bluuebunny/crossref_metadata_2025 huggingface dataset:
Mycoplasma pneumoniae infection in a clinical setting
Authors: Othman Norlijah , Isaacs David , Daley Andrew J. , Kesson Alison M.
Published: June 2008

Background: Mycoplasma pneumoniae infection predominantly affects the respiratory tract, although the other organs may also be involved. Previous studies compared the clinical features of patients with M. pneumonia pneumonia to other pathogens and these studies were predominantly adult case series rather than involving children. The objectives of the present study were to compare the clinical features, laboratory, and radiographic findings in children seropositive for M. pneumoniae infection with children tested for suspected M. pneumoniae infection who were seronegative.

Methods: Using a retrospective review of children who had complement fixation test (CFT) performed for suspected M. pneumoniae infection, children were classified as seropositive if the acute phase serum titer was ≥64, or paired samples taken 2–4 weeks apart showed a fourfold or greater rise in serum titer. In contrast, a patient with an antibody titer <64 or with paired sera showing less than a fourfold rise in titer was considered seronegative.

Results: One hundred and fifty‐one children were included. Seventy‐six children had serological evidence of M. pneumoniae infection and the remaining 75 were seronegative. Children with M. pneumoniae infection were more likely to have fever >6 days duration prior to admission, crackles on auscultation, radiographic consolidation and thrombocytosis at presentation. In addition, M. pneumoniae infection was associated with pneumonia whereas seronegative children were more likely to have upper respiratory tract infection or asthma.

Conclusions: Certain clinical parameters could assist in gauging the likelihood of M. pneumoniae infection in children, and thus direct whether antibiotic treatment is needed.
Analysis of temperature distribution near the crack tip under constant amplitude loading
Authors: PANDEY K. N. , CHAND S.
Published: June 2008

An analytical/numerical method has been developed to find the temperature rise near the crack tip under fatigue loading. The cyclic plastic zone ahead of the crack tip is assumed to be the shape of the source of heat generation and some fraction of plastic work done in cyclic plastic zone as heat generation. Plastic work during fatigue load was found by obtaining stress and strain distribution within the plastic zone by Hutchinson, Rice and Rosengren (HRR) crack tip singularity fields applied to small scale yielding on the cyclic stress strain curve. A two‐dimensional conduction heat transfer equation, in moving co‐ordinates, was used to obtain temperature distribution around the crack tip. Temperature rise was found to be a function of frequency of loading, applied stress intensity factor and thermal properties of the material. A power–law relation was found between the rise in temperature at a fixed point near the crack tip and range of stress intensity factor.
Influence of different load models on gear crack path shapes and fatigue lives
Authors: PODRUG S. , JELASKA D. , GLODEŽ S.
Published: June 2008

A computational model for determination of the service life of gears with regard to bending fatigue at gear tooth root is presented. In conventional fatigue models of the gear tooth root, it is usual to approximate actual gear load with a pulsating force acting at the highest point of the single tooth contact. However, in actual gear operation, the magnitude as well as the position of the force changes as the gear rotates. A study to determine the effect of moving gear tooth load on the gear service life is performed. The fatigue process leading to tooth breakage is divided into crack‐initiation and crack‐propagation period. The critical plane damage model has been used to determine the number of stress cycles required for the fatigue crack initiation. The finite‐element method and linear elastic fracture mechanics theories are then used for the further simulation of the fatigue crack growth.
The peak stress method applied to fatigue assessments of steel and aluminium fillet‐welded joints subjected to mode I loading
Authors: MENEGHETTI G.
Published: June 2008

The aim of this work is to present an engineering method based on linear elastic finite element (FE) analyses oriented to fatigue strength assessments of fillet‐welded joints made of steel or aluminium alloys and subjected to mode I loading in the weld toe region where fatigue cracks nucleate. The proposed approach combines the robustness of the notch stress intensity factor approach with the simplicity of the so‐called ‘peak stress method’. Fatigue strength assessments are performed on the basis of (i) a well‐defined elastic peak stress evaluated by FE analyses at the crack initiation point (design stress) and (ii) a unified scatter band (design fatigue curve) dependent on the class of material, i.e. structural steel or aluminium alloys. The elastic peak stress is calculated by using rather coarse meshes with a fixed FE size. A simple rule to calculate the elastic peak stress is also provided if a FE size different from that used in the present work is adopted. The method can be applied to joints having complex geometry by adopting a two‐step analysis procedure that involves standard finite element (FE) models like those usually adopted in an industrial context. The proposed approach is validated against a number of fatigue data published in the literature.
Weibull‐based methodology for condition assessment of cast iron water mains and its application
Authors: BELMONTE H. M. S. , MULHERON M. , SMITH P. A. , HAM A. , WESCOMBE K. , WHITER J.
Published: June 2008

A qualitative and quantitative understanding of how cast iron water distribution pipes fail in service would facilitate a targeted approach to the management of rehabilitation in the water industry. This paper proposes a technique for assessing the condition of pipes, based on strength characteristics obtained from small samples; this offers an alternative way of estimating the likelihood of failure to current methodologies based on pit‐depth measurements.

