bluuebunny/crossref_metadata_2025 huggingface dataset:
Monsoon-Frontal Interactions Drive Cyclone Biparjoy's Wake Recovery in the Arabian Sea
Authors: Kerhalkar Siddhant , Kannad Ankitha , Kinsella Alex , Tandon Amit , Sprintall Janet , Lee Craig M.
Published: October 2024

Cold wakes generated by cyclones enhance productivity and impact the
local air-sea interaction, paths and intensities of subsequent storms in
the region. However, in-situ observations of the recovery across such
wakes are rare. A cold wake in the Arabian Sea was surveyed using
multiple ship-board instruments approximately 10 days after the passage
of Cyclone Biparjoy in 2023. The wake, nearly 30
\unit{\km} wide, had a stronger (weaker)
buoyancy gradient at its eastern (western) edge and assumed a upfront
(downfront) orientation relative to the south-westerly monsoon winds.
This resulted in notable asymmetry in vertical temperature, salinity and
velocity structures at the edges of the wake. While the wake recovery
following a cyclone is often attributed to one-dimensional diurnal
heating and cooling process, these observations underscore the role of
coupling of monsoon winds and the underlying three-dimensional
submesoscale fronts in speeding the recovery of a slow-moving cyclone
through various submesocale processes.
Computerised Record Keeping System in Small and Medium Scale Enterprise
Authors:   aFormer Vice Chancellor, Koforidua Technical University, Koforidua, Ghana bFormer Computer Science Lecturer, Koforidua Technical University, Ghana cManaging Partner, Technobeacon Consulting Limited, UK dPrincipal Consultant, Werrys Limited, UK, Dzisi Smile , Egho-Promise Ehigiator , Ola Bamidele , Uche Airhihen Ewere
Published: October 2024

The significant role of Small and Medium Enterprises (SMEs) in various economies especially the developing ones have been highly established. These SMEs have been identified as the medium through which development and rapid industrialization of these economies can be achieved. The manual record-keeping system for processing of products bought and sold has been recognized as one of the most common challenge faced by SMEs. The manual record-keeping system of sales transactions of SMEs and seeks to address it by designing and developing an automated system. This is a case study on Big Donfica Investment Ghana Limited (BDIGL), a Small and Medium Enterprise located in Tamale, Northern region of Ghana. Data was collected using interview and the agile methodology model was used to develop the automated record-keeping system. The results of the study indicated that the automated system provides accurate and consistent details of sales transactions, it produces electronics receipts, sends real time sales transactions messages of all goods sold and login notifications to mobile phones. The study therefore recommends an automated record-keeping system for SMEs in their sales transactions. Further research on automated SMEs marketing is recommended. Keywords: Enterprises, SMEs, Sales transactions, Economies, Record keeping Journal Reference Format: Smile Dzisi, Ehigiator Egho-Promise, Bamidele Ola & Ewere Uche Airhihen (2022): Computerised Record Keeping System In Small and Medium Scale Enterprise. Journal of Behavioural Informatics, Digital Humanities and Development Research. Vol. 8. No.4 Pp 45—62. Available online at https://www.isteams.net/behavioralinformaticsjournal. dx.doi.org/10.22624/AIMS/BHI/V8N4P6xx
Uwarunkowania spożycia produktów mleczarskich
Authors: Chudzian Joanna
Published: October 2024

W artykule zaprezentowano dane na temat spożycia produktów mleczarskich z podziałem na kategorie produktowe. Dokonano także analizy czynników kształtujących spożycie produktów mleczarskich z uwzględnieniem charakterystyki konsumentów zidentyfikowanych na podstawie badań własnych. Artykuł kończy podsumowanie ze wskazaniem kierunków działań dla przedsiębiorstw z branży mleczarskiej.
EURO 2012 wyzwaniem organizacyjnym dla Polski
Authors: Postuła Marta
Published: October 2024

