without incidence. The patient has remained free of complications for nearly 8 years of follow-up care.

Conclusions:

Endovascular stent graft utilization of the thoracic aorta has increased the treatment scope for the management of emergent and elective aortic pathology. This is particularly useful in clinical scenarios deemed too high an open surgical risk secondary to significant comorbidities.
A Behavioral Manipulation Engages Right Frontal Cortex During Aphasia Therapy
Authors: Benjamin Michelle L. , Towler Stephen , Garcia Amanda , Park Hyejin , Sudhyadhom Atchar , Harnish Stacy , McGregor Keith M. , Zlatar Zvinka , Reilly Jamie J. , Rosenbek John C. , Gonzalez Rothi Leslie J. , Crosson Bruce
Published: January 2014

Background. An aphasia treatment was designed to shift laterality from the left to right lateral frontal lobe during word production by initiating word-finding trials with complex left-hand movements. Previous findings indicated successful relateralization. Objective. The current study was designed to ascertain whether the shift was attributable to the left-hand movement. Methods. Using stratified random sampling, 14 subjects were equally divided between Intention (IT) and Control (CT) treatments. CT was identical to IT, except with no left-hand movements. Both treatments trained picture naming (phases 1 and 2) and category-member generation (phase 3), each phase lasting 10 sessions. Functional magnetic resonance imaging of category member generation occurred at pretreatment, posttreatment, and 3-month follow-up. Results. IT shifted lateral frontal activity rightward compared with pretreatment both at posttreatment ( t = −2.602, df = 6, P < .05) and 3-month follow-up ( t = −2.332, df = 5, P < .05), but CT did not. IT and CT yielded similar changes for all picture-naming and category probes. However, IT patients showed gains for untrained category ( t = 3.33, df = 6, P < .01) and picture-naming probes ( t = 3.77, df = 5, P < .01), but CT patients did not. Conclusions. The rightward shift in lateral frontal activity for IT was because of the left-hand movements. IT evoked greater generalization than CT.
Smooth Pursuit “Bedside” Training Reduces Disability and Unawareness During the Activities of Daily Living in Neglect
Authors: Kerkhoff Georg , Bucher Leandra , Brasse Michael , Leonhart Eva , Holzgraefe Manfed , Völzke Volker , Keller Ingo , Reinhart Stefan
Published: January 2014

Background. Neglect is associated with disability, unawareness, poor long-term outcome, and dependence from caregivers. No randomized trial has evaluated the effects of smooth pursuit eye movement training (SPT) and visual scanning training (VST) at the bedside on these variables. Objective. To compare the effects of SPT and VST in postacute stroke at 1 month with left neglect. Methods: We carried out an assessor-blinded, randomized controlled trial. The 24 participants were randomly allocated to either SPT or VST (n = 12 each). They received 20 treatment sessions lasting 30 minutes each at the bedside over 4 weeks. Outcome measures included the Functional Neglect Index (FNI) based on 4 tasks: find objects on a tray, stick bisection, picture search, and gaze orientation. In addition, the Unawareness and Behavioral Neglect Index (UBNI) with 6 items about unawareness and 4 about neglect in activities of daily living, the Help index (required assistance in 10 functional activities), the Barthel Index, and the rehabilitation phase were rated by treatment-blinded assessors. Outcome measures were obtained before and immediately after the end of the interventions and at a 2-week follow-up. Results. Significantly greater improvements were obtained after SPT versus VST treatment in the FNI and UBNI, and there were continued improvements selectively in the SPT group 2 weeks later. Conclusions. SPT accelerates recovery from functional neglect and reduces unawareness significantly. Bedside neglect treatment using SPT is effective and feasible early after stroke.
Ascensia® WinGLUCOFACTS® Professional Software Improves Diabetes Health Outcomes
Authors: Janssen Michael , Portalatin Manuel , Wallace Jane , Zhong Weiping , Parkes Joan Lee
Published: January 2014

Background:

Traditionally, people with diabetes keep handwritten blood glucose (BG) logs. Although a useful, and a necessary component of diabetes management, logbooks can be incomplete, inaccurate and illegible, which may lead to faulty analyses of BG trends associated with meals, medications and daily activities. Ascensia®, WinGLUCOFACTS®, Professional Software (WinGLUCOFACTS) from Bayer HealthCare was developed to assist in diabetes management by providing text and graphic presentations of downloaded data. It has a unique Data Wizard™ tool that automatically identifies BG trends.

