bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of Optic Nerve Head Biomechanical Properties in Pseudoexfoliation Glaucoma with Real-time Elastography
Authors: Unal Ozlem , Caglayan Mehtap , Kosekahya Pinar , Yulek Fatma , Taslipinar Guzin
Published: June 2018

Purpose:

To investigate the biomechanical properties of the optic nerve head in patients
with Pseudoexfoliation (PEX) glaucoma using Real-time Elastography (RTE) and to compare these
results with those of Primary Open Angle Glaucoma (POAG) patients and healthy subjects.

Methods:

Twenty eyes of 20 PEX glaucoma patients (PEX group), 20 eyes of 20 POAG patients
(POAG group), and 20 eyes of 20 healthy subjects (control group) were enrolled in this prospective
study. The strain Ratios of Orbital Fat to Optic Nerve head (ROFON) and lateral rectus muscle to
optic nerve head (RLRON) were determined. Comparisons were performed using Chi-square,
Kruskal Wallis, Mann-Whitney U, and One-way ANOVA tests.

Results:

The strain ratios of orbital fat to optic nerve head were 2.34, 6.85 and 1.76 in PEX glaucoma, POAG, and control groups, respectively (p<0.001). The strain ratios of the lateral rectus muscle to the optic nerve head were 0.51, 0.82, and 0.55 in PEX glaucoma, POAG, and control groups, respectively (p=0.256).

Conclusion:

The strain ratios of orbital fat to optic nerve head were different in PEX glaucoma patients than in POAG and control groups. RTE can provide biomechanical assessment of the optic
nerve head in a non-invasive, quick, easily accessible, and user-friendly manner.
Detoxification of Aflatoxin B1 in Peanut Oil by Iodine Doped Supported TiO2 Thin Film Under Ultraviolet Light Irradiation
Authors: Xu Chengpeng , Ye Shengying , Cui Xiaolei , Zhang Quan , Liang Yan
Published: June 2018

Background:

Improper storage and raw materials make peanut oil susceptible to Aflatoxin
B1 (AFB1). The semiconductor TiO2 photocatalysis technology is an effective technology
which is widely used in sewage treatment, environmental protection and so on. Moreover, the photocatalytic
efficiency can be improved by doping I.

Method:

The experiment is divided into two parts. In the first part, supported TiO2 thin film (STF)
was prepared on the quartz glass tube (QGT) by the sol-gel and calcination method and the supported
iodine doped supported TiO2 thin film (I-STF) was synthesized using potassium iodate solution. In
the second part, the photocatalytic degradation of AFB1 was performed in a self-made photocatalytic
reactor. The AFB1 was detected by ELISA kit.

Results:

The photocatalytic degradation of AFB1 has been proven to follow pseudo first-order reaction
kinetics well (R2 > 0.95). The maximum degradation rate of 81.96%, which was reached at the
optimum iodine concentration of 0.1mol/L, was 11.38% higher than that with undoped STF.

Conclusion:

The doping of iodine reduces the band-gap of TiO2, thereby increasing the photocatalytic
response range. The proportion of Ti4+ in I-STF has decreased, which means that Ti4+ are replaced
by I. The I-STF prepared at iodine concentration of 0.1mol/L has good photocatalytic properties.
IoT based Low Power Wearable ECG Monitoring System
Authors: Kulkarni A.S. , Suchetha M. , Kumaravel N.
Published: June 2018

Background:

An electrocardiogram device monitors the cardiac status of a patient by
recording the heart’s electrical potential vs time. Such devices play a very important role to save
the life of patients who survive a heart attack or suffer from these patients. An early detection of
conditions that lead to the onset of cardiac arrest allows doctors to provide proper treatment on
time and prevents death or disability from cardiac arrest. Most developing countries have very
poor information about these health care issues.

Methods:

An actual deployment of the system was used to evaluate key aspects of the system
architecture, in particular, the possibility to monitor the ECG signal of single patients in a large
area and for a long time the possibility to access ECG data through the web interface. The test
deployment consisted of ECG sensor AD8232, wi-fi module and IoT server. The IoT server was
installed on a Linux/ windows machine. The wifi has been configured to connect to the server,
through an ADSL router.

Conclusion:

We have proposed a wireless wearable ECG monitoring system enabled with an IoT
platform that integrates heterogeneous nodes of ECG sensor and applications, has a long battery
life and provides a high-quality ECG signal. The system allows monitoring single/multiple
patients on a relatively large indoor area (home, building, nursing home, etc). As observed, this
result is obtained through a careful set of choices at the level of components, circuit solutions, and
algorithms. We would like to stress the fact that a dedicated overall output is not enough to
achieve an advantage in terms of overall sensor performance. The latter depends on the
optimization of the whole sensor. Indeed, this proposed ECG sensor, based on a high-performance
ADC and an arm processor, provides much better performance, in terms of power consumption
and noise, than many proposed system based on a purposely designed front-end chip.
Tuberculosis and HIV Coinfection–the Challenge in the Prevention, Detection and Treatment of Tuberculosis
Authors: Wang Yiyi , Wu Qi , Zhang Wei , Zhang Ning
Published: June 2018

Background:

Tuberculosis (TB) is still a major public health concern world-wide. The
increasing global burden of TB is linked to HIV infection. HIV-TB coinfection has also
conditioned clinical aspects of the TB. Since the HIV is beginning in the 1980s, the HIV infection
poses a significant challenge in global TB control.

Objective:

In this review we focused on the challenges of epidemiological and clinical feature of
tuberculosis presented by the HIV coinfection.

Method:

The article consists of a summary of the most important effects presented by the HIV
coinfection on epidemiological and clinical feature of tuberculosis. The article analyzes and
summary the causes for these challenges.

Results:

The major challenges to strategy of TB control and clinical feature of TB-HIV coinfection
are presented in this paper.