Program przygotowań do przeprowadzenia w Polsce Mistrzostw Europy w piłce nożnej w 2012 r. jest od kilku lat strategicznym przedsięwzięciem. Na proces ten składają się dwa zasadnicze zagadnienia: przygotowanie infrastruktury warunkującej przeprowadzenie turnieju oraz stworzenie odpowiedniej organizacji pozwalającej na maksymalnie sprawne przeprowadzenie tak dużej i długiej imprezy masowej. Należy podkreślić, że wszystkie elementy przygotowań do turnieju wymagają zastosowania możliwie nowoczesnych i wydajnych metod zarządzania. Efektywna realizacja zadań w aspekcie organizacyjnym w tym przypadku nie będzie jednorazowym działaniem w sytuacji awaryjnej, czy też nadzwyczajnej. Zmiana kulturowa (jeśli się dokona) może oznaczać, że polskie instytucje funkcjonują skutecznie w nowoczesnym środowisku zarządczym.
Nowe ramy strategiczne dla polityki rozwoju obszarów wiejskich w latach 2014-2020
Authors: Chlebicka Aleksandra , Litwiniuk Przemysław
Published: October 2024

Trwają prace nad przygotowaniem ostatecznego kształtu regulacji dotyczących polityk europejskich w nowej perspektywie finansowej Unii Europejskiej na lata 2014- 2020. Komisja Europejska przedstawiła między innymi propozycję nowego instrumentu koordynacji polityk, tzw. Wspólnych Ram Strategicznych (Common Strategic Framework), które miałyby przyczynić się do lepszej integracji wertykalnej i horyzontalnej polityk europejskich, w tym polityk wspierających rozwój obszarów wiejskich. Celem artykułu było przedstawienie ewolucji struktury finansowania rozwoju obszarów wiejskich oraz architektury Wspólnych Ram Strategicznych i skutków ich wprowadzenia dla programowania drugiego filara Wspólnej Polityki Rolnej.
Początki Wspólnej Polityki Rolnej w EWG
Authors: Czykier-Wierzba Dorota
Published: October 2024

Na mocy Traktatu Rzymskiego ustanowiona została Wspólna Polityka Rolna (WPR). W Traktacie określone zostały jej cele i zasady. W trakcie tworzenia WPR dokonano jej podziału na: politykę rynkową i strukturalną. Źródłami finansowania tej polityki były fundusze: EFOGR, EFS i EFRR. W wyniku konsekwentnie prowadzonej WPR poprawie uległa w EWG struktura agrarna, zmalało zatrudnienie w rolnictwie, wzrosła produkcja rolna i jej intensywność, zapewniona została także samowystarczalność EWG w zakresie większości artykułów żywnościowych. Wraz jednak ze wzrostem produkcji rolnej powiększały się w magazynach zapasy, których eksport warunkowany był wydatkowaniem z budżetu EWG coraz większych kwot na subsydia. W konsekwencji w szybkim tempie zaczęły wzrastać wydatki z budżetu na finansowanie tej polityki. Niezbędna stała się reforma WPR, którą wdrożono w 1986 roku. Wprowadzone modyfikacje WPR nie przyniosły jednak spodziewanych rezultatów. Od tego czasu polityka ta była jeszcze kilkakrotnie reformowana.
Wspieranie innowacyjności we Wspólnej Polityce Rolnej
Authors: Chlebicka Aleksandra , Gejbowicz Edmund
Published: October 2024

Zgodnie z dokumentami strategicznymi Unii Europejskiej podstawą zrównoważonego i inteligentnego wzrostu gospodarczego ma być innowacyjność. W związku z tym, w nowej perspektywie finansowej Unii Europejskiej 2014-2020, innowacyjność promuje się poprzez nowe działania i dodatkowe finansowanie. W artykule dokonano analizy krytycznej obecnie funkcjonujących i planowanych działań w ramach Wspólnej Polityki Rolnej wspierających innowacyjność.
Jakość życia mieszkańców wsi w wybranych regionach Polski
Authors: Gotowska Małgorzata , Jakubczak Anna
Published: October 2024