Examination of recovered pipe samples indicates that the strength of the cast iron pipe reduces over time as a result of corrosion, although other time‐dependent processes, such as fatigue, may also contribute to this degradation. Taken with previous work, this paper suggests that the variation in strength of small samples removed from cast iron water distribution pipes can be characterized using Weibull methods. It is argued that the Weibull modulus provides a useful indicator of the condition of the pipe. Using scaling arguments, inherent in the Weibull methodology, it is then possible to use data from small samples to predict the likely strength characteristics of water distribution pipes in the ground, which is reasoned to be a good measure of the potential performance of the pipe in service. The Weibull approach is applied to a number of different data sets obtained from testing samples extracted from a range of pipes, which have seen service at various locations in the Thames Water region. One of these data sets was from locations where failure had occurred in service. It is shown that the use of Weibull analysis can identify pipes in the network that have degraded the most significantly. A methodology is suggested whereby this information taken with other performance indicators can be used to identify the local regions where rehabilitation is required most urgently. Alternatively, it can be used to identify those regions of the network, which are in good condition and unlikely to need repair or replacement work.
Influence of foreign object damage on fatigue crack growth of gas turbine aerofoils under complex loading conditions
Authors: HALL R. , BYRNE J. , ZHAO T. , TONG J.
Published: June 2008

Foreign object damage (FOD) has been identified as one of the main life limiting factors for aeroengine blades, with the leading edge of aerofoils particularly susceptible. In this work, a generic edge ‘aerofoil’ geometry was utilized in a study of early fatigue crack growth behaviour due to FOD under low cycle fatigue (LCF), high cycle fatigue (HCF) and combined LCF and HCF loading conditions. Residual stresses due to FOD were analyzed using the finite element method. The longitudinal residual stress component along the crack path was introduced as a nodal temperature distribution, and used in the correction of the stress intensity factor range. The crack growth was monitored using a nanodirect current potential drop (DCPD) system and crack growth rates were correlated with the corrected stress intensity factor considering the residual stresses. The results were discussed with regard to the role of residual stresses in the characterization of fatigue crack growth.

 Small crack growth behaviour in FODed specimens was revealed only after the residual stresses were taken into account in the calculation of the stress intensity factor, a feature common to LCF, HCF and combined LCF + HCF loading conditions.
Premedication with melatonin vs midazolam in anxious children
Authors: ISIK BERRIN , BAYGIN ÖZGÜL , BODUR HALUK
Published: June 2008

Aim:  Failure of dental treatment caused by anxiety is a common problem in children. Oral midazolam has been the most commonly used premedication for pediatric patient but the use of midazolam may be associated with paradoxical reactions in children. Melatonin may induce a natural sleepiness and improve sedation. We have investigated premedication with melatonin compared with midazolam in children under nitrous oxide/oxygen (N2O/O2) sedation for dental treatment.

Methods:  In a randomized study, 60 children received either 3 mg of melatonin [Melatonina (3 mg®) 60 min before the procedure (n = 15); group I], 0.5 mg·kg−1 melatonin 60 min before the procedure (n = 15; group II), 0.75 mg·kg−1 midazolam [Dormicum (15 mg/3 ml ®) 15 min before the procedure (n = 15); group III] or 3 ml of 0.09 NaCl 15 min (n = 7) or 60 min before the procedure (n = 8; group IV) orally. The children were sedated with 40/60% N2O/O2 inhalation. The heart rate and O2 saturation were monitored during the treatment period. The level of sedation was assessed according to the Ramsay Sedation Scale. The children’s sedation success during dental treatment was classified. The sedation success and other sedation‐related events recorded. Comparisons among the four groups were made using one‐way anova or Kruskal–Wallis test, and if any significant differences were noted, the Tukey’s HSD or Mann–Whitney U‐test were used for intergroup comparisons. All differences were considered significant at P < 0.05.

Results:  The evaluation of sedation success was as follows: group I: satisfactory (n = 1), average satisfactory (n = 4), and unsatisfactory (n = 10); group II: satisfactory (n = 2), average satisfactory (n = 3), and unsatisfactory (n = 10); group III: satisfactory (n = 9), average satisfactory (n = 6); and group IV: satisfactory (n = 1), average satisfactory (n = 3), and unsatisfactory (n = 11).

Conclusion:  In these doses and clinical conditions, melatonin was similar to that of placebo and did not contribute to N2O/O2 sedation of anxious children.
Gypsy moth mating disruption in open landscapes
Authors: (Tcheslavskaia) Onufrieva Ksenia S. , Thorpe Kevin W. , Hickman Andrea D. , Leonard Donna S. , Mastro Victor C. , Roberts E. Anderson
Published: June 2008

1 Aerial applications of Disrupt II, a plastic laminated flake formulation containing a racemic form of the gypsy moth sex pheromone, disparlure, achieved > 99% reduction of mating among females on individual, isolated trees surrounded by an area cleared of trees.

2 These results support the use of mating disruption to eradicate isolated gypsy moth populations in open landscapes, such as parks, residential areas and commercial settings.

3 Mating success in both treated and untreated areas varied with the initial distance between males and females. When the initial distance between males and females was < 5 cm in an area receiving a dosage of 37.5 g of racemic disparlure per ha, mating success was reduced by 27% compared with a similar deployment in an untreated area. Mating was eliminated in areas treated at the same dosage when males and females were initially deployed 1 m apart but on separate trees.

4 This suggests that mating disruption may not be an effective tactic for gypsy moth eradication in cases where the infestation is concentrated on a small number of trees and males and females are in close proximity in space and time.
The effects of soil tillage on beneficial invertebrates within the vineyard
Authors: Sharley David J. , Hoffmann Ary A. , Thomson Linda J.
Published: June 2008

1 Tillage, commonly used in agroecosystems, can influence the abundance of invertebrates through factors such as habitat change and food availability.