Methods:

A one year outcome study was conducted at Baptist Primary Care (Jacksonville, Florida) to investigate whether use of WinGLUCOFACTS would improve BG control, diabetes related behaviors, and patient knowledge and attitudes. The cost effectiveness of this software in a primary care setting was also studied. Two physicians treated both the Test Group (90 subjects) and Control Group subjects (66 subjects). The Test Group subjects' diabetes was managed using WinGLUCOFACTS in conjunction with handwritten logs. The Control Group subjects' diabetes was managed using only handwritten logs. Both groups were scheduled to visit their physician 5 times, at 3 month intervals over the course of the 12 month study.

Results:

Hemoglobin A1C (A1C) dropped by about half a percentage point from baseline for both Control Group (−0.48) and Test Group subjects (−0.58) at the 3 month visit, a clinically significant change. The Control Group's A1C levels, however, increased at each succeeding visit, so that at 9 and 12 months it was statistically indistinguishable from baseline, whereas the Test Group's A1C remained significantly lower than baseline (−0.64 and −0.41; 90% confidence level). Based on published methodologies for calculating cost savings related to such a sustained reduction in A1C, annual cost savings would be $75.04 to $111.54 per patient or $75,040 to $111,540 per 1000 patients. The use of WinGLUCOFACTS also had a positive effect on patients' diabetes related behaviors and on their satisfaction with their care. A majority of Test Group subjects wanted their physician to continue using WinGLUCOFACTS. The physicians expressed satisfaction with this data management system, stating that it helped them to manage the Test Group subjects' diabetes by analyzing BG trends.

Conclusions:

The use of Ascensia® WinGLUCOFACTS® Professional Software from Bayer HealthCare helped in the management of patients' diabetes. It improved overall glycemic control, increased their knowledge of diabetes, increased SMBG frequency, and their satisfaction with care, and was cost effective. The primary care physicians confirmed the benefit afforded by this software in the real-world management of diabetes.
Self-Monitoring of Blood Glucose Levels Requires Intensive Training for Use of Meters to Obtain Reliable and Clinically Relevant Measurements
Authors: Mohr Thomas A. , Pfützner Andreas , Forst Senait , Forst Thomas , Schöndorf Thomas
Published: January 2014

Background:

Anecdotal reports from pediatric sites have indicated that some blood glucose meters may display wrong and misleading numbers rather than error indications, when operated in deviation from the instructions for use (IFU), eg by manipulating the strip during the count-down phase.

Methods:

This study was performed with 60 patients with diabetes (32 female, 28 male, 21 type 1, 39 type 2, age (mean±SD): 56±11 years) who measured their blood glucose levels twice with five different blood glucose meters (Precision® Xceed™ [Abbott Medisense], Freestyle Mini™ [Abbott Medisense], Accu-Chek® Comfort [Roche Diagnostics], Accu-Chek® Aviva [Roche Diagnostics], and Ascensia Contour® [Bayer Vital]). The first measurement was performed in accordance with the IFU, and the second by manipulating the test strip using a standardised inflexion/release procedure during the count-down phase. A standard glucose oxidase method (SuperGL) served as laboratory reference.

Results:

All meters worked in full compliance with current accuracy standards when operated according to the IFU. When manipulating the test strip, the results varied considerably: While changes in reliability were acceptable for two devices (Precision® Xceed®, Freestyle Mini™), the other devices produced an unacceptable number of errors and a series of entirely wrong values without error indication.

