bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of quality of compaction on flexural behaviour of high-performance concrete beams
Authors: Yoon Y.-S. , Jang I.-Y.
Published: October 2009

There is a possibility of a poor state of concrete compaction due to the segregation and interlocking of aggregate and paste, even if a self-compacting high-performance concrete is used for the reinforced concrete structural members. This paper presents the effects of the quality of compaction on the flexural behaviour of self-compacting high-performance concrete beams with three examples of different concrete filling conditions, that is, compaction. The first example of compaction specimen was soundly cast to obtain the perfect concrete filling condition. The second was cast in such a way that good concrete was filled between the longitudinal tensile reinforcement and the top, while poor concrete was intentionally poured below the tensile reinforcement to simulate the poor strength, workability and unsatisfactory compaction. The third was cast just as the second except that poorly compacted concrete was poured up to the neutral axis instead of just to the tensile reinforcement. Nine flexural tests were conducted on full-scale beam specimens. The performance of different states of compaction is discussed in terms of the flexural capacity, the load–displacement response, the failure pattern, the ductility and the crack control at service load levels. Test results demonstrate that the state of compaction has an insignificant effect on the ultimate flexural capacity whereas it has a great influence on the stiffness and ductility of structural members.
Influence of steel–concrete interface quality on reinforcement corrosion induced by chlorides
Authors: Castel A. , Vidal T. , François R. , Arliguie G.
Published: October 2009

To evaluate the degree of corrosion, reinforcements of 14-year-old and 17-year-old concrete members were completely exposed. These 3 m long beams were stored in three-point flexion in an aggressive environment consisting in sequences of drying and wetting by a salt fog (35 g/l of NaCl). The total chloride content was also measured at the level of all reinforcements. The chloride content appears to be significantly higher than the threshold that is generally used to evaluate corrosion initiation. A comparative analysis carried out on these experimental results shows that the steel–concrete interface quality (physical adhesion between steel and concrete) is greatly determinant to predict the initiation of corrosion in reinforced concrete members.
Alkali–silica reactivity with pessimum content on Devonian aggregates from the Belgian Arden massive
Authors: Merriaux K. , Lecomte A. , Degeimbre R. , Darimont A.
Published: October 2009

Tests of alkali–silica reactivity were conducted on Devonian aggregates from the Belgian Arden massive. These are ‘Bastogne sandstones’ of the metamorphosed Mirwart layer consisting of the silica rich psammite rock family. Petrography analysis reveals the presence of wavy extinction quartz and small size silica elements known to be potentially reactive to the alkalis in the base medium of concretes. Two accelerated tests were conducted according to the RILEM TC-106 and the French Standard NF P 18-590; they confirmed the strong reactive character of the sands from these materials. The reaction is strongest in the presence of certain percentage of non-reactive sand. For this reason, the aggregates are described as being ‘potentially reactive with pessimum content’. Their use in structures concretes must therefore be considered with the particular precaution of using cements that are low in free alkalis, and if necessary, with the addition of slag, fly ash or silica fume, all of which are known to reduce alkali–silica reactivity. Verification of the dimensional stability of target formulae must also be conducted on concrete test pieces.
Insights into the cracking and tension stiffening behaviour of reinforced concrete tension members revealed by computer modelling
Authors: Beeby A. W. , Scott R. H.
Published: October 2009

Research carried out jointly by the University of Leeds and the University of Durham into the behaviour of axially reinforced prisms subjected to pure tension led to formulae for the prediction of the deformations of such members that depended on the crack spacing under any particular load. This is a subject that does not appear to have been studied significantly in the past, and this paper describes an investigation of the development of crack spacing. This has been done by developing stochastic models of the process of crack formation. These models permitted various possible assumptions to be considered and the most realistic identified. The results of the stochastic modelling have then been used to develop formulae for the prediction of deformations, which have been tested against a large body of experimental data. Agreement between the experimental and calculated results has been shown to be good.
Relative strength of green glass cullet concrete
Authors: Sangha C. M. , Alani A. M. , Walden P. J.
Published: October 2009

The effect on concrete strength of green glass cullet as an aggregate replacement was investigated. Aggregate replacement by cullet identically matched the particle size distribution of the 10 mm all-in natural aggregate. Cullet produced by the Krysteline process was used throughout the study. Concretes made with cullet replacement were found to be stronger throughout the replacement range (10–60%) studied. The strength benefit due to the use of cullet can probably be attributed to better bonding achieved with the surrounding cement matrix. Strength gains between 28 days and two years for concrete with 60% cullet replacement were 100% greater than for the control concrete, for both compressive and tensile strengths. The performance of glass cullet was equally good with either Portland cement or cement containing ground granulated blastfurnace slag.
Multiple anchorage zones in fibre-reinforced polymer prestressed concrete structures
Authors: Gale L. , Ibell T. J.
Published: October 2009