Problemem badawczym opracowania była jakość życia mieszkańców obszarów wiejskich. Jako, że obszary te, szczególnie po okresie intensywnych zmian systemowych, które trwają do dnia dzisiejszego, przeszły wiele bardzo głębokich przeobrażeń obejmujących zarówno sferę gospodarczą jak i społeczną, obserwuje się liczne następstwa w odniesieniu do poziomu jak i jakości życia mieszkańców wsi. Są to obszary stale monitorowane i objęte wsparciem Państwa i Unii Europejskiej dlatego istotne jest poznanie efektów dotychczasowych działań na rzecz poprawy warunków i jakości życia ich mieszkańców. Analizą objęto ludność wiejską z trzech celowo wybranych województw, które reprezentowały różny poziom życia. W badaniach empirycznych posłużono się metodą CATI, wybór respondentów był celowo-losowy. Podstawowymi kryteriami doboru ankietowanych był wiek, wykształcenie, miejsce zamieszkania. Przeprowadzona analiza poczucia jakości życia mieszkańców obszarów wiejskich w połączeniu z poziomem życia umożliwiła ustalenie występowania zróżnicowania jakości życia. Określono sfery życia, z których mieszkańcy wsi są najmniej zadowoleni. Ustalono, że poziom zadowolenia z jakości życia jest różny w zakresie terytorialnym.
Perspektywy rozwoju rodzinnych gospodarstw rolnych w Polsce Wschodniej
Authors: Grużewska Agata , Niedziółka Małgorzata
Published: October 2024

W porównaniu z rozwiniętymi gospodarczo państwami Europy Zachodniej, Polska jest krajem o znacznym potencjale produkcyjnym rolnictwa. Jednocześnie różnorodność warunków przyrodniczych i ekonomiczno-organizacyjnych powoduje, że stopień wykorzystania tego potencjału był do tej pory zróżnicowany regionalnie. Szacuje się, że środki unijne współfinansujące liczne przedsięwzięcia miały istotne znaczenie dla łagodzenia skutków spowolnienia gospodarczego w Polsce i niemal w połowie przyczyniły się do osiągniętego w 2009 roku tempa wzrostu. W obszarze związanym z rozwojem rolnictwa dominowały projekty związane z inwestycjami w modernizację rodzinnych gospodarstw rolnych. Celem pracy było określenie perspektyw rozwoju rodzinnych gospodarstw rolnych na terenie Polski Wschodniej.
Przemiany w polskim przemyśle cukrowniczym na tle reform regulacji rynku cukru w Unii Europejskiej
Authors: Judzińska Agnieszka
Published: October 2024

Celem opracowania była próba oceny wpływu reformy rynku cukru w UE na polski przemysł cukrowniczy. Analizę przeprowadzono w oparciu o dane statystyczne dotyczących sektora cukrowniczego w odniesieniu do produkcji, handlu, efektywności i wyników finansowych. Reforma WPR wywarła zarówno pozytywny jak i negatywny wpływ na polski przemysł cukrowniczy. Korzystnym aspektem była modernizacja i koncentracja sektora, jak również poprawa jego efektywności i sytuacji ekonomicznofinansowej. W 2011 roku zysk netto branży cukrowniczej zwiększył się do 1,3 mld zł, a rentowność netto wyniosła blisko 20%. Negatywne skutki dotyczą głownie regulacji rynkowych, w szczególności spadku produkcji oraz pogorszenia salda wymiany handlowej, co przyczyniło się do zmniejszenia dochodowości sektora i osłabienia jego konkurencyjności na rynkach zagranicznych. W 2009 i 2011 roku Polska była importerem netto cukru. Ujemne saldo obrotów wyniosło odpowiednio 56 i 24 tys. ton.
Wspólna Polityka Rolna wobec wyzwań rolnictwa na Dolnym Śląsku
Authors: Berbeka Tomasz , Kutkowska Barbara
Published: October 2024