Conclusions:

The use of all devices is recommended when used according to the IFU. The use under the artificially induced impaired testing conditions is a major concern. This study underlines the importance of appropriate patient training regarding adherence to the IFU of glucose meters.
Overview of Glycemic Control in Critical Care: Relating Performance and Clinical Results
Authors: Chase J. Geoffrey , Hann Christopher E. , Shaw Geoffrey M. , Wong Jason , Lin Jessica , Lotz Thomas , LeCompte Aaron , Lonergan Timothy
Published: January 2014

Background:

Hyperglycemia is prevalent in critical care and tight control can save lives. Current ad-hoc clinical protocols require significant clinical effort and produce highly variable results. Model-based methods can provide tight, patient specific control, while addressing practical clinical difficulties and dynamic patient evolution. However, tight control remains elusive as there is not enough understanding of the relationship between control performance and clinical outcome.

Methods:

The general problem and performance criteria are defined. The clinical studies performed to date using both ad-hoc titration and model-based methods are reviewed. Studies reporting mortality outcome are analysed in terms of standardized mortality ratio (SMR) and a 95th percentile (±2σ) standard error (SE95%) to enable better comparison across cohorts.

Results:

Model-based control trials lower blood glucose into a 72–110 mg/dL band within 10 hours, have target accuracy over 90%, produce fewer hypoglycemic episodes, and require no additional clinical intervention. Plotting SMR versus SE95% shows potentially high correlation (r=0.84) between ICU mortality and tightness of control.

Model-based methods provide tighter, more adaptable one method fits all solutions, using methods that enable patient-specific modeling and control. Correlation between tightness of control and clinical outcome suggests that performance metrics, such as time in a relevant glycemic band, may provide better guidelines. Overall, compared to the current one size fits all sliding scale and ad-hoc regimens, patient-specific pharmacodynamic and pharmacokinetic model-based, or one method fits all control, utilizing computational and emerging sensor technologies, offers improved treatment and better potential outcomes when treating hyperglycemia in the highly dynamic critically ill patient.
Physiological Monitoring of the Warfighter
Authors: Friedl Karl
Published: January 2014

Modern battlefield conditions and technologies are becoming increasingly complex. In this current military environment, the need to remotely monitor each warfighter's physical and mental condition has become an essential component of the health, safety, and optimal effectiveness of a military unit.
Measurement Quality of Blood Glucose Meters: Is There a Need for an Institution with an Unbiased View?
Authors: Heinemann Lutz
Published: January 2014

The quality of self-monitoring of blood glucose (SMBG) with modern blood glucose meters is considered by many as not being a relevant topic anymore. However, in reality, a number of open questions about the quality of the measurement exists. Even if the meters fulfill the established quality criteria when they receive approval, there is no independent institution that performs a regular, critical comparison of the quality of the measurement of all blood glucose meters after their approval. Such an institute could also evaluate the quality of the different batches of test strips. In addition, it can evaluate the impact of other factors that are known to have an impact on the quality of measurement, e.g., the ambient temperature and the hematocrit. Such an institution will be very helpful to counterbalance complaints by the patients, physicians and authorities about an industry that earns a lot of money but does not provide solutions for the topics raised.
A Model of Self-Treatment Behavior, Glucose Variability, and Hypoglycemia-Associated Autonomic Failure in Type 1 Diabetes
Authors: Breton Marc , Clarke William L , Farhy Leon , Kovatchev Boris
Published: January 2014

Background:

Type 1 diabetes patients face a lifelong behaviorally controlled optimization problem: maintaining strict glycemic control without increasing the risk of hypoglycemia. Because internal insulin secretion in type 1 diabetes (T1DM) is practically absent, this optimization is entirely dependent on the interplay among (i) self-treatment behavior, (ii) interaction between exogenous insulin and carbohydrates utilization, and (iii) internal defenses against hypoglycemia. This article presents a mathematical model and a computer simulation of the relationship among self-treatment in T1DM, blood glucose (BG) variability, and hypoglycemia-associated autonomic failure (HAAF).

Method:

A stochastic behavioral self-control process was coupled with a dynamical system simulation of the dampening effect of counterregulation on BG oscillations. The resulting biobehavioral control system was compared to data from a field clinical trial (85 T1DM patients, 21–62 years old, T1DM of at least 2 years duration, and at least two documented severe hypoglycemia episodes during the previous year).