Conclusion:

HIV/TB co-infection is synergic, interactive and reciprocal with significant impact.
The infection of HIV and Mtb affect each other and the breakdown the immune function in
TB/HIV coinfected individual. HIV infection has changed the strategy of TB control, however
HIV increases global burden of TB, the reduction in the TB incidence rate is far from sufficient.
Atypically clinical manifestations in TB/HIV co-infected patients and increased MDR-TB and
XDR-TB contribute to the challenges in the diagnosis and treatment. Increased complexity of
managing patients requires expertise in the clinical m knowledge. The focused efforts to control
HIV-related TB are of great urgency. These findings will provide insight into the prevention,
detection and treatment of tuberculosis and will guide advances towards tuberculosis control.
Conurbation, Urban, and Rural Living as Determinants of Allergies and Infectious Diseases: Royal College of General Practitioners Research and Surveillance Centre Annual Report 2016-2017 (Preprint)
Authors: de Lusignan Simon , McGee Christopher , Webb Rebecca , Joy Mark , Byford Rachel , Yonova Ivelina , Hriskova Mariya , Matos Ferreira Filipa , Elliot Alex J , Smith Gillian , Rafi Imran
Published: June 2018

BACKGROUND

Living in a conurbation, urban, or rural environment is an important determinant of health. For example, conurbation and rural living is associated with increased respiratory and allergic conditions, whereas a farm or rural upbringing has been shown to be a protective factor against this.

OBJECTIVE

The objective of the study was to assess differences in general practice presentations of allergic and infectious disease in those exposed to conurbation or urban living compared with rural environments.

METHODS

The population was a nationally representative sample of 175 English general practices covering a population of over 1.6 million patients registered with sentinel network general practices. General practice presentation rates per 100,000 population were reported for allergic rhinitis, asthma, and infectious conditions grouped into upper and lower respiratory tract infections, urinary tract infection, and acute gastroenteritis by the UK Office for National Statistics urban-rural category. We used multivariate logistic regression adjusting for age, sex, ethnicity, deprivation, comorbidities, and smoking status, reporting odds ratios (ORs) with 95% CIs.

RESULTS

For allergic rhinitis, the OR was 1.13 (95% CI 1.04-1.23; P=.003) for urban and 1.29 (95% CI 1.19-1.41; P<.001) for conurbation compared with rural dwellers. Conurbation living was associated with a lower OR for both asthma (OR 0.70, 95% CI 0.67-0.73; P<.001) and lower respiratory tract infections (OR 0.94, 95% CI 0.90-0.98; P=.005). Compared with rural dwellers, the OR for upper respiratory tract infection was greater in urban (OR 1.06, 95% CI 1.03-1.08; P<.001) but no different in conurbation dwellers (OR 1.00, 95% CI 0.97-1.03; P=.93). Acute gastroenteritis followed the same pattern: the OR was 1.13 (95% CI 1.01-1.25; P=.03) for urban dwellers and 1.04 (95% CI 0.93-1.17; P=.46) for conurbation dwellers. The OR for urinary tract infection was lower for urban dwellers (OR 0.94, 95% CI 0.89-0.99; P=.02) but higher in conurbation dwellers (OR 1.06, 95% CI 1.00-1.13; P=.04).

CONCLUSIONS

Those living in conurbations or urban areas were more likely to consult a general practice for allergic rhinitis and upper respiratory tract infection. Both conurbation and rural living were associated with an increased risk of urinary tract infection. Living in rural areas was associated with an increased risk of asthma and lower respiratory tract infections. The data suggest that living environment may affect rates of consultations for certain conditions. Longitudinal analyses of these data would be useful in providing insights into important determinants.
Qualitative Assessment of the Perceptions of Undergraduate Students and Advisors on Academic Guidance in Saudi Arabia
Authors: Alshehry Amel Thafer
Published: June 2018

This paper describes the perceptions of undergraduate students and their advisors on the role and challenges of academic guidance in Saudi Arabia. For this, five focus groups comprising six to eight students and one advisor were interviewed, and their responses to four questions were qualitatively analyzed. The responses from all groups emerged in four major themes, two related to the student’s perspectives and two related to those of the advisors. Overall, the students identified the unfamiliarity with the purpose of academic guidance and a failure of their advisors to follow their progress as the primary challenges. The advisors highlighted the lack of student feedback and academic guidance training as the obstacles to successful student progress. The findings presented here suggest that universities should incorporate student and advisor feedback into the academic guidance systems to ensure student success.
Study of Scottish Gaelic Versions of ‘Snow-White’
Authors: Fraser Joy
Published: June 2018

No abstract
Breton Analogue To ‘Wandering Willie’s Tale’
Authors: Simpson Jacqueline
Published: June 2018

No abstract
Remembering Jim Mather
Authors: Catford J.C.
Published: June 2018

No abstract
Books Received
Authors: - -
Published: June 2018

No abstract
Carnival and Other Festivity in Scotland in the Nineteenth Century
Authors: Burnett John
Published: June 2018

No abstract
Hero’s Lament: Aithbhreac inghean Coirceadail’s Lament for Niall Óg mac Néill
Authors: Flahive Joseph
Published: June 2018

No abstract
Supernatural Beings in the Far North: Folkore, Folk Belief, and the Selkie
Authors: McEntire Nancy Cassell
Published: June 2018

No abstract
Prophecy and Cultural Conflict in Gaelic Tradition
Authors: Newton Michael
Published: June 2018

No abstract
Caterwauling and Demon Raising: The Ancient Rite of the Taghairm?
Authors: Wiseman Andrew E.M.
Published: June 2018

No abstract
Last Georgic, or James Grahame’s Revision of Eighteenth-Century Rural Labour
Authors: Zimmerman Donald Mark
Published: June 2018