W opracowaniu przedstawiono ocenę udziału rolnictwa dolnośląskiego w absorpcji środków finansowych przeznaczanych dla gospodarstw rolnych. Dokonano także próby określenia miejsca woj. dolnośląskiego w skali kraju. Dla rolnictwa dolnośląskiego największe znacznie miały takie instrumenty jak: dopłaty bezpośrednie oraz wsparcie terenów ONW, programy rolnośrodowiskowe oraz renty strukturalne. Po roku 2007 także instrumenty wsparcia grup producentów rolnych, modernizację gospodarstw rolniczych oraz działania na rzecz poprawy infrastruktury rolniczej i leśnej. Obecny kształt wsparcia finansowego kierowanego dla gospodarstw rolnych umacnia w regionie przede wszystkim gospodarstwa większe obszarowo o roślinnym profilu produkcji. Instrumenty WPR nie przyczyniły się do oczekiwanego rozwoju produkcji zwierzęcej w województwie, nie udało się również stworzyć odpowiedniej bazy przetwórczej w sektorze rolno- -spożywczym. Działania z zakresu rent strukturalnych oraz jednorazowej premii dla młodych rolników wpłynęły korzystnie na przemiany obszarowe rolnictwa dolnośląskiego, z drugiej jednak strony płatności bezpośrednie proces ten spowalniają faworyzując pośrednio właścicieli nieruchomości rolnych. Istotnym wyzwaniem pozostaje kwestia upełnorolnienia gospodarstw rodzinnych w oparciu o grunty Skarbu Państwa. Szansą dla rolnictwa dolnośląskiego, a w szczególności jego dywersyfikacji, są proponowane zmiany we WPR po roku 2013 – które prawdopodobnie wpłyną na dywersyfikację upraw, będą korzystniejsze dla gospodarstw mniejszych obszarowo, a „greening” oraz modulacja w połączeniu z degresją w płatnościach obszarowych dla gospodarstw większych obszarowo spowoduję zmiany w produkcji na bardziej przyjazne środowisku i służące realizacji rozwoju zrównoważonego. Najistotniejszą formą wsparcia pozostaną w dalszym ciągu płatności bezpośrednie w ramach nowego systemu.
Gospodarowanie ziemią a Wspólna Polityka Rolna
Authors: Niezgoda Dionizy
Published: October 2024

Celem tych badań było dokonanie oceny przyjętych celów Wspólnej Polityki Rolnej (WPR) w odniesieniu do rolnictwa. Kryteriami jej oceny są podział wartości dodanej netto oraz okres zwrotu aktywów w badanych latach i klasach gospodarstw wg ESU. Z badań wynika, że ekonomia podażowa w sprzężeniu zwrotnym z konkurencją doskonałą pozwoliły osiągnąć cele konsumentów żywności. Podział wartości dodanej netto między gospodarstwa trudno nazwać sprawiedliwym mimo, że środki finansowe na rozwój rolnictwa mają charakter społeczny. Partycypacja w podziale wartości dodanej netto była tym wyższa im większym potencjałem produkcyjnym (aktywa) dysponowało gospodarstwo. Taki podział z ekonomicznego i społecznego punktu widzenia trudno uznać za właściwy ponieważ okres zwrotu aktywów w gospodarstwach o wielkości >100 ESU był dłuższy niż w gospodarstwach o wielkości od 16 do 100 ESU. Ten niekorzystny trend był szczególnie widoczny w latach 2008-2010 czyli w okresie kryzysu gospodarczego. Kondycja ekonomiczna tych dużych gospodarstw podobnie jak przedsiębiorstw determinowana jest przez wahania rynku kapitałowego, co nie służy stabilizacji bezpieczeństwa żywnościowego.
Rozwój rolnictwa w Polsce w warunkach Wspólnej Polityki Rolnej
Authors: Poczta Walenty , Rzeszutko Anna
Published: October 2024