Results:

The mathematical simulation was able to reproduce characteristics of hypoglycemic events observed during a field clinical trial, such as temporal clustering of hypoglycemic episodes associated with HAAF and occurrence of severe hypoglycemia as a result of periods of HAAF augmented by increased BG variability.

Conclusion:

This investigation offers a mathematical model of HAAF—the primary barrier to intensive insulin treatment. This combined modeling/computer simulation/data analysis approach explains the temporal relationship among behaviorally induced hypoglycemia, glucose variability, and autonomic failure in T1DM. This explanation is valuable not only because it indicates that signs of HAAF can be detected in patients' natural environment via self-monitoring or continuous glucose monitoring, but also because it allows for tracking of the risk of severe hypoglycemia over time.
Electrochemical Sensor Array for Glucose Monitoring Fabricated by Rapid Immobilization of Active Glucose Oxidase within Photochemically Polymerized Hydrogels
Authors: Mugweru Amos , Clark Becky L. , Pishko Michael V.
Published: January 2014

Background:

Currently, monitoring blood glucose levels for diabetic patients is invasive and painful, involving pricking the finger to obtain a blood sample three to four times daily. The need for frequent tests and pain involved with testing leads to poor compliance. In order to raise compliance, we propose to create an implantable electrochemical sensor array that would monitor glucose levels continuously.

Methods:

Glucose sensor arrays were fabricated on gold electrodes on flexible polyimide sheets by photopolymerization of the biocompatible polymer poly(ethylene glycol) diacrylate (PEG-DA) to develop hydrogels and encapsulate the sensing elements. Using conventional silicon fabrication methods, arrays of five gold microdisk electrodes were fabricated using lift-off photolithography and sputtering techniques. A redox polymer was then attached electrostatically to the electrode, and glucose oxidase was entrapped inside the hydrogel on the array of electrodes by ultraviolet-initiated photopolymerization of PEG-DA.

Results:

When the array of fabricated sensors was sampled together the elements behaved like one large electrode with peak current equivalent to the sum of individual array elements. The enzyme, glucose oxidase, catalyzed the oxidation of glucose and then exchanged electrons with the redox polymer in the hydrogel. The entrapped glucose oxidase was found to respond linearly to increasing glucose concentrations (0–360 mg/dl), as determined using cyclic voltammetry.

Conclusion:

The fabricated microarray sensors were individually addressable and showed no cross talk between adjacent array elements as assessed using cyclic voltammetry. We have fabricated an array of glucose sensors on flexible polyimide sheets that exhibits the desired linear response in the biological range.
On-Chip Microdialysis System with Flow-Through Glucose Sensing Capabilities
Authors: Hsieh Yi-Cheng , Zahn Jeffrey D.
Published: January 2014

Background:

Microdialysis is a sampling technique based on controlling the mass transfer rate of different-sized molecules across a semipermeable membrane. Because the dialysis process has minimal effects on the surrounding fluid, it is viewed as a tool for continuous monitoring of human metabolites. In diabetes treatment, microdialysis probes have been used as sampling systems coupled to a glucose biosensor but may struggle to obtain high recoveries of analytes, as the sampling housing, probes, and glucose sensors are fabricated as separate pieces and then assembled, resulting in a large dead volume, which limits sensing frequency. An in situ combination of a miniaturized microdialysis probe with an integrated glucose sensor could help solve some of these problems.

Method:

The system was fabricated by bonding a 6-μm-thick polycarbonate track-etch membrane with 100-nm-diameter pores onto microfluidic channels with the electrochemical glucose sensing electrodes patterned within the microchannels.

Results:

In vitro experiments demonstrating glucose microdialysis with continuous sensing were conducted. The permeability of glucose to the polycarbonate membrane with a 100-nm-diameter pore size was obtained to be 5.44 μm/s. Glucose recovery of 99% was observed using this microdialysis system at a perfusion flow rate of 0.5 μl/min. Experiments monitoring fluctuating glucose concentrations in the time domain at 99% recovery were also performed. The lag time was measured to be 210 seconds with 45 seconds contributed by mass transfer limitations and the rest from dead volume within the experimental setup.