No abstract
Good Man’s Croft
Authors: Lyle Emily
Published: June 2018

The ‘croft’ of the title is a piece of cultivable land which is left untilled in order to devote it to a supernatural being, one name for whom is the ‘good man’. The practice is documented in Scotland in the sixteenth and seventeenth centuries through official and kirk records concerned with stamping out the practice and in the eighteenth and nineteenth centuries through accounts which see it as an interesting survival from the past. The setting aside of the piece of land had a definite purpose and was designed to keep the livestock, especially cattle, healthy. The croft could be an old one, or it could be freshly established, and there is one detailed description of how a croft could be made by placing stones at the four corners and charming them.The ‘croft’ of the title is a piece of cultivable land which is left untilled in order to devote it to a supernatural being, one name for whom is the ‘good man’. The practice is documented in Scotland in the sixteenth and seventeenth centuries through official and kirk records concerned with stamping out the practice and in the eighteenth and nineteenth centuries through accounts which see it as an interesting survival from the past. The setting aside of the piece of land had a definite purpose and was designed to keep the livestock, especially cattle, healthy. The croft could be an old one, or it could be freshly established, and there is one detailed description of how a croft could be made by placing stones at the four corners and charming them.
Influence of the love of money and morality on intention to purchase counterfeit apparel
Authors: Gültekin Beyza
Published: June 2018

I examined the influence of dimensions of the love of money (rich, importance, achievement, budget) and moral judgment toward counterfeit product purchase, on consumers' intention to purchase counterfeit apparel. Data were collected from 185 participants in Ankara, Turkey, who had purchased
counterfeit apparel. Results showed that the achievement and budget dimensions of the love of money positively influenced counterfeit purchase intention and, as predicted, moral judgment toward counterfeit product purchase negatively affected the intention to purchase counterfeit apparel.
In contrast, the influence of the rich and importance dimensions of the love of money on counterfeit purchase intention was nonsignificant. My aim was that the practical outcome of this study would be to reduce consumer demand for counterfeit products through achieving an increase of awareness
of morality, which reduces counterfeit purchase intention.
A Boa Denúncia: A construção dos relatos para a produção da informação na Central Disque-Denúncia
Authors: Vianna Mariana Dos Santos , Geraldo Pedro Heitor Barros
Published: June 2018

Este artigo analisa a construção do relato realizada pelos atendentes da Central de Atendimento da Central Disque-Denúncia, “o coração da Central”, a partir do preenchimento do sistema para a elaboração da denúncia. O objetivo é compreender como os atendentes realizam o preenchimento do sistema da Central Disque-Denúncia, particularmente o espaço destinado ao relato – base da denúncia – e principalmente quais são as questões formuladas pelos mesmos para dispor de uma informação qualificada que possa realizar o preenchimento de uma “boa denúncia”. Como conclusão, a pesquisa empírica demonstra como as formas de categorização da qualidade da denúncia segundo os critérios institucionais da Central Disque-Denúncia, tendo em vista esta atividade como primordial para o funcionamento da instituição.
TRABALHO NAS PRISÕES: exercício de cidadania ou instrumento de controle social?
Authors: Faceira Lobelia Da Silva
Published: June 2018

O artigo tem o objetivo de analisar as mediações do trabalho dos presos na Penitenciária Industrial Esmeraldino Bandeira (SEAPEB), situada no estado do Rio de Janeiro (Brasil). A categoria trabalho aparece no universo carcerário como instrumento de “ressocialização”, fonte de subsistência, possibilidade de ocupação do tempo e um espaço na hierarquia. O estudo tem a proposta de reconstruir a historicidade do trabalho nas prisões e suas mediações no processo de constituição da vida social dos presos, destacando as condições materiais dadas para a realização desse trabalho. Historicamente, a concepção de trabalho nas prisões está relacionada ao objetivo de minimizar a ociosidade e tensões dos presos no cotidiano prisional, reforçando o traço disciplinador e controlador da instituição total prisão.
Este é um chamado à ação contra a escravidão na América – abolicionismos e movimentos sociais na terra da liberdade.
Authors: Cardoso Neves Fernando Henrique , Braida Ricardo
Published: June 2018

O tema deste trabalho é abolicionismo penal e movimentos sociais. Dentro desta perspectiva, voltamos nossa atenção para a greve prisional que teve início em 9 de setembro de 2016 nos Estados Unidos. Apesar de  muitos movimentos sociais tomarem para si um discurso anti-prisional, o posicionamento examinado rompe com esta homogeneidade. O objetivo deste artigo é demonstrar os grupos e as estratégias que participam deste movimento. Tal exercício dar-se-á pela análise do material exposto na internet desde os chamados anteriores à greve. Os resultados demonstram tanto sua heterogeneidade como as implicações desta numa reflexão entre Direito e movimentos sociais.
Privacidade e acesso à informação econômica de empresas mineradoras
Authors: Avila Negri Sergio Marcos Carvalho , Raad Fernandes Elora Raad Fernandes
Published: June 2018

O presente estudo exploratório pretende investigar, de maneira empírica, se companhias mineradoras de capital aberto divulgam informações econômicas, especificamente a remuneração de seus administradores. Este questionamento surge a partir da premissa da mineração como atividade que põe em risco direitos humanos e da importância, na sociedade atual, do acesso à informação para o exercício pleno da democracia. Utiliza-se a metodologia empírica, baseada nas regras de inferência formuladas por Epstein e King (2013), para analisar os Formulários de Referência das companhias de mineração que negociam suas ações na BM&F Bovespa e buscar as informações pretendidas, a fim de se realizar inferências descritivas. Como referencial teórico, adota-se as relações estabelecidas por Rodotà (2007, 2008, 2015) entre o direito ao acesso à informação e a democracia. Conclui-se, ao final do trabalho, que o argumento da privacidade pode estar sendo utilizado como trunfo estratégico para omitir informações.
Pertença ao clube: o boom da arbitragem comercial e os meios de entrada na "comunidade"
Authors: Chasin Ana Carolina
Published: June 2018