Celem opracowania była identyfikacja zmian jakie zaszły w sektorze rolnym w Polsce w warunkach jego funkcjonowania w ramach Wspólnej Polityki Rolnej Unii Europejskiej. Zgodnie z założeniem, że rozwój rolnictwa obejmuje zarówno wzrost ilościowy podstawowych wskaźników makroekonomicznych jak i przemiany strukturalne, w artykule zwrócono uwagę zarówno na zmiany wielkości dochodów i produkcji wywołane wzrostem popytu wewnętrznego i zewnętrznego (handel zagraniczny), jak i na zmiany w strukturze obszarowej gospodarstw oraz w relacjach między czynnikami produkcji. Przeprowadzone badania pozwoliły na stwierdzenie, iż w warunkach członkostwa Polski w UE w sektorze rolnym nastąpiły pożądane - pozytywne przeobrażenia, które wskazują na występowanie procesów rozwojowych w rolnictwie. Uzyskane wsparcie finansowe znacznie przyczyniło się do wzrostu dochodów rolniczych, a funkcjonowanie w ramach JRE wpłynęło na wzrost obrotów w handlu zagranicznym. Zmianom tym towarzyszyła poprawa relacji między wykorzystywanymi czynnikami produkcji oraz wzrost ich produktywności i dochodowości.
Znaczenie wsparcia unijnego w pobudzaniu rozwoju gmin
Authors: Szwacka-Mokrzycka Joanna
Published: October 2024

W artykule przeprowadzono analizę wykorzystania wsparcia unijnego w zakresie projektów infrastrukturalnych realizowanych w gminach: Krzywda, Łuków, Stanin Stoczek Łukowski. Dokonano analizy wykorzystania wsparcia unijnego w badanych gminach oraz oceny ich sytuacji finansowej, w celu zbadania jego wpływu na pozyskiwanie dofinansowania z funduszy unijnych.
Działania Agencji Rynku Rolnego w ramach Wspólnej Polityki Rolnej
Authors: Trajer Marzena , Wojtkiewicz Marek
Published: October 2024

W opracowaniu przedstawiono działalność Agencji Rynku Rolnego od akcesji Polski do Unii Europejskiej. ARR jako unijna agencja płatnicza realizuje (w ramach I filara Wspólnej Polityki Rolnej) zasadniczą część zadań dotyczących realizacji jednego z celów WPR, jakim jest stabilizacja rynków rolno-żywnościowych. W artykule omówiono realizację przez Agencję głównych kierunków działań stabilizacyjnych, tj.: zakupów i sprzedaży interwencyjnej produktów rolno-żywnościowych, wsparcia prywatnego przechowywania, działań w zakresie obrotu produktami rolno-spożywczymi poza obszar celny UE, kwotowania produkcji. Przedstawiono również objęte wspólną polityką rolną działania na rzecz wspierania konsumpcji, które w ostatnich latach ze względu również na swoje istotne funkcje społeczne, nabierają coraz większego znaczenia. Zaprezentowano także wspieranie promocji żywności, spełniającej ważną rolę w stymulowaniu popytu na żywność wytwarzaną na rynku unijnym.
Diagnosis and Classification
Authors: Cypress Marjorie , Tomky Donna
Published: October 2024

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The prevalence of diabetes and prediabetes continues to increase at alarming rates. From 1980 to 2014, the number of individuals with diagnosed diabe tes has increased fourfold to 22 million with continued estimates of 8.1 million people with undiagnosed diabetes. Prediabetes rates also are increasing, and it is estimated that 86 million Americans ages 20 years or older have prediabetes. These problems are not limited to the U.S.