2 The effects of tillage on the composition and abundance of invertebrates were examined in a vineyard near Mildura in Victoria, Australia, focusing particularly on groups that might act as natural enemies in vineyards. We used pitfall traps at ground level and sticky traps in the canopy.

3 The collections were first sorted to order. Beetles (Coleoptera) were sorted to family and ants (Hymenoptera: Formicidae) to genus.

4 Ants were the only group to be affected by tillage when all months were considered. The same genera occurred in both treatments but the abundance of several genera was reduced by tillage. Families of several beetles, including predators, increased in tilled areas. Spider, millipede, centipede and earwig numbers were decreased by tillage. In the canopy, Trichogrammatidae and other parasitoids decreased in abundance after tillage.

5 These results indicate that tillage influences the composition of invertebrates and has the potential to negatively affect the abundance of beneficial groups.
Genetic diversity of the cotton aphid Aphis gossypii in the unstable environment of a cotton growing area
Authors: Brévault T. , Carletto J. , Linderme D. , Vanlerberghe‐Masutti F.
Published: June 2008

1 Spatial and temporal habitat heterogeneity represented by annual crops is a major factor influencing population dynamics of phytophagous insect pests such as the cotton aphid Aphis gossypii Glover. We studied the effects of instability of the cotton agroecosystem resulting from the temporary availability of the plant resource and the repeated use of insecticides on the genetic variability of the cotton aphids.

2 Samples of A. gossypii were collected in cotton plots, treated or not with insecticides and from vegetable crops (Malvaceae, Cucurbitaceae and Solanaceae) within the cotton growing area of northern Cameroon. The genetic structure of the samples was assessed using eight microsatellite markers. Insecticide resistance was estimated through the detection of two mutations in the ace‐1 gene that are associated with insensitivity of acetylcholinesterase to carbamate and organophosphate insecticides.

3 The results obtained show that both host plants and insecticides act in genetic structuring of A. gossypii. Ninety‐three percent of aphids collected on cotton were characterized by the same microsatellite multilocus genotype, Burk1, which also displays the insecticide resistant alleles.

4 During the dry season, the cotton crop season after, the genotype Burk1 was principally found on two other malvaceous cultivated plants, rosella and okra, acting as suitable reservoir plants. The ability of the cotton aphid to move among asynchronous suitable habitats in response to changes in resource availability enables the pest to exploit unstable cropping systems. An understanding of the cotton aphid life system may aid to improve strategies for integrated resistance management.
New methods for the detection of insecticide resistant Myzus persicae in the U.K. suction trap network
Authors: Anstead James A. , Williamson Martin S. , Denholm Ian
Published: June 2008

1 Myzus persicae is a highly polyphagous pest of U.K. agriculture. It presents particular control difficulties because it has developed resistance to several insecticide classes.

2 For almost 20 years, M. persicae collected in the U.K. suction trap network have been analysed for insecticide resistance and the data disseminated to growers via a resistance bulletin. These data are generated by the biochemical analysis of individuals for two major resistance phenotypes: (i) elevated carboxylesterase and (ii) modified acetylcholinesterase (MACE).

3 The development of new polymerase chain reaction (PCR)‐based technologies using fluorescently labelled probes has allowed other resistance mechanisms, such as knockdown resistance to pyrethroids (kdr/super‐kdr), to be detected and has greatly increased the speed and accuracy of resistance monitoring. Unfortunately, these newer PCR‐based assays are incompatible with the older biochemical assays.

4 The present study describes the development and testing of new compatible methods for detecting elevated carboxylesterases and MACE for use on M. persicae caught in the field or suction traps.

5 These new tests have significant advantages over present methodologies by allowing individual aphids to be tested for three resistance mechanisms quickly and accurately on a single platform.
Longitudinal screening of serum lipids in children and adolescents with Type 1 diabetes in a UK clinic population
Authors: Edge J. A. , James T. , Shine B.
Published: June 2008

Aims  To determine the prevalence of abnormal lipid levels in a large group of children and adolescents with Type 1 diabetes and to examine the changes longitudinally. In addition, to study the relationships of any lipid abnormalities to glycaemic control, age and duration of diabetes.

Methods  Non‐fasting blood samples were taken annually from all the patients in the Oxford Children's diabetes clinic and total cholesterol (TC), high‐density lipoprotein (HDL) cholesterol, triglycerides (TG) and glycated haemoglobin (HbA1c) measured over a period of 8 years. Low‐density lipoprotein (LDL) cholesterol and non‐HDL were calculated from these values and compared. Tests performed less than 4 months after diagnosis were excluded.

Results  A total of 229 children had complete data from more than 1 year and 798 sets of data were examined. TC was lower in males and increased with duration of diabetes and with increasing HbA1c. HDL cholesterol fell with increasing age, but independently increased with duration, and was not related to HbA1c. LDL cholesterol and non‐HDL cholesterol were highly correlated (r = 0.9). Both were lower in males and increased with duration of diabetes. Non‐HDL cholesterol increased with HbA1c. A total of 23.7% had HDL cholesterol < 1.1 mmol/l and 22.5% had TC > 5.2 mmol/l. Thirty‐eight per cent had LDL cholesterol > 2.6 mmol/l and 10.8% > 3.4 mmol/l, the thresholds for lifestyle and drug intervention respectively.