A arbitragem é um instituto previsto no direito brasileiro que consiste num mecanismo extraestatal de resolução de conflitos. A partir de 1996 – ano de aprovação da lei que regulamentou o seu funcionamento – um novo domínio da prática jurídica começa a se constituir ao redor das instituições que realizam essa atividade. O artigo tem como objetivo identificar os processos de formação e recrutamento no interior de um segmento específico desse domínio: o da arbitragem comercial. Tal nicho é altamente prestigioso, sendo referido explicitamente por seus praticantes nos termos de um "clube" ou "grupo seleto". Duas vias de entrada são identificadas: uma mais comum, trilhada por estudantes que se envolvem com a prática a partir de competições simuladas e de estágios em escritórios especializados; outra, mais inusual, percorrida por ministros e desembargadores aposentados que realizam uma reconversão em suas carreiras para se inserirem no circuito. Tal abordagem nos permite flagrar uma série de aspectos relativos à configuração desse novo domínio da prática, bem como à sua posição no interior do campo mais amplo do direito.
Concentração do Crédito e Desenvolvimento Regional: a experiência do estado do Rio de Janeiro
Authors: Gama Fábio , Bastos Suzana Quinet de Andrade
Published: June 2018

O presente trabalho analisa a relação entre moeda e desempenho econômico regional a luz da abordagem regional pós-keynesiana, tendo como base de análise 87 municípios do Estado do Rio de Janeiro no período de 2000 a 2010. Como metodologia, parte-se das técnicas de análise fatorial e de análise de agrupamento (clusters), criando insumos para a estimação de uma regressão de painel com efeitos fixos. Os resultados indicam evidências a favor da hipótese de efeitos heterogêneos das variáveis financeiras sobre o desempenho econômico dos municípios, ou seja, a variabilidade nas variáveis financeiras teve efeitos adversos maiores no cluster de município subdesenvolvidos quando comparados aos municípios desenvolvidos.
Sustentabilidade Energética, Especialização Produtiva e Desenvolvimento: como superar este paradoxo?
Authors: Cavalieri Henrique , Mendes Heitor , Hasenclever Lia
Published: June 2018

O artigo faz uma avaliação comparativa dos empregos gerados na indústria extrativa de P&G e em sua cadeia de fornecedores no Brasil e no Estado do Rio de Janeiro na década de 2000. Os resultados apontam para uma expansão da qualificação e remuneração desses empregos, tendo a indústria de P&G e parte de seus segmentos correlatos uma alta concentração de ocupações mais exigentes em escolaridade e com maiores salários em comparação com o restante da economia. Não obstante, a capacidade da indústria de P&G transbordar sua dinâmica para outros setores é ainda limitada, resultando em um padrão de desenvolvimento pouco sustentável. Sugere-se que somente a partir da diversificação da indústria é que se poderá contornar o paradoxo da sustentabilidade energética e baixo desenvolvimento devido a uma excessiva especialização em indústrias extrativas.
OS EFEITOS DA LIBERALIZAÇÃO COMERCIAL NA POBREZA DAS NAÇÕES: UMA ANÁLISE POR MEIO DA RENDA REAL E DO BEM-ESTAR
Authors: Al-Alam Eduardo Ledesma , Massuquetti Angélica , Azevedo André Filipe Zago de
Published: June 2018

A pobreza, embora tenha declinado nas últimas décadas, continua sendo um dos maiores desafios a serem enfrentados no século XXI. Este estudo investiga os efeitos da liberalização comercial sobre a pobreza em diferentes regiões em desenvolvimento do mundo. A análise ocorre de forma indireta, observando os impactos sobre a renda real e o bem-estar destas regiões. É utilizado o modelo de equilíbrio geral computável Global Trade Analysis Project (GTAP), sendo realizadas três simulações de liberalização comercial, buscando comparar os benefícios da abertura dos países desenvolvidos em relação à liberalização plena, com contrapartida dos países em desenvolvimento. Os resultados revelam que os ganhos de renda real e bem-estar das regiões em desenvolvimento são maiores quando elas próprias participam do processo de abertura ao lado das regiões desenvolvidas. As simulações vão ao encontro dos resultados de Hertel et al. (2009), em que a liberalização comercial realizada em todas as regiões se mostrou mais benéfica aos países mais pobres do que a liberalização comercial com ênfase apenas em países desenvolvidos, como é o caso da Rodada Doha.
APRESENTAÇÃO: O GT TRABALHO E EDUCAÇÃO DA ANPED
Authors: Vendramini Célia Regina , Da Silva Mariléia Maria
Published: June 2018

Os trabalhos reunidos no número 29 da Revista Trabalho Necessário contam com artigos de demanda contínua e artigos que integram um número temático acerca de temas e questões que compõem os desafios dos estudos acerca da relação trabalho e educação. Há algumas décadas, as pesquisas no Brasil vêm acompanhando e analisando as transformações no mundo do trabalho e suas repercussões na educação e na escola. Tais pesquisas têm como pressuposto o trabalho como base sobre a qual se desenvolvem os diferentes e complexos elementos que constituem o ser humano, sua história, sociabilidade, cultura e, portanto, sua educação.
GÊNERO, PATRIARCADO, TRABALHO E CLASSE
Authors: Hirata Helena
Published: June 2018

A conjunção das palavras-chave que compõem o título desse artigo remete imediatamente ao conjunto de reflexões e práticas do que se convencionou denominar “feminismo materialista” Assim, esse texto apresenta, de início, o feminismo materialista para, em seguida, abordar o tema do trabalho das mulheres e, mais geralmente, a relação entre trabalho e gênero, no contexto de um capitalismo patriarcal. Discute, enfim, o paradigma da interseccionalidade, que propõe a interdependência e a não-hierarquização das relações de poder de gênero, raça e classe social.
CAMINHOS DA EDUCAÇÃO SOCIALISTA
Authors: Ciavatta Maria
Published: June 2018