Corrosion in conventional steel-reinforced and prestressed concrete structures is a major durability concern within the construction industry. Fibre-reinforced polymer (FRP) materials have received widespread interest as an alternative material to steel. Due to the low stiffness of these materials in comparison with steel, it could be argued that concrete structures containing FRP should be prestressed. In doing so, this removes much of the strain capacity in the FRP, so that serviceability of the structure is ensured and efficient use is made of all materials. Although relevant research into FRP-prestressed concrete is well established, the area of anchorage zones has received very little attention. The current research concentrates on the behaviour of post-tensioned anchorage zones subject to multiple anchors, with the feasibility of adopting FRP bars as equilibrium reinforcement. Over 50 anchorage zone specimens have been tested, subject to multiple loads under a strip-loading condition. Specimens were loaded vertically through square bearing plates to represent post-tensioning action, and both aramid- and carbon-fibre-reinforced polymer (AFRP and CFRP, respectively) bars were used as reinforcement. Test results have been compared with predictions based on an existing design approach that has been modified for the case of FRP reinforcement. It has been found that the existing design approach is overly-conservative when low percentages of FRP reinforcement are adopted and appears to become unsafe when high percentages of FRP reinforcement are present within the specimens. Furthermore, it has been found that such FRP reinforcement generally has less of an influence on the ultimate load capacity than might have been expected at the outset. However, it provides both crack growth resistance and integrity of the anchorage zone. Moreover, the distance between the loading plates has a major influence on the cracking and ultimate load behaviour of anchorage zones.
Reservoir outlet works for water supply
Authors: Scott C. W.
Published: October 2009

The outlet works of a reservoir are the prime means by which the reservoir satisfies its required purpose and are the main interface with the owner's operational staff. This paper reviews the function of outlet systems from water supply reservoirs. Options that have been adopted at reservoirs in the UK over the past 50 years are reviewed and some conclusions and recommendations on the design of outlet works are made.
Erosion of a sediment deposit from a rigid rectangular channel by clear water
Authors: Omid M. H. , Narayanan R. , Nalluri C.
Published: October 2009

A layer of sediment of nearly uniform size in a smooth rectangular channel is allowed to erode due to incoming flow of clear water. Bed load is the only mode of transport studied. The motion of the sediment is wave-like with a V-shaped front followed by a raised bed of nearly uniform thickness terminating in a step. The speed of the erosion front is related to the sediment diameter, thickness of the undisturbed bed and the upstream velocity of the flow. The thickness of the erosion wave is expressed as a function of the specific energy of the upstream flow and the sediment diameter. The simplified model developed relates the speeds of movements of the front and the downstream step of the erosion wave. The results presented in this paper are expected to be useful in estimating the sediment discharge from the sediment deposit and hence the time required for flushing it from the rectangular channel.
A new joint probability appraisal of flood risk
Authors: Samuels P. G. , Burt N.
Published: October 2009

Prior to the construction of the Cardiff Bay Barrage the risk of flooding of the Cardiff Bay waterfront was from inundation by surge tides. The barrage has substantially eliminated the probability of tidal flooding, and the residual flood risk now depends upon the ability of the inland bay to provide sufficient storage for river floodwater during periods of high tide. In the course of the feasibility and design studies the actual reduction in flood hazard was not quantified, but the design was carried out against specific combinations of tidal levels and fluvial flows. Recent research for MAFF at HR Wallingford has now made viable the assessment of the actual degree of flood risk, where flooding depends on the combination of two or more events. This paper presents a new joint probability appraisal of the standard of flood defence for the land around the inland bay, and demonstrates the conservatism incorporated in the original design methodology for flood risks. An examination of individual floods and surge tides and of the daily flow and tide records for a concurrent 18-year period has shown no positive correlation between concurrent high tides and river floods. An ISIS flow model of the Rivers Taff and Ely, the inland bay and the operation of the barrage structure was used to identify combinations of hydro-meteorological events that give specific levels in the inland bay. A statistical frequency assessment of these levels in the inland bay has provided ‘return periods’ for the still water level in the inland bay exceeding, for example, 7·5 m OD and 8·0 m OD. This frequency assessment was undertaken for sea levels with and without an allowance for future rise in mean sea level attributable to global warming. The ISIS modelling contained some conservative assumptions, notably the assumed coincidence between the peak of the river flow and high tide in the Bristol Channel, and the effect of these assumptions was investigated by some sensitivity tests. Finally, a best estimate of the return period for these levels in the inland bay was made using the sensitivity testing and the results of a study in 1994 of the effects of the operation of the barrage. It is concluded that the construction of the barrage is a significant flood defence benefit to Cardiff, which now has greater protection from flooding from the inland bay than the Thames Barrier provides for London. Flood risk from impoundment of the inland bay for the waterfront area remains very low even for the currently used scenarios for mean sea level rise due to global warming to the year 2100.
The renewal of a large water intake pipeline at Lake Geneva
Authors: Gerodetti M. , Ruefenacht H.
Published: October 2009

The capacity increase of the Prieuré lake water-treatment plant in Geneva (Switzerland) required a corresponding increase in capacity of the water intake facilities. Three alternatives were considered. The selected project consisted of a new 2000 mm diameter offshore intake pipeline with a total length of 3 km, linked to an existing pipeline on-shore. Due to the expected low subatmospheric pressures during transient flow, severe design criteria had to be established for the buckling stability of the pipe shell and special attention was given to the corrosion protection scheme of the selected steelpipe. This paper describes the design and construction of the project.
Hydraulic characteristics of the Jamuna River gauging section, Bangladesh
Authors: Tarekul Islam G. M. , Chowdhury J. U.
Published: October 2009