Conclusions  Abnormalities in plasma lipid levels are common in this age group and the prevalence increases with poor glycaemic control and with duration of diabetes. Around 10% of adolescents would fit criteria for lipid‐lowering medication in adults, but further study is needed to examine the risks and benefits in this age group.
Variability of lipids in patients with Type 2 diabetes taking statin treatment: implications for target setting
Authors: Sathyapalan T. , Atkin S. L. , Kilpatrick E. S.
Published: June 2008

Aims  To determine the biological variability of lipids in patients with Type 2 diabetes (T2DM) who are on statin treatment and then to assess any implications for current lipid targets.

Methods  A cross‐over study of biological variation of lipids in 26 patients with T2DM taking either simvastatin 40 mg or atorvastatin 10 mg. After 3 months on one statin, fasting lipids were measured on 10 occasions over a 5‐week period. Following 3 months on the other statin, 10 further samples were taken over 5 weeks. The main outcome measures were biological variability of total cholesterol (TC), low‐density lipoprotein (LDL) cholesterol, high‐density lipoprotein (HDL) cholesterol and triglycerides.

Results  The coefficient of variation (CV) of TC, LDL, HDL and triglycerides on simvastatin was 8.17, 13.11, 7.95 and 12.06%, respectively, whereas the CV on atorvastatin was 6.92, 10.30, 5.13 and 19.71%, respectively, with no statistically significant differences between statins. Treating to sustain a target TC < 5.0 mmol/l or LDL < 3.0 mmol/l means needing to maintain a mean TC of 4.3–4.4 mmol/l or LDL of 2.4–2.5 mmol/l. Treating to consistently achieve an LDL < 2.0 mmol/l means aiming for a mean of only 1.5–1.6 mmol/l.

Conclusion  In patients with T2DM taking either simvastatin or atorvastatin, the mean TC and LDL concentrations needed to consistently remain below a target are much lower than the target value itself. This means that guideline target limits extrapolated from the mean values of patients participating in clinical studies may overestimate the lipid reductions required.
Glycaemic control and diabetes care utilization in young adults with Type 1 diabetes1
Authors: Sparud‐Lundin C. , Öhrn I. , Danielson E. , Forsander G.
Published: June 2008

Objectives  To explore how glycaemic control in young adults is related to diabetes care utilization during the transition to adult diabetes care and if these variables differ between males and females.

Methods  This is a retrospective, longitudinal design following patients’ records from age 18–24 years. Adolescents (n = 104) connected to one paediatric outpatient clinic and referred to six different adult clinics were included. Data were collected regarding gender, age at diagnosis and transfer, yearly glycated haemoglobin (HbA1c) and body mass index, severe hypoglycaemia and diabetic ketoacidosis, retinopathy and diabetes care utilization.

Results  HbA1c decreased over time in females (P = 0.004) but not in males. Less than 10% had HbA1c in the recommended range during the study period. The decrease in severe hypoglycaemia and diabetic ketoacidosis was not significant. The prevalence of background retinopathy increased from 5 to 29% during the study period (P < 0.001). Mean transfer age was 19.8 years. The youths visited the paediatric clinic more often than the adult clinic (P < 0.001) and females visited adult care more often than males (P = 0.04). There was a steady decrease in the number of visits/year over time (P < 0. 001). Poor glycaemic control was associated with more visits for both males and females (P = 0.005) in adult care.

Conclusions  As there was no gender difference in the relation between HbA1c and the number of visits in adult diabetes care, the higher frequency of visits in adult care for females cannot be solely explained by their glycaemic control. Gender differences regarding diabetes care utilization should be further explored.
A comparison of diabetes clinics with different emphasis on routine care, complications assessment and shared care
Authors: Cheung N. W. , Yue D. K. , Kotowicz M. A. , Jones P. A. , Flack J. R. ,   on behalf of the Australian National Association of Diabetes Centres (a collaboration of the Australian Diabetes Society,   Australian Diabetes Educators Association)
Published: June 2008

Objective  To compare clinical outcomes of patients attending diabetes clinics with different models of care.

Methods   Diabetes centres which participated in the Australian National Diabetes Information Audit and Benchmarking (ANDIAB) data collection were invited to nominate whether they provided (i) routine diabetes care only (model A), (ii) routine care and structured annual complications screening (model B) or (iii) annual review and complications screening in a system of shared care with general practitioners (model C). De‐identified case data were extracted from ANDIAB and outcomes according to the three clinic models were compared.

Results  Data on 3052 patients from 18 diabetes centres were analysed. Centres which practised annual complications screening (models B and C) had higher rates of nephropathy and lipid screening and a higher rate of attainment of recommended blood pressure and glycated haemoglobin (HbA1c) targets. The implementation of appropriate treatment for patients who had not attained the targets was similar for all three clinic models.