O objetivo principal deste texto foi situar a pedagogia socialista no contexto histórico das sociedades onde se realizaram algumas experiências. Abordamos o tema em três momentos: questões conceituais e sua historicidade; o contexto dos processos revolucionários onde gerou-se a ideia também revolucionária da emancipação humana e da pedagogia socialista; por último, algumas experiências realizadas segundo esse ideário de homem e de sociedade, na Revolução Russa, na Revolução Cubana e no Movimento dos Trabalhadores Rurais sem Terra (MST).
TRABALHO DOCENTE NA EDUCAÇÃO BÁSICA: AS CONDIÇÕES E A JORNADA DE TRABALHO NA EDUCAÇÃO FÍSICA NA EDUCAÇÃO DE JOVENS E ADULTOS TRABALHADORES NO MUNICÍPIO DE BELÉM DO PARÁ
Authors: Santos Costa Maria Da Conceição
Published: June 2018

Este estudo analisa a configuração do trabalho docente em Educação Física na Educação de Jovens e Adultos a partir das condições e jornada de trabalho materializadas na Educação Básica do Município de Belém - Pará. A pesquisa foi realizada com oito docentes da Rede Municipal de Ensino e fundamentada na teoria crítica dialética. As condições e jornada de trabalho têm se caracterizado como aspectos que medeiam a configuração de um trabalho precário e intensificado na escola pública. Ao mesmo tempo, os docentes resistem e apontam a relevância da EF para a formação dos jovens e adultos trabalhadores.
Asset Impairment and Depreciation before the 15th Century
Authors: Kuter Mikhail , Gurskaya Marina , Andreenkova Angelina , Bagdasaryan Ripsime
Published: June 2018

This paper investigates impairment and depreciation accounting in the 13th to 15th century. It finds that the first known instance of impairment accounting was in 1321, while for depreciation, it was 1399 not, as has previously been claimed, 1299. The study demonstrates the difference in approach at that time between the two forms of adjustment and shows that impairment was the original form of adjustment for reduction in asset values, a form that was applied in situations where physical assets had been lost, or deteriorated, or devalued over the reporting period. In contrast, depreciation was algorithmic, linked to a time-based straight-line depreciation charge equivalent to 10 percent per annum. These findings not only relocate recognition of the emergence of depreciation provisions to the end of the 14th century but, also, from France to Spain. However, in both cases, in Italian firms with Italian accountants.
Use of Big-Data Algorithms to Characterize Patients with T2D on Basal Insulin (BI) Who Add a Glucagon-Like Peptide-1 Receptor Agonist (GLP-1 RA) and Predict Their A1C Response
Authors: ZIMMERMANN ESTHER , LENART ADAM , DA ROCHA FERNANDES JOAO DIOGO , EGGERT SARAH , RANTHE MATTIS F.
Published: June 2018

Machine learning allows extensive analysis of big complex data. This study had two aims: 1) characterize patients on BI who add a GLP-1RA and 2) identify predictors of ≥1% decline in A1C. Patients with T2D who were prescribed BI for ≥90 days but not GLP-1RA for 180 days beforehand (in the U.S. IBM Explorys database between 2010 and 2016) were included (N=80,019). For the A1C analysis, A1C readings ≤180 days before, and 180-360 days after initiating GLP-1RA were required (N=8731). Logistic regression with 23 pre-specified variables, and subsequent hypothesis-free machine learning models, with 155000 additional variables covering clinical, claims and billing data addressed both aims. GLP-1RA initiators were characterized by a BI duration of >180 days (vs. ≤180 days) estimated odds ratio (OR) 5.87 (95% CI: 5.49-6.27), receiving oral antidiabetic drugs(s) OR 1.70 (1.64-1.77) and co-medication(s) (both vs. none) OR 3.22 (2.96-3.50), a BMI >30 kg/m2 (vs. <30 kg/m2) OR 1.93 (1.84-2.03), age <75 years (vs. ≥75 years) OR 3.63 (3.37-3.92) and private insurance (vs. non-private) OR 2.2 (2.10-2.31). Variable selection via machine learning confirmed the importance of these variables. Baseline A1C was the only strong predictor of ≥1% decline in A1C, ORs (95% CI) compared with A1C <7% were 4.99 (3.29-7.57), 7.04 (4.77-10.39), 14.56 (9.98-21.24), 23.21 (15.92-33.85), 36.28 (25.05-52.54), 73.14 (50.32-106.32) for categories 7-<7.5, 7.5-<8, 8-<8.5, 8.5-<9, 9-<10, ≥10%, respectively. Machine learning, applying 155000 variables, confirmed the importance of baseline A1C. On average, patients who improved lowered A1C from 10.0% (interquartile range [IQR]: 8.6-11.0) to 7.7% (IQR 6.7-8.4). Patients with T2D on BI who added a GLP-1RA were likely to be <75 years old and had characteristics of progressed disease. Baseline A1C determined a ≥1% decline in A1C, suggesting patients on BI with high A1C would benefit from combination treatment with GLP-1RA.

Disclosure

E. Zimmermann: Employee; Self; Novo Nordisk A/S. Stock/Shareholder; Spouse/Partner; Novo Nordisk A/S. A. Lenart: Employee; Self; Novo Nordisk A/S. J. da Rocha Fernandes: Employee; Self; Novo Nordisk A/S, International Diabetes Federation. S. Eggert: Employee; Self; Novo Nordisk A/S. M.F. Ranthe: Employee; Self; Novo Nordisk A/S. Stock/Shareholder; Self; Novo Nordisk A/S.
Effect of the Combination Therapy of Liraglutide, a GLP-1 Receptor Analog, and IDegAsp in Patients with Type 2 Diabetes
Authors: HARADA MARINA , SHINODA MINORI , SAKAMOTO RIKA , SUZUKI JUN , TAKAHASHI KENICHIRO , YAMAKAWA TADASHI
Published: June 2018

Background: Diabetes care management aims to not only achieve good glycemic control but also maintain the quality of life (QoL). Basal insulin-treated patients frequently receive bolus insulin as a strengthening therapy; however, concerns exist about QoL due to the increasing number of injections. We examined the glycemic effect and QoL in patients treated with liraglutide (Lira) and insulin degludec/insulin aspart (IDegAsp).