In 2014, the World Health Organization estimated that more than 422 million people worldwide had diabetes, and that number is expected to double by the year 2030. Almost 40% of the population over the age of 65 years suffers from diabetes. Diabetes is listed as the seventh leading cause of death and is linked with heart disease, hypertension, blindness, kidney disease, nervous system disease, amputations, and dental disease. Although historically type 2 diabetes (T2D) has been an adult disease, more children are being diagnosed with T2D and risk ear lier and more serious complications. As the U.S. and the world continue to see rising rates of diabetes, it stands as one of the most common diseases that nurses will encounter in their professional lives. It is essential that nurses appreciate the tremendous growth of diabetes in the population and be knowledgeable about the classification and diagnostic criteria for diabetes and prediabetes so that early and appropriate interventions can be instituted. Diagnosing diabetes or prediabetes early decreases the risks for complications and improves outcomes to lessen the burden on individuals, families, communities, and society.
Nutrition Therapy: Healthy Eating and Regular Physical Activity
Authors: Franz Marion J. , Daly Anne
Published: October 2024

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Ideally, individuals with diabetes should be referred to a registered dietitian/nutritionist (RDN) at or soon after diagnosis and for ongoing follow-up and support.1Nutrition therapy is the preferred term and should be used instead of diet or dietary management. Nutrition therapy is the treatment of a disease, in this case diabetes, or condition through the modification of nutrient or whole food intake and often is provided by a wide range of health professionals.1 Conversely, medical nutrition therapy (MNT) is defined as an evidence-based application of the nutrition care process provided by an RDN and can be covered as a Medicare benefit. Both nutrition therapy and MNT should involve nutrition assessment, nutrition diagnosis, nutrition interventions (e.g., education and counseling), and nutrition monitoring and evaluation with ongoing follow-up to support long-term lifestyle changes, evaluate outcomes, and modify interventions as needed. In addition to diabetes MNT provided by an RDN, diabetes self-management education and support are critical components of care for all people with diabetes and must include nutrition therapy as an essential core topic and self-care behavior.2 Unfortunately, national data indicate that only about half of the people with diabetes report receiving some type of diabetes education,3 and in a study of 18,404 patients with diabetes, only 9.1% had at least one nutrition visit within a 9-year period.4
Treatment Strategies for Type 1 Diabetes
Authors: Childs Belinda P. , Kruger Davida
Published: October 2024

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Type 1 diabetes (T1D) is a complex, multihormonal disease. Insulin has been the primary treatment for T1D. To successfully manage T1D, however, individuals must integrate several diabetes treatment components into their lifestyle, including management of insulin administration, food intake, and physical activity. The individual with T1D and the health-care provider must share an understanding of the disease process and available treatment strategies and collaborate in determining the best treatment choices.
Self-Management Practices: Problem Solving
Authors: Hinnen Deborah , Guthrie Richard A.
Published: October 2024

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The essence of diabetes self-management is problem solving, detecting patterns, and making proactive changes in the food plan, physical activity, or medication protocols. These are advanced skills for people with diabetes. First, the basic self-care skills for diabetes management must be mastered, including glucose monitoring, insulin injection and oral medication dosing and timing, hypoglycemia prevention and treatment, daily schedule delineation, basic meal planning, and knowing when to call the practitioner. As a component of continuous, lifelong outpatient diabetes education, all nurses working with people with diabetes should be able to teach, reinforce, and verify these daily care activities.
Acute Complications of Diabetes
Authors: Hirsch Irl B. , Childs Belinda P.
Published: October 2024

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Diabetic ketoacidosis (DKA), hyperosmolar hyperglycemic syndrome (HHS), and hypoglycemia are the most common acute complications of diabetes. To prevent significant mortality and morbidity, it is important for the health-care provider and the individual with diabetes to identify the symptoms and institute appropriate treatment promptly.
Cardiovascular Complications
Authors: McCarthy Margaret M. , Chyun Deborah A.
Published: October 2024

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Cardiovascular disease (CVD), which includes stroke, peripheral vascular disease, hypertension, angina, myocardial infarction (MI), heart failure, and sudden cardiac death, is the leading cause of death in patients with type 1 diabetes (T1D) or type 2 diabetes (T2D). Adults with diabetes have death rates from heart disease that are about two to four times higher than adults without diabetes.1 Hypertension, which is present in ∼40–60% of patients with T2D, plays a major role in the development of stroke, MI, and heart failure.