Conclusions  In our study, clinic models which incorporate a system of structured complications screening were more likely to have met screening guidelines. Patients in a shared‐care model were at least as likely to have met management targets as those attending diabetes clinics for their routine care. Therefore, a system of shared care by general practitioners supported by annual review at a diabetes clinic may be an acceptable model which improves the capacity to manage large numbers of people with diabetes, without loss of quality of care.
Prevalence and projections of diabetes and pre‐diabetes in adults in Sri Lanka—Sri Lanka Diabetes, Cardiovascular Study (SLDCS)
Authors: Katulanda P. , Constantine G. R. , Mahesh J. G. , Sheriff R. , Seneviratne R. D. A. , Wijeratne S. , Wijesuriya M. , McCarthy M. I. , Adler A. I. , Matthews D. R.
Published: June 2008

Aims  To determine the prevalence of diabetes mellitus and pre‐diabetes (impaired fasting glucose and impaired glucose tolerance) in adults in Sri Lanka. Projections for the year 2030 and factors associated with diabetes and pre‐diabetes are also presented.

Methods  This cross‐sectional study was conducted between 2005 and 2006. A nationally representative sample of 5000 adults aged ≥ 18 years was selected by a multi‐stage random cluster sampling technique. Fasting plasma glucose was tested in all participants and a 75‐g oral glucose tolerance test was performed in non‐diabetic subjects. Prevalence was estimated for those > 20 years of age.

Results  Response rate was 91% (n = 4532), males 40%, age 46.1 ± 15.1 years (mean ± standard deviation). The age–sex standardized prevalence (95% confidence interval) of diabetes for Sri Lankans aged ≥ 20 years was 10.3% (9.4–11.2%) [males 9.8% (8.4–11.2%), females 10.9% (9.7–12.1%), P = 0.129). Thirty‐six per cent (31.9–40.1%) of all diabetic subjects were previously undiagnosed. Diabetes prevalence was higher in the urban population compared with rural [16.4% (13.8–19.0%) vs. 8.7% (7.8–9.6%); P < 0.001]. The prevalence of overall, urban and rural pre‐diabetes was 11.5% (10.5–12.5%), 13.6% (11.2–16.0%) and 11.0% (10.0–12.0%), respectively. Overall, 21.8% (20.5–23.1%) had some form of dysglycaemia. The projected diabetes prevalence for the year 2030 is 13.9%. Those with diabetes and pre‐diabetes compared with normal glucose tolerance were older, physically inactive, frequently lived in urban areas and had a family history of diabetes. They had higher body mass index, waist circumference, waist–hip ratio, systolic/diastolic blood pressure, low‐density lipoprotein cholesterol and triglycerides. Insulin was prescribed to 4.4% (2.7–6.1%) of all diabetic subjects.

Conclusions  One in five adults in Sri Lanka has either diabetes or pre‐diabetes and one‐third of those with diabetes are undiagnosed.
Plasma triglycerides and LDL cholesterol are related in a parabolic fashion in the general population and patients with Type 2 diabetes mellitus: long‐term follow‐up results from the Hoorn study
Authors: Brouwers M. C. G. J. , Dekker J. M. , Van Greevenbroek M. M. J. , Van Der Kallen C. J. H. , Heine R. J. , De Bruin T. W. A. , Stehouwer C. D. A.
Published: June 2008

Aims  Low‐density lipoprotein cholesterol (LDL‐C) levels are often fairly normal in Type 2 diabetes mellitus (DM). We anticipated that a parabolic relation between plasma triglycerides and LDL‐C, as previously demonstrated in familial combined hyperlipidaemia (FCHL), might account for this phenomenon.

Methods  Our hypothesis was tested in 1343 subjects derived from the general population who were studied on two occasions 6 years apart (the Hoorn study). Three groups were constructed depending on plasma triglycerides: group A (individuals with both measurements below 1.5 mmol/l), group B (one measurement below and one above 1.5 mmol/l) and group C (both measurements above 1.5 mmol/l). Diabetes status was ascertained by an oral glucose tolerance test.

Results  In a mixed linear model, a significant, positive relation between triglycerides and LDL‐C was observed for males in group A (βa = 0.5, P < 0.001) and group B (βb = 0.2, P < 0.001), whereas a significant negative relation was found for males in group C (βc = −0.2, P = 0.003). The regression slopes did not differ between diabetic and non‐diabetic subjects. Similar results were obtained for women, with the exception that the relation was not significantly negative in group C (βc = −0.1, P = 0.4).

Conclusion  Plasma triglcyerides and LDL‐C are related in a parabolic fashion, not only in FCHL, but also in the general population and Type 2 DM. These findings aid our interpretation of typical dyslipidaemia and the effects of treatment that are frequently observed in hypertriglyceridaemic states.
Childhood body mass index (BMI), breastfeeding and risk of Type 1 diabetes: findings from a longitudinal national birth cohort
Authors: Viner R. M. , Hindmarsh P. C. , Taylor B. , Cole T. J.
Published: June 2008

Aims  To perform a longitudinal analysis of the association between childhood body mass index (BMI) and later risk of Type 1 diabetes, controlling for socio‐economic status, birthweight, height in early and late childhood, breastfeeding history and pubertal status.

Methods  Analysis of the 1970 British Birth Cohort, followed up at age 5, 10 and 30 years (n = 11 261). Data were available on birthweight, breastfeeding; height, weight, pubertal status, socio‐economic status at age 10 years; self‐report data on history of diabetes (type, age at onset) at age 30 years. Cox proportional hazards models were used to examine relations of childhood growth, socio‐economic status and breastfeeding history to the incidence of Type 1 diabetes between 10 and 30 years of age.