The Jamuna is a large braided river in Bangladesh, characterised by high seasonal variability in flow, with a mean discharge of nearly 20 000 m3/s. Hydraulic characteristics of the gauging section have been investigated by analysing the cross-sectional parameters, velocity, discharge and local water surface slope data based on two consecutive years of intensive measurements. The water surface width was more than 8 km during high flood conditions in both years. The gauging section is not stable because of severe erosion and deposition during monsoon. The stage–discharge relationship varies from year to year as well as within the year. The geometric and resistance characteristics during decreasing flow can differ from those during increasing flow. The resistance to flow at flood stage is quite small compared with that at low stage. The stage–discharge curve for a flood wave forms a clockwise loop which is in contrast with the familiar anticlockwise loop. An improved fit of the yearly stage–discharge relationship can be obtained by dividing the annual data set into four subsets to represent different hydraulic conditions.
Discharge assessment in mobile-bed compound meandering channels
Authors: O'Sullivan J. J. , Myers W. R. C. , Lyness J. F. , Lambert M. F.
Published: October 2009

Many discharge prediction methods have been developed for compound meandering channels. Most of these methods have been found to produce reasonable results for fixed-bed channels, but the effects of the presence of a mobile main channel bed on discharge assessment have yet to be assessed. Sediment movement increases the complexity of experiments by facilitating the creation of bedforms, which alter flow resistance. The shape characteristics of these bedforms and their associated roughness are known to depend on channel stage and geometry, and to vary with flow conditions. This paper seeks to assess the performance of six discharge assessment methods using the Phase C mobile-bed meandering UK Flood Channel Facility (FCF) overbank flow data. The results show that the accuracy of the different methods depends heavily on the boundary roughness, and the James and Wark (1992) method performed most consistently for the range of floodplain configurations tested. A modification to this method is also presented that is shown to improve the accuracy of the predicted discharges.
Calibration of DFN Model with Well Test Data – A Case Study of the North Kuwait Jurassic Complex
Authors: Limsukhon Manoch , Ghorayeb Kassem , Aziz Rafi Mohammad , Narhari Srinivasan Rao , Chakraborty Subrata
Published: October 2009

The North Kuwait Jurassic Complex (NKJC) consists of six green fields with four identified reservoirs in the naturally fractured Jurassic carbonate formation. An integrated model has been constructed by incorporating seismic, geological, petrophysical, and engineering data to estimate the hydrocarbon pore volumes and to provide multiscenario production forecasts under various assumptions.

A discrete fracture network (DFN) model was also incorporated using image logs, core data, and volume curvature attributes. The DFN model is further upscaled into a dual-porosity dynamic simulation model. Fracture characterization in the dynamic model requires translating the DFN attributes into three-directional permeability, aperture, and matrix-fracture transfer functions.

Because of the inherent uncertainty of the fracture properties (fracture length, aperture, permeability, intensity, and connectivity) and the uncertainty involved in translating the "forest" of fractures into a dual-porosity model, calibration of the resulting model with well test and production data is essential to ensuring a dynamic model with acceptable predictive capabilities. There is a higher degree of uncertainty in the fracture geometry than in the matrix properties in the NKJC. This led to the decision to modify the fracture properties rather than the matrix properties for the purpose of calibrating/history matching the dynamic model.

The following data was used for the purpose of calibrating the fracture network model: Short-duration production tests from 31 wellsLong-term production data (48 months) from a testing facility (9 wells)Sixteen pressure transient datasets (drawdown + buildup) from 12 wellsEight months of production history from 20 wells
Use of C-Arm Fluoroscopy by Nurses for Placement of PICC Lines
Authors: Royce Barry
Published: October 2009

The Minnesota Department of Health Ionizing Radiation Rules “prohibits the use of fluoroscopy by a person other than a licensed practitioner of the healing arts... when the licensed practitioner of the healing arts is not physically present in the room” (Minnesota Administrative Rules, 2007). Getting a licensed practitioner into the room caused delays in completing PICC line insertion procedures. To minimize these delays we considered multiple options; one of the options was to have PICC nurses licensed to operate the fluoroscopy machine. This article will explain the process the Vascular Access Department at the University of Minnesota Medical Center, Fairview went through to make this option a reality.