Methods: Patients with type 2 diabetes treated with basal-supported oral therapy (BOT) and DPP-4 inhibitor were enrolled in this observational study. Basal insulin was switched to IDegAsp at the same dose and DPP-4 inhibitor to Lira simultaneously; no titration protocol was used. We estimated the clinical and laboratory parameters and assessed the change in QoL within 12 weeks using the diabetes therapy-related QoL (DTR-QoL) questionnaire. The timing of dose up in regard to IDegAsp and Lira was also determined.

Results: Fourteen patients were enrolled (male/female: 9/5, age (years): 63.6). The IDegAsp dose ranged from 9.1 to 13.7 U; all patients received 0.9 mg/day of Lira. The combination therapy significantly decreased HbA1c levels (8.7% vs. 7.1%, P=0.02), pre-breakfast glucose level (138.2 mg/dL vs. 108.9 mg/dL, P=0.044), bodyweight (62.9 kg vs. 60.3 kg, P=0.003), and BMI (24.6 vs. 23.5, P=0.004). The total DTR-QoL score at baseline was 61.6 and significantly improved to 73.2 (P=0.004). Significant improvement was also seen in D3 score (hypoglycemia; 63.6 vs. 81.4, P=0.036). D4 score (satisfaction with treatment) showed an increasing trend (59.0 vs. 78.2) and was negatively correlated with HbA1c levels (P=0.049).

Conclusion: The change from BOT to the combination therapy of Lira and IDegAsp significantly improved glycemic control and reduced the bodyweight without deteriorating QoL in type 2 diabetes, although the treatment modality changed from one-injection to two-injection therapy.

Disclosure

M. Harada: None. M. Shinoda: None. R. Sakamoto: None. J. Suzuki: None. K. Takahashi: None. T. Yamakawa: None.
Improving Appropriate Basal Insulin Use in Clinical Practice—Impact of Physician Education on T2D Clinical Management
Authors: LARKIN AMY , LACOUTURE MICHAEL , LE ANNE
Published: June 2018

Although insulin is among the most effective antihyperglycemic agents, initiation is often delayed. We studied whether online continuing medical education (CME) could improve the clinical performance and confidence of primary care physicians (PCPs) and endocrinologists (endos) regarding use of basal insulin. The CME activity consisted of an online, 30-minute, video-based roundtable panel discussion. Educational effects were assessed using 3 case-based and 1 self-efficacy repeated pair pre-/post-assessment questions and McNemar’s chi-squared test. The activity launched online August 16, 2016, and data were collected through December 20, 2016. Overall improvements were seen for PCPs (n = 197; P <.001) and endos (n = 27; P =0.014). Relative percent changes from pre- to post-assessment were between 15% and 126% for PCPs and -4% to 40% for endos. While only 7% of PCPs and 19% of endos answered all 4 questions correctly on the pre-assessment, 28% of PCPs and 41% of endos answered all correctly on the post-assessment. The greatest improvements were seen in dosing strategies for preventing hypoglycemia (44% improvement in PCP, P <.001, and 18% in endos, P = 0.025), individualizing therapy in a patient with high glucose variation (23% improvement in PCP, P <.001, and 7% in endos, P = 0.4), and insulin initiation (8% improvement in PCP, P = 0.039, and 22% in endos, P = 0.058). PCPs reported a confidence level of 2.86 on the pre-assessment and 3.45 on the post -assessment, for a total confidence shift of 20.6%. Endos reported a confidence level of 4.04 on the pre-assessment and 4.44 on the post -assessment for a confidence shift of 10.1%. This study demonstrates the success of an online, roundtable activity in improving performance of PCPs and endos regarding use of newer basal insulins. Studies have shown that case questions are an effective way to measure clinical performance in practice; therefore this activity is expected to translate into improved T2D management in clinical care.

Disclosure

A. Larkin: None. M. LaCouture: None. A. Le: None.
Ultra-rapid Lispro (URLi) Shows Faster Absorption of Insulin Lispro vs. Humalog® during Insulin Pump (CSII) Use in Patients with T1D
Authors: KAZDA CHRISTOF M. , LEOHR JENNIFER , LIU RONG , HARDY THOMAS , REDDY SHOBHA , CHUA SHANE P.C. , GUO XIAONAN , HOVELMANN ULRIKE , KAPITZA CHRISTOPH
Published: June 2018

URLi (LY900014), a novel ultra-rapid mealtime insulin in Phase 3 development, is shown to reduce postprandial glucose after subcutaneous injection. This study evaluated the pharmacokinetics and pharmacodynamics (PD) of URLi via CSII. In a double-blind, randomized cross-over study, 24 adult patients with T1D received URLi or insulin lispro (Humalog®; HL) for 3 days. Mixed meal tolerance tests (MMTT) were conducted on Days 1 and 3 after catheter insertion using a standard (1.5 U/min) single-wave bolus. URLi showed faster insulin lispro absorption on both days compared to HL. URLi reduced time to early half-maximal drug concentration by 37% (-8.5 min) and 32% (-5.3 min) compared to HL on Days 1 and 3 (both p<0.0001). Area under the insulin lispro concentration time curve (AUC) for the first 15 min was >50% higher than HL after dosing with URLi on Days 1 and 3 (p<0.005). URLi reduced 1-hour postprandial glucose excursion of the MMTT by 45% on Day 1 (p=NS) and 47% on Day 3 (p=0.059) compared with HL (Figure). Accelerated URLi absorption was associated with trends toward lower postprandial glucose excursion for the entire MMTT (57% and 20% reductions in ∆AUC[0-5h] on Days 1 and 3; both NS). The study was not powered for PD assessment which may contribute to the lack of statistical significance. No differences were seen in the number or severity of hypoglycemic events or local tolerability between URLi and HL.