Conclusion:

The electrochemical sensing component was able to continuously track concentration changes in the reservoir. This system is expected to have the proper sensitivity to track physiologically relevant concentration changes of glucose with a lag time of less than 1 minute and minimal amplitude reduction for continuous glucose monitoring for diabetes treatment.
Fiber-Coupled Fluorescence Affinity Sensor for 3-Day in Vivo Glucose Sensing
Authors: Ballerstadt Ralph , Evans Colton , Gowda Ashok , McNichols Roger
Published: January 2014

Background:

To evaluate the feasibility of an implantable fiber-coupled fluorescence affinity sensor (FAS) for glucose monitoring in humans, we studied the acute and chronic in vivo performance in hairless rats and pigs.

Methods:

The implantable fiber-coupled FAS was constructed by filling a dialysis chamber made of a regenerated cellulose membrane mounted to the distal tip of an optical fiber with fluorescent chemistry based on concanavalin A. Blood sugar changes in animals were induced by injections of insulin and dextrose. Determination of interstitial glucose concentrations in skin tissue was facilitated by measuring the fluorescence response of the FAS.

Results:

The acute in vivo response of the fiber-coupled FAS exhibited good correlation coefficients (>0.77) with blood sugar changes and minimal lag times (2–10 min) after 2 hours of sensor implantation. Equilibrium of the sensor signal with interstitial fluid was required less than 60 min after implantation. For both rats and pigs, chronic response of the FAS to blood sugar modulations measured during the third day of implantation successfully demonstrated proof-of-concept for short-term glucose monitoring. A slight decrease in sensitivity after 3 days in the small animal model was assumed to be caused by excessive mechanical forces on the implanted device because of high animal motility.

Conclusions:

Overall, the chronic in vivo performance of the FAS in two different animal models over 3 days was clinically acceptable and comparable to other continuous glucose monitoring platforms. The major benefit of the FAS is the absence of “autodestructive” side products and any device-related warm-up time after sensor reconnection.
Combined Insulin Pump Therapy with Real-Time Continuous Glucose Monitoring Significantly Improves Glycemic Control Compared to Multiple Daily Injection Therapy in Pump Naïve Patients with Type 1 Diabetes; Single Center Pilot Study Experience
Authors: Lee Scott W. , Sweeney Tom , Clausen Debbie , Kolbach Celia , Hassen Allen , Firek Anthony , Brinegar Charles , Petrofsky Jerrold
Published: January 2014

Objectives:

This study assessed the safety and clinical effectiveness of the training protocol for initiating insulin pump therapy with real-time continuous glucose monitoring (MiniMed Paradigm REAL-Time System) in a stepwise approach on pump naive subjects with type 1 diabetes compared to a control group who remained on multiple daily injection (MDI) therapy.

Methods:

This was a 15-week treat-to-target pilot study of 16 adult subjects (n = 50% male, age 45.9 ± 16 years) with type 1 diabetes (duration of diabetes 21.9 ± 11 years) on MDI therapy with hemoglobin A1c levels at or above 7.5% at baseline. Subjects were randomized to either the study arm (using a combined insulin pump and real-time continuous glucose monitoring system) or the control arm [which continued on MDI therapy with self-monitored blood glucose (SMBG) only]. All subjects dosed insulin according to results of SMBG by finger stick and uploaded data into the CareLink data management software.

Results:

Significant improvements in glycemic control were observed from baseline in both study groups—study arm: pre-A1c 9.45 ± 0.55 and post-A1c 7.4 ± 0.66 ( p = 0.00037); control arm: pre-A1c 8.58 ± 1.30 and post-A1c 7.5 ±1.01 ( p = 0.04). Both arms had no incidence of severe hypoglycemia.