Our team has demonstrated that with proper training, education, machine maintenance and completion of competencies, nurses can operate fluoroscopy independently and clear PICC lines for use with a high degree of safety, efficiency and accuracy.
Accuracy and Timeliness of RN vs. MD Radiological Interpretation of PICC Tips
Authors: Pocius Stacey , Miley Kristine , Rockwood Judy
Published: October 2009

Traditionally, nurses placing peripherally inserted central catheters, (PICCs) must obtain radiological clearance before utilizing the catheter. At West Virginia University Hospitals, this clearance is performed by a radiologist. The PICC team at WVUH felt strongly that this process could be expedited if they were able to interpret the PICC placements themselves. They took a proactive approach and attended specialized training in the radiological interpretation of PICC tips. They then utilized the West Virginia State Board of Examiners for Registered Nurses decision making algorithm to determine that this practice would be within their scope of practice. The team chose to conduct a retrospective study of cross-sectional data to determine if their radiological interpretations were as accurate as the radiologists. A two-tailed t-test was done to determine if they could clear the PICCs in a more timely fashion than awaiting clearance from the radiologists. The premise of reviewing this data was to ensure that their accuracy and timeliness would have a positive impact on patient care delivery.
Visceral Fat Area and Markers of Insulin Resistance in Relation to Colorectal Neoplasia
Authors: Yamamoto Shuichiro , Nakagawa Toru , Matsushita Yumi , Kusano Suzushi , Hayashi Takeshi , Irokawa Masataka , Aoki Takatoshi , Korogi Yukunori , Mizoue Tetsuya
Published: October 2009

OBJECTIVE

Although abdominal obesity and related metabolic abnormalities are hypothesized to promote colorectal carcinogenesis, direct confirmation of this effect is required. Here, we examined the relation of early-stage colorectal neoplasia to visceral fat area and markers of insulin resistance.

RESEARCH DESIGN AND METHODS

Subjects were participants in a comprehensive health screening conducted at the Hitachi Health Care Center, Ibaraki, Japan. During a 3-year period (2004–2007), a total of 108 patients with early-stage colorectal neoplasia, including 22 with early cancer, were identified among individuals who received both colorectal cancer screening and abdominal computed tomography scanning. Three control subjects matched to each case subject were randomly selected from those whose screening results were negative. Conditional logistic regression analysis was used to examine the association of measures of obesity and markers of insulin resistance with colorectal neoplasia, with adjustment for smoking and alcohol drinking.

RESULTS

Visceral fat area, but not subcutaneous fat area, was significantly positively associated with colorectal cancer, with odds ratios (95% CI) for the lowest to highest tertile of visceral fat area of 1 (reference), 2.17 (0.45–10.46), and 5.92 (1.22–28.65), respectively (Ptrend = 0.02). Markers of insulin resistance, particularly fasting glucose, were also positively associated with colorectal cancer risk. In contrast, no associations were observed for colorectal adenomas.

CONCLUSIONS

These results suggest that visceral adipose tissue accumulation and insulin resistance may promote the development of early-stage cancer but not adenoma in the colorectum.
Capture of Type 1 Diabetes–Susceptible HLA DR-DQ Haplotypes in Japanese Subjects Using a Tag Single Nucleotide Polymorphism
Authors: Nakanishi Koji , Shima Yukio
Published: October 2009

OBJECTIVE

To identify type 1 diabetes–susceptible HLA DR-DQ haplotypes using tag single nucleotide polymorphisms (SNPs) and to estimate the disease risk using these tag SNPs.

RESEARCH DESIGN AND METHODS

Five tag SNPs were typed in a total of 211 Japanese subjects including 201 patients with type 1 diabetes who had already been typed for HLA-DRB1, -DQA1, and -DQB1 alleles and 300 control subjects.

RESULTS

Tag SNP rs2395185 captured haplotypes involving all DR4 specificities and DR9 specificity with a sensitivity of 98.5% and specificity of 94.9%. Using the T allele of rs2395185, we obtained an odds ratio (95% CI) of 2.87 (2.21–3.74) for type 1 diabetes. In addition, rs3129888 captured haplotypes involving HLA-DRB1*0802 with a sensitivity of 92.3% and specificity of 98.9%.

CONCLUSIONS

Typing of two tag SNPs (rs2395185 and rs3129888) may be useful for the screening of Japanese subjects at genetic risk of type 1 diabetes.
Metabolic Syndrome Over 10 Years and Cognitive Functioning in Late Midlife
Authors: Akbaraly Tasnime N. , Kivimaki Mika , Shipley Martin J. , Tabak Adam G. , Jokela Markus , Virtanen Marianna , Marmot Michael G. , Ferrie Jane E. , Singh-Manoux Archana
Published: October 2009

OBJECTIVE

Evidence that the metabolic syndrome is a risk factor for poor cognition is mixed and is focused mainly on the elderly population; rarely is an adjustment made for socioeconomic factors. We examined this association in late midlife, with particular focus on cumulative effects and the role of socioeconomic circumstances.

RESEARCH DESIGN AND METHODS

Analyses were performed for 4,150 white participants from the Whitehall II study. Metabolic syndrome, using the National Cholesterol Education Program Adult Treatment Panel III criteria, was assessed three times over the 10-year follow-up (1991–2001). Cognitive function was assessed using a battery of six tests at the end of the follow-up.

RESULTS

After adjustment for demographic variables, health behaviors, and health status, participants with persistent metabolic syndrome (at least two of the three screenings) over the 10-year follow-up had lower cognitive performance than participants who never had metabolic syndrome. No significant differences in cognitive function were observed between participants with nonpersistent metabolic syndrome (one of the three screenings) and those who never had metabolic syndrome during the follow-up. Adjustment for adult occupational position attenuated this association by between 41 and 86%, depending on the measure of cognitive function. Adjustment for education had little effect.