Disclosure

C.M. Kazda: Employee; Self; Eli Lilly and Company. J. Leohr: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company. Employee; Spouse/Partner; Accenture. Stock/Shareholder; Spouse/Partner; Accenture. R. Liu: Employee; Self; Eli Lilly and Company. Employee; Spouse/Partner; Eli Lilly and Company. T. Hardy: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company. S. Reddy: None. S.P.C. Chua: Employee; Self; Eli Lilly and Company. X. Guo: None. U. Hovelmann: None. C. Kapitza: Research Support; Self; ADOCIA, Boehringer Ingelheim GmbH, Dance Biopharm, Eli Lilly and Company, Johnson & Johnson Services, Inc., MedImmune, MSD K.K., Mylan, Nordic Bioscience, Novo Nordisk Inc., Poxel SA, Roche Diagnostics Corporation, Saniona, Sanofi-Aventis, Senseonics, Zealand Pharma A/S.
Total and Severe Hypoglycemia Is Reduced with Use of Inhaled Technosphere Insulin (TI, Afrezza®) Relative to Insulin Aspart in Type 1 Diabetes
Authors: BLONDE LAWRENCE , POMPILIO FRANK , BRUCE SIMON R. , GRANT MARSHALL L. , KENDALL DAVID M.
Published: June 2018

Hypoglycemia (HG) and fear of HG limit effective insulin therapy and contribute to suboptimal glycemic control. Ultra-short acting insulins reduce HG risk by providing their glucose-lowering effect early and reducing the risk of late postprandial HG. AFFINITY-1, a treat-to-target study in T1D on multiple daily injection therapy, demonstrated one such ultra-short acting insulin, TI (Afrezza®), was non-inferior to SC aspart in A1C reduction (Bode et al, Diabetes Care 2015). Consistent with its action profile, a lower rate of HG was observed in TI users overall, particularly in the 2-5 h post-meal interval and in those achieving target A1C<7%.

In this post-hoc analysis of patients with reported A1C values at end of treatment, mean rates for all HG and severe HG obtained from combined SMBG and AE reporting were significantly lower with TI than with aspart (Figure). A negative binomial regression including treatment, region, type of basal insulin, and A1C at end of treatment yielded an LS-mean HG rate for patients on TI 26% lower than comparable patients on aspart across the entire A1C range (mean ratio:0.74, 95% CI: 0.68-0.81).

TI’s rapid onset and ultra-short action provide insulin when needed at meals and between meals.

This profile improves overall and prandial glucose control and, as demonstrated in AFFINITY-1, has the potential to reduce the risk of late post-meal HG.

Disclosure

L. Blonde: Other Relationship; Self; AstraZeneca. Speaker's Bureau; Self; AstraZeneca. Advisory Panel; Self; Intarcia Therapeutics, Inc.. Other Relationship; Self; Lexicon Pharmaceuticals, Inc.. Advisory Panel; Self; Janssen Pharmaceuticals, Inc.. Other Relationship; Self; Janssen Scientific Affairs, LLC.. Speaker's Bureau; Self; Janssen Pharmaceuticals, Inc.. Advisory Panel; Self; Merck & Co., Inc., Novo Nordisk Inc.. Speaker's Bureau; Self; Novo Nordisk Inc.. Other Relationship; Self; Novo Nordisk Inc., Sanofi. Advisory Panel; Self; Sanofi. Speaker's Bureau; Self; Sanofi US. F. Pompilio: Employee; Self; MannKind Corporation. Stock/Shareholder; Self; MannKind Corporation, Amgen Inc. S.R. Bruce: Consultant; Self; MannKind Corporation, Oramed Pharmaceuticals, Inc. M.L. Grant: Employee; Self; MannKind Corporation. Stock/Shareholder; Self; MannKind Corporation. D.M. Kendall: Employee; Self; MannKind Corporation. Employee; Spouse/Partner; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company.
Lower Pharmacokinetic and Pharmacodynamic Within-Day Variability of Individual Clinical Doses of Insulin Glargine 300 U/ml vs. Glargine 100 U/ml in T1DM
Authors: FANELLI CARMINE , LUCIDI PAOLA , CANDELORO PAOLA , CIOLI PATRIZIA , ANDREOLI ANNA MARINELLI , BOLLI GEREMIA B. , PORCELLATI FRANCESCA
Published: June 2018

Previous studies have examined variability of pharmacokinetics (PK, plasma insulin concentration) and pharmacodynamics (PD, glucose infusion rate, GIR) of basal insulins at steady-state (SS) and at fixed doses in all subjects studied. To establish within-day PK/PD variability of individual, different, doses of insulin Glargine 300 U/ml (Gla-300) vs. Glargine 100 U/ml (Gla-100) that people with T1DM use in real life. Eighteen T1DMs [age 40±11 years, diabetes duration 26±12 years, BMI 23.4±2.1 kg/m2, A1C 7.2±0.5% (55±6 mmol/mol)] were studied after 3 month treatment with Gla-300 and Gla-100 titrated to fasting euglycemia, with a 24 h euglycemic clamp (randomized, crossover). The individual basal insulin doses that subjects used (0.35±0.Gla-300, 0.28±0.07 Gla-100, U/kg) were injected s.c. in the clamp study. Prior to clamp, glycemic control was comparable with Gla-300 and Gla-100. In the clamp, the individual doses of Gla-300 and Gla-100 resulted in 24 h PK/PD bioequivalence, but in lower variability indices of PK/PD with Gla-300 vs. Gla-100 (Table).

In conclusion, at clinical, individual doses used by T1DMs in real life, Gla-300 has lower PK/PD within-day variability vs. Gla-100. These results may explain the lower glycemic variability and lower risk for hypoglycaemia reported in clinical studies with Gla-300 vs. Gla-100.