Conclusion:

In this pilot study, the Paradigm REAL-Time System was initiated safely and effectively in type 1 diabetes patients who were pump naïve using a stepwise educational protocol.
The Need for Continuous Blood Glucose Monitoring in the Intensive Care Unit
Authors: Weiss Ram , Lazar Isaac
Published: January 2014

Insulin-based regimens decrease morbidity and mortality among critically ill patients by way of keeping glucose at tight control. Utilizing these regimens involves multiple measurements of glucose by way of finger pricking or through indwelling vascular catheters in order to adjust insulin doses. The limitations and risks of these methods of glucose monitoring are related to potential erroneous measurements, increased risk of infection, and a significant excess workload. An automated blood glucose monitoring device for glucose monitoring of critically ill patients is needed to improve patient care while avoiding the disadvantages of currently used glucose monitoring methodologies.
Incorporating a Generic Model of Subcutaneous Insulin Absorption into the AIDA v4 Diabetes Simulator
Authors: Lehmann Eldon D. , Tarín Cristina , Bondia Jorge , Teufel Edgar , Deutsch Tibor
Published: January 2014

Introduction:

AIDA v4 is an interactive educational diabetes simulator that has been made available, for over a decade, without charge via the Internet. The software is currently freely accessible at http://www.2aida.org . This report sets out a collaborative development plan to enhance the program with a new model of subcutaneous insulin absorption, which permits the simulation of rapidly acting and very long-acting insulin analogues, as well as insulin injection doses larger than 40 units.

Methods:

A novel, generic, physiological subcutaneous insulin absorption model is overviewed and a methodology is proposed by which this can be substituted in place of the previously adopted insulin absorption model utilized within AIDA v4.3a. Apart from this substitution it is proposed to retain the existing model of the glucoregulatory system currently used in AIDA v4.3a.

Results:

Initial simulation results based on bench testing of this approach using MATLAB are presented for the exogenous insulin flow profile ( Iex) following subcutaneous injections of a rapidly acting insulin analogue, a short-acting (regular) insulin preparation, intermediate-acting insulins (both Semilente and neutral protamine Hagedorn types), and a very long-acting insulin analogue.

Discussion

It is proposed to implement this collaborative development plan—first by bench testing the approach in MATLAB and then by integrating the generic subcutaneous insulin absorption Iex model into the AIDA simulator in Pascal. The aim is to provide enhanced functionality and educational simulations of regimens utilizing novel insulin analogues, as well as injections larger than 40 units of insulin.
A Telemedicine System That Includes a Personal Assistant Improves Glycemic Control in Pump-Treated Patients with Type 1 Diabetes
Authors: Rigla Mercedes , Hernando M. Elena , Gómez Enrique J. , Brugués Eulalia , García-Sáez Gema , Torralba Verónica , Prados Agustina , Erdozain Luisa , Vilaverde Joana , de Leiva Alberto
Published: January 2014

Background:

The DIABTel system, a Web-based telemedicine application, integrates a whole communication system (glucometer, insulin pump, wireless hand-held assistant) for medical remote advice. We sought to evaluate, in terms of glycemic control, the DIABTel system in a randomized crossover clinical study.

Methods:

Ten patients with type 1 diabetes [5 women, age 40.6 (21–62) years, diabetes duration 14.7 (3–52) years] were included. During the 4-week active phase, data sent by patients were analyzed by the physician and modifications of the basal rate and bolus were advised in the following 24 hours. During the control phase, patients sent glucose data without any feedback from the medical center.

Results:

The mean numbers of daily glucose values and bolus sent by patients during the active period were 4.46 ± 0.91 and 4.58 ± 0.89, respectively. The personal digital assistant functionalities used more frequently by patients were (times per week) data visualization (8.1 ± 6.8), data download from the insulin pump (6.8 ± 3.3), and synchronization with the telemedicine server (8.5 ± 4.9). After the experimental phase, serum fructosamine decreased significantly (393 ± 32 vs 366 ± 25 μmol/liter; p < 0.05) and hemoglobin A1c (HbA1c) tended to decrease (8.0 ± 0.6 vs 7.78 ± 0.6; p = 0.073), whereas no changes were observed during the control phase. The number of treatment modifications proposed and performed by the patients correlated with the change observed in HbA1c during the active phase (r = −0.729, p = 0.017).

Conclusions:

The DIABTel system, a telemedicine system that includes a wireless personal assistant for remote treatment advising, allows better glycemic control in pump-treated patients with type 1 diabetes. To our knowledge, this is the first study that demonstrates improved glycemic control with the use of a telemedicine system that incorporates insulin delivery data.