CONCLUSIONS

Only persistent metabolic syndrome was associated with lower cognitive performance in late midlife. Adult occupational position but not education had a substantial impact on this association; these results highlight the importance of adult socioeconomic circumstances in identifying and targeting risk factors for cognitive aging.
Diabetes Distress but Not Clinical Depression or Depressive Symptoms Is Associated With Glycemic Control in Both Cross-Sectional and Longitudinal Analyses
Authors: Fisher Lawrence , Mullan Joseph T. , Arean Patricia , Glasgow Russell E. , Hessler Danielle , Masharani Umesh
Published: October 2009

OBJECTIVE

To determine the concurrent, prospective, and time-concordant relationships among major depressive disorder (MDD), depressive symptoms, and diabetes distress with glycemic control.

RESEARCH DESIGN AND METHODS

In a noninterventional study, we assessed 506 type 2 diabetic patients for MDD (Composite International Diagnostic Interview), for depressive symptoms (Center for Epidemiological Studies-Depression), and for diabetes distress (Diabetes Distress Scale), along with self-management, stress, demographics, and diabetes status, at baseline and 9 and 18 months later. Using multilevel modeling (MLM), we explored the cross-sectional relationships of the three affective variables with A1C, the prospective relationships of baseline variables with change in A1C over time, and the time-concordant relationships with A1C.

RESULTS

All three affective variables were moderately intercorrelated, although the relationship between depressive symptoms and diabetes distress was greater than the relationship of either with MDD. In the cross-sectional MLM, only diabetes distress but not MDD or depressive symptoms was significantly associated with A1C. None of the three affective variables were linked with A1C in prospective analyses. Only diabetes distress displayed significant time-concordant relationships with A1C.

CONCLUSIONS

We found no concurrent or longitudinal association between MDD or depressive symptoms with A1C, whereas both concurrent and time-concordant relationships were found between diabetes distress and A1C. What has been called “depression” among type 2 diabetic patients may really be two conditions, MDD and diabetes distress, with only the latter displaying significant associations with A1C. Ongoing evaluation of both diabetes distress and MDD may be helpful in clinical settings.
Pro12Ala Polymorphism in thePPARGGene Contributes to the Development of Diabetic Nephropathy in Chinese Type 2 Diabetic Patients
Authors: Liu Limei , Zheng Taishan , Wang Feng , Wang Niansong , Song Yanyan , Li Ming , Li Lifang , Jiang Jiamei , Zhao Weijing
Published: October 2009

OBJECTIVE

Oxidative stress is a major contributing factor in the development of diabetic nephropathy. Peroxisome proliferator–activated receptor γ heterozygous mice and Pro12Ala polymorphism in PPARG exhibited increased resistance to oxidative stress. Smoking increases the production of reactive oxygen species, which accelerates oxidative stress under hyperglycemia. To determine whether the Pro12Ala polymorphism, alone or in combination with smoking, contributes to the development of diabetic nephropathy, a case-control study was performed in 760 Chinese patients with type 2 diabetes.

RESEARCH DESIGN AND METHODS

Among patients, 532 had diabetic nephropathy with microalbuminuria (n = 245) or overt albuminuria (n = 287), and 228 did not show either of these symptoms but had had diabetes for ≥10 years and were not undergoing antihypertension treatment.

RESULTS

After adjustment for confounders, the Pro/Pro genotype was significantly associated with diabetic nephropathy (odds ratio 2.30 [95% CI 1.18–4.45], P = 0.014); smoking was also an independent risk factor for diabetic nephropathy (1.99 [1.08–3.68], P = 0.029). In addition, we identified possible synergistic effects; i.e., the high-risk group (smokers with the Pro/Pro genotype) showed 4.52 times higher risk (1.78–11.48, P = 0.002) of diabetic nephropathy than the low-risk group (nonsmokers with the Pro/Ala genotype) in a multiple logistic regression analysis controlled for the confounders.

CONCLUSIONS

Our results indicated that the Pro/Pro genotype and smoking were significant independent risk factors for diabetic nephropathy. The possible synergistic effects of genotype and smoking may aggravate oxidative stress and contribute to the development of diabetic nephropathy.
A1C and Diabetes Diagnosis: The Rancho Bernardo Study
Authors: Kramer Caroline K. , Araneta Maria Rosario G. , Barrett-Connor Elizabeth
Published: October 2009

OBJECTIVE

To examine the sensitivity and specificity of A1C as a diagnostic test for type 2 diabetes in older adults.

RESEARCH DESIGN AND METHODS

Cross-sectional study of community-dwelling adults without known diabetes who had an oral glucose tolerance test and A1C measured on the same day.

RESULTS

Mean age of the 2,107 participants was 69.4 ± 11.1 years; 43% were men. Based on the American Diabetes Association (ADA) criteria, 198 had previously undiagnosed type 2 diabetes. The sensitivity/specificity of A1C cut point of 6.5% was 44/79%. Results were similar in age- and sex-stratified analyses. Given the A1C cut point of 6.5%, 85% of participants were classified as nondiabetic by ADA criteria.