Disclosure

C. Fanelli: Advisory Panel; Self; Sanofi. Other Relationship; Self; Menarini Group. P. Lucidi: Other Relationship; Self; Abbott, Menarini Group, Sanofi-Aventis. P. Candeloro: None. P. Cioli: None. A. Marinelli Andreoli: None. G.B. Bolli: Speaker's Bureau; Self; Menarini Group, Sanofi. Research Support; Self; Sanofi. F. Porcellati: Advisory Panel; Self; Sanofi. Board Member; Self; Sanofi. Other Relationship; Self; Medtronic. Board Member; Self; Eli Lilly and Company.
Prediction of Nonsevere Hypoglycemia—The Influence of Glycemic Variability in the HypoAna Study
Authors: AGESEN RIKKE M. , KRISTENSEN PETER L. , BECK-NIELSEN HENNING , NØRGAARD KIRSTEN , JENSEN TONNY , THORSTEINSSON BIRGER , TARNOW LISE , PEDERSEN-BJERGAARD ULRIK
Published: June 2018

Introduction: In the struggle for tight glycemic control many type 1 diabetes patients daily experience large blood glucose fluctuations. It has been demonstrated that increased glucose variability is a predictor of hypoglycemia, which is the main limiting factor for achieving the recommended HbA1c target. The relationship between glucose variability and hypoglycemia might seem intuitive, but the exact nature of the relationship is difficult to elucidate. In this study we wanted to clarify the relationship between occurrence of non-severe hypoglycemia and glycemic variability in type 1 diabetic patients at high risk of severe hypoglycemia.

Material and Methods: 72 patients participated for 4 x 3 days of blinded CGM recordings during a 2-year randomized balanced cross-over study with human insulins (regular/NPH) and insulin analogs (aspart/detemir). CGM recordings were used to calculate the coefficient of variation (CV) in glucose.

Results: Treatment with insulin analogs resulted in a significant lower nocturnal CV (mean 29.2%, SD 9.1) than treatment with human insulin (mean 36.9%, SD 9.1) (p<0.0001). CV was a significant risk marker of nocturnal asymptomatic hypoglycemia ?3.9 mmol/l in a multivariate analysis. A 1% increase in CV corresponds to a 5% (p<0.0001) increase in asymptomatic hypoglycemia. CV did not predict hypoglycemia during daytime at this threshold.

Conclusion: Treatment with insulin analogs provides less glycemic variability during night-time. The coefficient of variation in patients suffering from recurrent severe hypoglycemia predicts the occurrence of especially nocturnal hypoglycemia.

Disclosure

R.M. Agesen: None. P.L. Kristensen: Other Relationship; Self; Eli Lilly and Company. H. Beck-Nielsen: None. K. Nørgaard: Research Support; Self; Roche Diabetes Care Health and Digital Solutions. Advisory Panel; Self; Novo Nordisk A/S. Stock/Shareholder; Self; Novo Nordisk A/S. Research Support; Self; Novo Nordisk A/S. Advisory Panel; Self; Medtronic. Speaker's Bureau; Self; Medtronic, Zealand Pharma A/S, Novo Nordisk A/S. Research Support; Self; Zealand Pharma A/S. T. Jensen: Stock/Shareholder; Self; Novo Nordisk A/S. B. Thorsteinsson: None. L. Tarnow: Stock/Shareholder; Self; Novo Nordisk A/S. U. Pedersen-Bjergaard: Advisory Panel; Self; Novo Nordisk A/S. Consultant; Self; Novo Nordisk A/S. Research Support; Self; Novo Nordisk A/S. Advisory Panel; Self; Sanofi-Aventis. Consultant; Self; Medtronic.
The Use of Supportive Tools and Education Enables Self-Titration with Insulin Glargine 300 (Gla-300) or 100 U/mL (Gla-100) in People with Type 2 Diabetes (T2DM)—Results from TAKE CONTROL, INNOVATE, and AUTOMATIX
Authors: KVAPIL MILAN , BONNEMAIRE MIREILLE , GOYEAU HARMONIE , PAPANAS NIKOLAOS , POPESCU LUIZA , SCHULTES BERND , SIEBER JOCHEN , DUVNJAK LEA
Published: June 2018

Supporting people with T2DM with education and titration tools may empower them to optimize basal insulin self-titration in order to reach glycemic targets. Three multicenter, randomized, open-label, parallel-group studies have investigated self-titration (supported by either a paper algorithm, web tool or device) vs. physician-led titration in people with T2DM, switching to or initiating Gla-300 (TAKE CONTROL and AUTOMATIX) or Gla-100 (INNOVATE). Fasting blood glucose targets for self-titration were 80-130 mg/dL (4.4-7.2 mmol/L) in TAKE CONTROL and 90-130 mg/dL (5.0-7.2 mmol/L) in both INNOVATE and AUTOMATIX. Self-titration resulted in greater or similar mean HbA1c reductions from baseline vs. physician-led titration (Table). By using self-titration with Gla-300, more people with T2DM achieved fasting glucose targets without confirmed or severe hypoglycemia vs. physician-led titration (TAKE CONTROL and AUTOMATIX). Severe hypoglycemia and other safety outcomes were similar between titration arms in all 3 studies. Self-titration with Gla-300 and Gla-100 using either a paper or device-based algorithm resulted in improved or similar reductions in HbA1c, without an increased risk of hypoglycemia or safety concerns.

Disclosure

M. Kvapil: None. M. Bonnemaire: Employee; Self; Sanofi. Stock/Shareholder; Self; Sanofi. H. Goyeau: Employee; Self; Sanofi. Stock/Shareholder; Self; Sanofi. N. Papanas: None. L. Popescu: Employee; Self; Sanofi. Stock/Shareholder; Self; Sanofi. B. Schultes: Advisory Panel; Self; Novo Nordisk A/S, Sanofi, AstraZeneca, Eli Lilly and Company, Bayer AG, Boehringer Ingelheim GmbH. Speaker's Bureau; Self; Sanofi, Eli Lilly and Company, MSD K.K., Bayer AG, Boehringer Ingelheim GmbH. J. Sieber: Employee; Self; Sanofi. Stock/Shareholder; Self; Sanofi. L. Duvnjak: None.