Results  Sixty‐one subjects (0.5%) reported Type 1 diabetes at 30 years of age; 47 (77%) reported onset ≥ age 10 years. Higher BMI z‐score at 10 years predicted higher risk of subsequent Type 1 diabetes (hazard ratio 1.8, 95% confidence interval 1.2 to 2.8, P = 0.01) when adjusted for birthweight, pubertal status, breastfeeding history and socio‐economic status. Repeating the model for childhood obesity, the hazard ratio was 3.1 (1.0, 9.3; P = 0.05). Birthweight, breastfeeding, height growth and pubertal timing were not associated with incidence of Type 1 diabetes.

Conclusions  Higher BMI in childhood independently increased the risk of later Type 1 diabetes, supporting suggestions that obesity may provide a link between Type 1 and Type 2 diabetes. This supports observations of a rise in Type 1 diabetes prevalence. Reduction in childhood obesity may reduce the incidence of Type 1 as well as Type 2 diabetes.
Point‐of‐care testing as a tool for screening for diabetes and pre‐diabetes
Authors: Rush E. , Crook N. , Simmons D.
Published: June 2008

Aim  To determine the utility of finger‐prick point‐of‐care testing (POCT) of blood glucose for the detection of dysglycaemia.

Methods  A fasting POCT and an oral glucose tolerance test (OGTT) with laboratory assays were performed as part of the baseline screening for 5309 participants enrolled in the Te Wai o Rona Diabetes Prevention Strategy. Participants were aged 46 ± 19 years with no self‐reported diabetes. Dysglycaemia, including diabetes, was defined using World Health Organization criteria. Agreement between the two fasting plasma glucose measurements and their screening properties (with sensitivity and specificity for cut points) were compared using receiver operator characteristic analysis.

Results  A total of 3225 participants had both capillary and venous fasting blood sampled within 30 min and then underwent OGTT. New diabetes was found in 161 participants (5.0%) and pre‐diabetes in 414 [impaired glucose tolerance 299 (9.3%), impaired fasting glucose 115 (3.6%)]. The mean difference in capillary and venous measures was 0.02 mmol/l (95% confidence interval −0.04 to +0.01; limits of agreement –1.37 to 1.33 mmol/l). Capillary POCT was a poorer predictor of dysglycaemia and impaired glucose tolerance and new diabetes (area under curve 0.76 and 0.71) than venous laboratory analysis (area under curve 0.87 and 0.81 respectively). Optimal screening criteria were best at a venous glucose of 5.4 mmol/l; 77% sensitivity/specificity.

Conclusions  POCT significantly underestimated the true blood glucose at diagnostic levels for diabetes. POCT cannot be recommended as a means of screening for or diagnosing diabetes or pre‐diabetes.
The personal cost of diabetic foot disease in the developing world—a study from Pakistan
Authors: Ali S. M. , Fareed A. , Humail S. M. , Basit A. , Ahmedani M. Y. , Fawwad A. , Miyan Z.
Published: June 2008

Aims  The aim of the present study was to estimate the direct cost of treatment of diabetic foot ulcer at a tertiary care hospital in Karachi, Pakistan in order to assess the extent of the economic burden which it imposes.

Methods  Out of 383 patients seen at Foot clinic of Baqai Institute of Diabetology and Endocrinology (BIDE), records of 214 patients were analyzed while 169 patients left against medical advice (LAMA). The UT system was used to classify ulcer types. Information was retrieved on resource consumption (physician services, chiropody, investigations, medicines, hospital care and surgical procedures). Interventions were summed and multiplied by the unit price of each resource, using charges levied at BIDE in the year 2005, in order to calculate the total cost of treatment.

Results  64% were male, with mean age 52.7 ± 10.2 years. Mean duration of diabetes was 16.2 ± 6.6 years. Majority (62.1%) were Grade 2 ulcer. The estimated direct cost of management increased from 2700 ± 250 rupees (£21 ± 2) for a UT grade 1, stage B ulcer to 37 415 ± 24 125 rupees (£288 ± 186) for UT grade 2, stage D and 49 058 ± 30 144 rupees (£378 ± 232) for UT grade 3, stage D ulcers, respectively. The mean direct cost of major amputation (transtibial or transfemoral) was 46 182 ± 30 742 (£356 ± 237) whilst the cost of a minor amputation was 50 494 ± 30 488 rupees (£389 ± 235).

Conclusions  This retrospective study, despite having limitations, is important for a developing world country with limited data on health economics. Further larger scale prospective studies are needed to address this issue in more detail.
NICE guidance on diabetes in pregnancy: management of diabetes and its complications from preconception to the postnatal period. NICE clinical guideline 63. London, March 2008
Authors: Walker J. D.
Published: June 2008

The care of pregnant women with disorders of glucose metabolism is a satisfying part of diabetes care but outcomes remain less than ideal. The evidence base to improve care has grown over subsequent decades and clinicians will welcome up‐to‐date NICE guidance on this topic. This review looks at the guidance from the perspective of a secondary care diabetes team.
A longitudinal study of affective and anxiety disorders, depressive affect and diabetes distress in adults with Type 2 diabetes
Authors: Fisher L. , Skaff M. M. , Mullan J. T. , Arean P. , Glasgow R. , Masharani U.
Published: June 2008

Aims  To report the prevalence and correlates of affective and anxiety disorders, depressive affect and diabetes distress over time.