CONCLUSIONS

The limited sensitivity of the A1C test may result in delayed diagnosis of type 2 diabetes, while the strict use of ADA criteria may fail to identify a high proportion of individuals with diabetes by A1C ≥6.5% or retinopathy.
Gestational Diabetes Mellitus: NICE for the U.S.?
Authors: Simmons David , McElduff Aidan , McIntyre Harold David , Elrishi Mohamed
Published: October 2009

OBJECTIVE

To compare recent U.S. and U.K. guidelines on gestational diabetes mellitus (GDM).

RESEARCH DESIGN AND METHODS

The guidelines from the American Diabetes Association, the American College of Obstetricians and Gynecologists, and the National Institute for Health and Clinical Excellence (NICE) in the U.K. were collated and compared using a general inductive approach.

RESULTS

There are substantial differences in the recommendations between the U.K. and the U.S. guidelines. Of particular note are the reduced sensitivities of the early and later antenatal and postnatal screening and diagnostic criteria. NICE undertook a cost-effectiveness analysis using lower prevalence estimates and limited outcomes and still showed screening for GDM to be cost-effective.

CONCLUSIONS

The latest NICE recommendations appear to reduce access to proven, cost-effective management of GDM, an issue relevant in the current U.S. health care policy debate.
Effectiveness of Continuous Glucose Monitoring in a Clinical Care Environment
Authors:   Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group
Published: October 2009

OBJECTIVE

To determine whether continuous glucose monitoring (CGM) is effective in the management of type 1 diabetes when implemented in a manner that more closely approximates clinical practice.

RESEARCH DESIGN AND METHODS

After completion of a 6-month randomized controlled trial (RCT) evaluating CGM in children, adolescents, and adults with type 1 diabetes, CGM was initiated in the trial's control group with less intensive training and follow-up than was included in the RCT. Subjects had an outpatient training session, two follow-up phone calls, and outpatient visits at 1, 4, 13, and 26 weeks. For subjects with baseline A1C ≥7.0%, the primary outcome was change in A1C at 6 months.

RESULTS

CGM use decreased from a median of 7.0 days/week in the first month in the ≥25-year-old group, 6.3 days/week in the 15–24 year olds, and 6.8 days/week in the 8–14 year olds to 6.5, 3.3, and 3.7 days/week in the 6th month, respectively (P < 0.001 for each age-group). Among subjects with baseline A1C ≥7.0%, CGM use was associated with A1C reduction after 6 months (P = 0.02 adjusted for age-group). Severe hypoglycemia decreased from 27.7 events per 100 person-years in the 6-month control phase of the RCT to 15.0 events per 100 person-years in the 6-month follow-up CGM phase (P = 0.08).

CONCLUSIONS

Frequent use of CGM in a clinical care setting may improve A1C and reduce episodes of hypoglycemia. However, sustained frequent use of CGM is less likely in children and adolescents than in adults.
Bilateral caudate nucleus infarction resulting from left ventricular diastolic dysfunction
Authors: Varoglu Asuman
Published: October 2009

Bilateral caudate infarct is a very rare neurological situation, usually caused by small-artery disease resulting from a cardiac embolism. The most prominent clinical features of caudate vascular lesions are behavioral and cognitive abnormalities. We report here a case of bilateral infarction of the caudate nucleus and right parietal lobe with loss of consciousness and left hemiparesia resulting from left ventricular diastolic dysfunction (LVDD). A 50-year-old woman was admitted to our clinic with symptoms of mental status change. One day ago before appearing at our clinic, the patient was hospitalized because of food intoxication and diarrhea. Her neurological examination revealed that orientation-cooperation was impaired, and motor weakness was found in the left extremities, predominantly in the upper limb. The lesions detected by CT and MRI were located on the bilateral caudate nucleus and right parietal lobe. Transthoracic echocardiography revealed LVDD. Therefore, the patient was diagnosed as having had an ischemic stroke. Three days after the treatment, all neurological deficits had improved and the patient was discharged. Attending physicians should be alert to the presence of permanent or intermittent complications of LVDD in patients with ischemic cerebral events, especially in patients with the bilateral caudate nucleus infarcts.
THE PUBLIC AWARENESS OF APHASIA: AN INTERNATIONAL SURVEY
Authors: Code Chris , Mackie Nina Simmons , Armstrong Elizabeth , Stiegler Lillian , Armstrong Jennifer , Bushby Emily , Carew‐Price Philippa , Curtis Helen , Haynes Polly , McLeod Elizabeth , Muhleisen Vibecke , Neate Julie , Nikolas Angela , Rolfe Deanna , Rubly Claire , Simpson Rebecca , Webber Alison
Published: October 2009

We surveyed 929 shoppers in Exeter (England), Louisiana (USA) and Sydney (Australia) to determine what they knew of aphasia. Between 10% and 18% said they had heard of aphasia but only between 1.5% and 7.6% had even some basic knowledge of aphasia. We found that more females knew something about aphasia than males and that older people were more likely to have heard of it, although those with some knowledge were significantly younger. Informants had heard of aphasia mainly through their work or the media and were mainly professionals like teachers, nurses, therapists, managers and administrators, followed by a retired/student group. We found some differences in awareness levels in the different locations we sampled. Results have implications for targeting awareness raising and campaigning.
PHONOLOGICAL AND ORTHOGRAPHIC APPROACHES TO THE TREATMENT OF WORD RETRIEVAL IN APHASIA
Authors: Herbert Ruth , Best Wendy , Hickin Julie , Howard David , Osborne Felicity
Published: October 2009

We present a preliminary report on a study of the treatment of word finding difficulties in aphasia using phonological and orthographic cues. These techniques although often used to cue word finding in the immediate term have been little evaluated in terms of therapy designed to improve word retrieval in the long term. The first phase using cued word retrieval in a picture naming task was followed by a second phase designed to facilitate use of treated words in real‐life contexts. The results from both phases were encouraging with improved word retrieval for three out of the four participants. The implications for clinical practice are discussed.
TREATMENT OF WORD RETRIEVAL IN APHASIA: GENERALISATION TO CONVERSATIONAL SPEECH
Authors: Hickin Julie , Best Wendy , Herbert Ruth , Howard David , Osborne Felicity
Published: October 2009

The question of whether treatment gains in picture naming generalise to conversation remains relatively unexplored. Several difficulties surround data collection and analysis. A quantitative measure of word retrieval in aphasia is presented along with relevant details relating to the reliability of the measure, and the relationship between word retrieval in picture naming and noun retrieval in conversation. We discuss the clinical application of the measure and its applicability outside the field of aphasia.
VOICE THERAPY OUTCOMES IN VOCAL FOLD NODULES: A RETROSPECTIVE AUDIT
Authors: McCrory Eimear
Published: October 2009

Twenty‐six speech and language therapy (SLT) clinical files, in which patients presented with a medical diagnosis of bilateral or unilateral vocal fold nodule(s), were audited retrospectively over a six year period (1992–1998). The objective of the study was to evaluate current practice within our trust in the management of patients with vocal fold nodules against what was considered ‘best practice’ and to take action for improvements where deficits were identified. Multidimensional outcome measurements were employed. This study lends support to experimental findings of treatment effectiveness. Results demonstrated elimination and/or reduction of vocal fold nodules in over 70% of clinical files audited. Post‐therapy over 80% of patients presented with either a normal voice quality or a mild degree of dysphonia.
SUPPORTING PARTNERS OF PEOPLE WITH APHASIA IN RELATIONSHIPS AND CONVERSATION (SPPARC)
Authors: Lock Sarah , Wilkinson Ray , Bryan Karen , Maxim Jane , Edmundson Anne , Bruce Carolyn , Moir Diana
Published: October 2009

This paper reviews new theoretical and practical developments in working with partners of people with aphasia and describes the development of a clinician's resource entitled ‘SPPARC: Supporting Partners of People with Aphasia in Relationships and Conversation’. It focuses particularly on one part of that resource: the SPPARC Conversation Training Programme, which adapts conversation analysis for clinical use. The paper describes the stages involved in assessing and working on conversation in everyday life.
HELPING CHILDREN WITH COMMUNICATION DIFFICULTIES IN THE CLASSROOM
Authors: Cleary Philomena , McFadden Stephanie
Published: October 2009

As we move towards a more inclusive education system teachers are becoming more aware of children with speech and language difficulties and the implications for their future learning and literacy development. In order to address this and promote collaborative working practice between teachers and speech and language therapists two advisory speech and language therapy posts were created for a two‐year pilot project.
SPEECH AND LANGUAGE THERAPY FOR ADULTS IN HACKNEY: AN ASSESSMENT OF NEED
Authors: Heron Chris
Published: October 2009

With the development of separate community and the hospital trusts in the London borough of Hackney, at a time of increasing numbers and range of referrals, a number of gaps in service became apparent. The need for community adult speech and language therapy (SLT) in Hackney was identified, based on previous studies and other relevant literature. Comparison with services locally and nationally shows clearly that Hackney, in having virtually no community SLT for adults, is significantly disadvantaged. It was intended that this work would result in the widest consultation and discussion by the relevant agencies to explore ways of meeting this need.
SHARING STORIES: LIFE HISTORY NARRATIVES IN STUTTERING RESEARCH
Authors: Kathard Harsha
Published: October 2009

The life experiences of people who stutter (PWS) have not featured prominently in research. Historically, the profession of speech and language therapy has amassed data and developed its theory of stuttering within a positivistic frame. As a consequence, the existing over‐arching theory of research and practice does not engage holistically with the dynamic personal, socio‐cultural and political contexts of the individual who stutters. Therefore a conceptual shift is required in ontology, epistemology and methodology underpinning the knowledge construction process. The use of the life history narratives as a research tool is promoted. An exploratory study of a single participant is presented to illuminate the methodological approach and emerging theoretical constructs.
‘INSURING’ A CORRECT DIFFERENTIAL DIAGNOSIS ‐ A ‘FORENSIC’ COLLABORATIVE EXPERIENCE
Authors: Abudarham Sam , White Alfred
Published: October 2009