Methods  In a non‐interventional study, 506 patients with Type 2 diabetes were assessed three times over 18 months (9‐month intervals) for: major depressive disorder (MDD), general anxiety disorder (GAD), panic disorder (PANIC), dysthymia (DYS) (Composite International Diagnostic Interview); depressive affect [Center for Epidemiological Studies–Depression (CES‐D)]; Diabetes Distress Scale (DDS); HbA1c; and demographic data.

Results  Diabetic patients displayed high rates of affective and anxiety disorders over time, relative to community adults: 60% higher for MDD, 123% for GAD, 85% for PANIC, 7% for DYS. The prevalence of depressive affect and distress was 60–737% higher than of affective and anxiety disorders. The prevalence of individual patients with an affective and anxiety disorder over 18 months was double the rate assessed at any single wave. The increase for CES‐D and DDS was about 60%. Persistence of CES‐D and DDS disorders over time was significantly greater than persistence of affective and anxiety disorders, which tended to be episodic. Younger age, female gender and high comorbidities were related to persistence of all conditions over time. HbA1c was positively related to CES‐D and DDS, but not to affective and anxiety disorders over time.

Conclusions  The high prevalence of comorbid disorders and the persistence of depressive affect and diabetes distress over time highlight the need for both repeated mental health and diabetes distress screening at each patient contact, not just periodically, particularly for younger adults, women and those with complications/comorbidities.
Hypertriglyceridaemia is associated with an increased likelihood of albuminuria in extreme duration (> 50 years) Type 1 diabetes
Authors: Daousi C. , Bain S. C. , Barnett A. H. , Gill G. V.
Published: June 2008

Aims  To explore the association between dyslipidaemia and albuminuria at the extreme of diabetes duration.

Methods  Data and samples were collected from 400 patients with extreme duration (> 50 years) of Type 1 diabetes in the UK (Golden Years Cohort). Urinary albumin–creatinine ratio (ACR), glycated haemoglobin (HbA1c), creatinine, non‐fasting triglycerides, total cholesterol, high‐density lipoprotein‐ and low‐density lipoprotein‐cholesterol were analysed in all patients.

Results  Thirty‐six percent of patients had albuminuria (micro‐ or macroalbuminuria). After adjusting for age, gender, HbA1c, disease duration and presence of macrovascular disease, hypertriglyceridaemia was more likely to be associated with the presence of albuminuria.

Conclusions  High triglycerides may be a potential risk factor for progression of diabetic nephropathy at the extreme of diabetes duration, but the benefit of targeting this aggressively remains to be evaluated further.
Symptoms of depression prospectively predict poorer self‐care in patients with Type 2 diabetes
Authors: Gonzalez J. S. , Safren S. A. , Delahanty L. M. , Cagliero E. , Wexler D. J. , Meigs J. B. , Grant R. W.
Published: June 2008

Aims  To examine prospectively the association of depression symptoms with subsequent self‐care and medication adherence in patients with Type 2 diabetes mellitus.

Methods  Two hundred and eight primary care patients with Type 2 diabetes completed the Harvard Department of Psychiatry/National Depression Screening Day Scale (HANDS) and the Summary of Diabetes Self‐Care Activities (SDSCA) at baseline and at follow‐up, an average of 9 months later. They also self‐reported medication adherence at baseline and at a follow‐up.

Results  Baseline HANDS scores ranged from 0 to 27, with a mean score of 5.15 ± 4.99. In separate linear regression models that adjusted for baseline self‐care, patients with higher levels of depressive symptoms at baseline reported significantly lower adherence to general diet recommendations and specific recommendations for consumption of fruits and vegetables and spacing of carbohydrates; less exercise; and poorer foot care at follow‐up (β ranging from −0.12 to −0.23; P < 0.05). Similarly, each one‐point increase in baseline HANDS score was associated with a 1.08‐fold increase in the odds of non‐adherence to prescribed medication at follow‐up (95% confidence interval 1.001, 1.158, P = 0.047). Increases in depression scores over time also predicted poorer adherence to aspects of diet and exercise.

Conclusions  Depressive symptoms predict subsequent non‐adherence to important aspects of self‐care in patients with Type 2 diabetes, even after controlling for baseline self‐care. Although the relationship between symptoms of depression and poorer diabetes self‐care is consistent, it is not large, and interventions may need to address depression and self‐care skills simultaneously in order to maximize effects on diabetes outcomes.
Renal failure and rhabdomyolysis associated with sitagliptin and simvastatin use
Authors: Kao D. P. , Kohrt H. E. , Kugler J.
Published: June 2008

Background  Sitagliptin is a new oral glucose‐lowering medication that acts via the incretin hormone system. The most common side‐effects are headache and pharyngitis, and few serious adverse events were observed during clinical trials. Dose adjustment is recommended in renal insufficiency, but long‐term safety experience is limited.

Case report  We present a patient with chronic renal insufficiency who developed leg pain, weakness and tenderness after starting treatment with high‐dose sitagliptin while on simvastatin. The patient had acute renal failure and rhabdomyolysis that resolved with cessation of sitagliptin, simvastatin, ezetimibe, diuretics and olmesartan. All drugs except sitagliptin, ezetimibe and simvastatin were resumed, and the patient was subsequently started on lovastatin without recurrence of rhabdomyolysis.