Mr. J was referred to a speech and language therapist (SLT) by a consultant psychiatrist. He had sustained an industrial accident which he claimed was responsible for a range of problems which included a speech and language problem. Some three years after his accident, he brought an action for damages arising out of the accident. His solicitor, on the recommendation of, the consultant psychiatrist, contacted the SLT requesting his views as to whether Mr. J's speech difficulties were due to the injuries sustained and requesting recommendations for further treatment. The SLT saw Mr. J and concluded that he had problems at all communication levels, the greatest being an articulatory impairment. Some reports' suggested a psychological basis for his problems and others, including the psychiatrists', suggested an organic basis.
A SURVEY TO IDENTIFY THERAPISTS' HIGH‐TECH AAC KNOWLEDGE, APPLICATION AND TRAINING
Authors: Matthews Rebecca
Published: October 2009

Recent research in Australia (Balandin and Iacono 1998) has identified a lack of postgraduate training in high tech or electronic alternative and augmentative communication (AAC) equipment for speech and language therapists (SLTs). At Treloar College (TC) the SLTs have acquired wide experience and knowledge that could be shared with others who have fewer clinical opportunities to acquire skill in this area of expertise. Questionnaires were sent to 500 SLTs selected at random. The purpose of the questionnaire was to identify how knowledgeable SLTs in various clinical settings across the UK considered themselves to be in the prescription, training, support and use of high tech AAC in an increasingly technological world.
EARLY SCREENING FOR DYSLEXIA — A COLLABORATIVE PILOT PROJECT
Authors: Ball Sandy , Becker Tanya , Boys Mo , Davies Stella , Noton Heather
Published: October 2009

An ongoing collaborative project, currently being piloted in 12 Wiltshire primary schools, is described. The aim is to provide a means of identifying potentially dyslexic children by the end of Key Stage 1 (Year 2) with a view to early intervention. The causal links identified by research between phonological skills and literacy development are taken as the theoretical basis of an initial screening procedure, and an intervention package is implemented for identified children. Those demonstrating persistent difficulties one year later are further assessed over a school term using an assessment package designed to identify those children showing a dyslexic profile. Further intervention is then planned and implemented.
EXPERIENCES OF ENDING APHASIA THERAPY
Authors: Hersh Deborah
Published: October 2009

Despite a considerable literature on assessment and treatment issues in aphasiology, little has been written about how therapy ends. We lack detail about how clinicians decide to terminate treatment and about how patients and carers view leaving therapy. This paper explores experiences and perceptions of aphasia treatment termination. It uses in‐depth interview data gathered in South Australia as part of a doctoral study with a speech pathologist, three ex‐patients with aphasia and one spouse. This case study allows comparison of client and professional narratives to each other and also to the official discharge documentation in the medical file. The discharge process arising from this analysis is discussed.
MEASURING QUALITY OF LIFE IN PEOPLE WITH APHASIA THE STROKE SPECIFIC QUALITY OF LIFE SCALE
Authors: Hilari Katerina , Byng Sally
Published: October 2009

Assessing health related quality of life (HRQOL) in people with communication disabilities is a challenge in health related research. Materials used to assess HRQOL are often linguistically complex and their mode of administration usually does not facilitate people with communication disabilities to give their experiences. We are currently running a medium scale study (80 participants) which aims to explore the HRQOL of people with long‐term aphasia and to assess the psychometric properties and the acceptability of the Stroke Specific Quality of Life Scale (SS‐QOL) (Williams et al. 1999) as a single measure for the assessment of HRQOL in this population. Here the initial stages of modifying the SS‐QOL for use with people with aphasia will be presented. We will concentrate on the process of making the scale communicatively accessible to people with aphasia and increasing its content validity with this population group.
EVALUATION OF A MODEL OF INTERVENTION TO CREATE A VISUALLY ENRICHED ENVIRONMENT
Authors: Bell Tracey , Purcell Margaret , Walker Brenda , Nisbet Nara
Published: October 2009

Within a day resource for people with learning disabilities ‘stand‐alone’ signing training proved ineffectual to sustain lasting change in the formalised gestural behaviours of carers. Consideration was given to setting conditions pre‐ and post‐training and a new model of delivery evolved, designed in partnership with day resource staff. Aims of intervention were to promote the adoption and active use of signing as an aid to communication and move towards a partnership framework which values the role of carers as co‐facilitators and lessens dependency on the therapist. This paper describes and evaluates a training model which was found to be successful in translating knowledge into changes in practice and discusses the critical factors which should be built into future interventions.
CAN'T OR WON'T? EVIDENCE RELATING TO AUTHORSHIP IN FACILITATED COMMUNICATION
Authors: Emerson Anne , Grayson Andrew , Griffiths Adrienne
Published: October 2009

Most experimental evaluations of Facilitated Communication (FC) provide no evidence that this technique is valid. Important as they are, controlled test‐based studies have characteristically not done justice to the complexity of the issues which surround FC. This paper summarises a long term evaluation project involving various forms of data collection. In this study too, controlled testing has shown very little evidence for the validity of the technique. In contrast, other sources of data, including records of naturally occurring message passing and intensive video analysis have provided evidence that the communication skills of some FC users have been enhanced. An overview of the project is presented, and discussed in relation to the blurring of findings (observations of behaviour) and inferences (judgements of communicative competence) in the extant literature.