Conclusions  High doses of sitagliptin may have worsened this patient's renal failure and precipitated rhabdomyolysis by increasing circulating levels of simvastatin. Given the high likelihood that sitagliptin will be co‐administered with statins and renally active medications, further study of long‐term safety of sitagliptin in renal sufficiency may be warranted.
Combined association of maternal and paternal family history of diabetes with plasma leptin and adiponectin in overweight Hispanic children
Authors: Koebnick C. , Kelly L. A. , Lane C. J. , Roberts C. K. , Shaibi G. Q. , Toledo‐Corral C. M. , Davis J. N. , Weigensberg M. J. , Goran M. I.
Published: June 2008

Aims  To investigate the importance of a maternal and paternal family history of Type 2 diabetes and their combined association with plasma leptin and adiponectin levels in overweight Latino children with a family history of Type 2 diabetes (T2DM).

Methods  This cross‐sectional study investigated the combined association of a maternal and paternal family history of T2DM with leptin and adiponectin in 175 overweight Latino children (age 11.1 ± 1.7 years). All subjects had a family history of T2DM. Plasma adiponectin and leptin levels, body fat measured by dual‐energy X‐ray absorptiometry, Tanner stage, age and insulin sensitivity were assessed.

Results  After adjustment for age, gestational diabetes, insulin sensitivity and body fat, a combined maternal and paternal family history of T2DM was associated with higher leptin concentrations (P = 0.004) compared with a maternal or paternal family history alone. This association was most pronounced at Tanner stage 1 (P for interaction family history × tanner stage = 0.022). The presence of a combined maternal and paternal family history of T2DM accounted for 4% (P = 0.003) of the variation in leptin concentrations. No such combined association was observed for adiponectin levels.

Conclusions  Maternal and paternal family history of T2DM may have an additive impact on leptin, but not on adiponectin levels independent of adiposity and insulin sensitivity in overweight Latino children. This may contribute to a further clinically relevant deterioration of metabolic health in this population.
The role of theory‐constitutive metaphor in nursing science
Authors: Greenwood Jennifer , Bonner Ann
Published: June 2008

Abstract  The current view of theoretical statements in science is that they should be literal and precise; ambiguous and metaphorical statements are useful only as pre‐theoretical, exegetical, and heuristic devices and as pedagogical tools. In this paper we argue that this view is mistaken. Literal, precise statements apply to those experiential phenomena which can be defined either conventionally by criterial attribution or by internal atomic constitution. Experiential phenomena which are defined relationally and/or functionally, like nursing, in virtue of their nature, require metaphorical description and explanation. In such cases, metaphor is theory‐constitutive. Using insights from the philosophies of language and mind, and examples from nursing practice, education, and our own empirical research, we explore the nature of metaphor and its role in theory constitution. We argue that the apparent resistance of certain experiential phenomena to literal description and explanation is not necessarily indicative of pre‐theoretic linguistic imprecision. We suggest, rather, that such resistance provides useful insights into the nature of such experiential phenomena. We also suggest that the aim of scientific theory should be methodological or epistemological precision and not merely linguistic precision.
Occupational distress in nursing: a psychoanalytic reading of the literature
Authors: Evans Alicia M. , Pereira David A. , Parker Judith M.
Published: June 2008

Abstract  Occupational stress in nursing has attracted considerable attention as a focus for research and as a consequence multiple objects of nurses' stress, or ‘stressors’, have been identified. This paper puts into question the dominant conceptual and methodological approach to occupational stress in nursing research by both foregrounding the notion of anxiety and juxtaposing it with the notion of ‘stress’. It is argued that the notion of ‘stress’ and the domination of the questionnaire have produced a narrow reading of the topic. Some of the literature on occupational stress/anxiety in nursing is reviewed and our analysis illustrates how the identified objects of stress have a tendency to multiply contingent on the number of studies undertaken. Thus definitive objects of nurses' stress remain elusive. We argue that a return to the notion of ‘anxiety’ and methodological approaches other than empirical ones can bring both depth and breadth to the consideration of occupational distress in nursing. Further, we argue that the object of ‘anxiety’ is unconscious, thus unknown, and given this, a more informative approach is to map nurses' response to anxiety, the discursive formations arising out of anxiety, rather than attempt to define those objects of anxiety.
Critical realism: a philosophical framework for the study of gender and mental health
Authors: Bergin Michael , Wells John S. G. , Owen Sara
Published: June 2008

Abstract  This paper explores gender and mental health with particular reference to the emerging philosophical field of critical realism. This philosophy suggests a shared ontology and epistemology for the natural and social sciences. Until recently, most of the debate surrounding gender and mental health has been guided either implicitly or explicitly within a positivist or constructivist philosophy. With this in mind, key areas of critical realism are explored in relation to gender and mental health, and contrasted with the positions of positivism and constructivism. It is argued that critical realism offers an alternative philosophical framework for the exploration of gender issues within mental health care.
Photo methods for qualitative research in nursing: an ontological and epistemological perspective
Authors: Hansen‐Ketchum Patricia , Myrick Florence
Published: June 2008

Abstract The use of photo research methods is influenced by underlying ontological and epistemological assumptions. Variant assumptions about reality and knowledge converge to conceive a relationship between the knower and what can be known. These assumptions provide the rationale for decided ways of engaging participants in the process of scientific inquiry. In this paper, we examine how perspectives of realism and relativism may shape epistemological understandings and influence type and use of photo methods in qualitative research. Based on deliberations about underlying ontological and epistemological assumptions and related strengths and challenges of photo methods, we assert that photo methods contribute to the development of knowledge that both matters to participants and informs nursing practice.