The pathophysiology of CVD in individuals with diabetes is complex, and the development of atherosclerotic coronary artery disease (CAD) involves the interaction of many factors, including hypertension, dyslipidemia, impaired endothelial function, inflammation, central adiposity, and hemostatic abnormalities involving platelet function, thrombosis, and fibrinolysis. Although the direct role of hyperglycemia remains controversial, hyperglycemia plays an important role in the development of microvascular complications that contribute to adverse outcomes, as well as to lipid and coagulation abnormalities that directly influence the development and progression of CAD. In patients with diabetes, CAD is generally more widespread, with stenosis in a greater number of vessels, along with more obstructive lesions within each vessel. Diffuse disease involving long segments or the distal aspects of the artery may be present, thereby limiting the usefulness of either percutaneous or surgical revascularization. Therefore, multiple risk factors must be controlled for successful prevention and management of CAD.
Ocular Changes with Diabetes
Authors: Phelps Roger H.
Published: October 2024

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Diabetic retinopathy is the leading cause of new blindness in Americans ages 20–74 years, and most diabetes-related blindness is preventable. Nurses can participate in this prevention by
Dental Issues in Patients with Diabetes
Authors: Spollett Geralyn , Crape Charles A.
Published: October 2024

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Individuals with diabetes are two to three times more likely than those without the disease to develop dental problems, such as caries, periodontal and oral mucosal diseases, and tooth loss. Dental problems can affect glycemic control and may lead to the vascular complications associated with diabetes. Those with periodontal disease and diabetes may have worse diabetes control and be at greater risk for developing cardiorenal complications. Epidemiological studies have found a high degree of association between periodontal disease and diabetes, with this relationship being bidirectional. Poorly controlled diabetes can complicate routine dental visits, as well as oral surgery and dental implant procedures. Maintaining recommended blood glucose levels and following guidelines for good oral hygiene, including regular checkups, are key factors in reducing the incidence of dental problems.
Dermatological Changes Associated with Diabetes
Authors: Spollett Geralyn
Published: October 2024

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Just as diabetes interferes with the physiology of the microvasculature of the eye and kidney, it similarly affects the small vessels of the skin, which may lead to skin changes. Although there are theories concerning the pathophysiology of certain cutaneous disorders associated with diabetes, many causes are unknown. In a clinical analysis of 750 patients with diabetes, a skin disorder was present in 594 patients, with the most common being cutaneous infection (47.5%), xerosis (26.4%), and inflammatory skin diseases (20.7%).

Dyslipidemia and other metabolic changes associated with diabetes also can create dermatological changes. Autoimmune skin diseases such as vitiligo can occur in autoimmune type 1 diabetes (T1D). In rare cases, medications that are used to treat diabetes can cause adverse skin reactions. In general, how the disruption of normal insulin and glucose metabolism affects the skin is not completely understood.
Peripheral and Autonomic Neuropathy
Authors: Spollett Geralyn , Childs Belinda P.
Published: October 2024

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Diabetic neuropathy is a chronic complication that is among the most costly and disabling of all the complications of diabetes. It affects both the peripheral nervous system (sensory and motor) and the autonomic nervous system (ANS). It affects at least 50% of all people with diabetes, yet it is poorly understood. It can have a range of presentations; for example, it may present with obvious symptoms ≥5 years after the diagnosis of type 1 diabetes (T1D), as the initial symptom of previously undiagnosed type 2 diabetes (T2D), or it may be unrecognized and discovered only by careful diagnostic testing. Emerging evidence indicates that neuropathy can be present years before any alteration in glucose levels, at the early stages of diabetes pathogenesis. Symptoms of diabetic peripheral neuropathy (DPN) often start with numbness and paresthesia in the toes and feet and can progress to the fingers and hands. Diabetic autonomic neuropathy affects innervation to all of the organs of the body and can cause dysfunction in any body part.
Evaluation and Management of the Diabetic Foot
Authors: Liu George T. , Garwood Caitlin S. , Steinberg John S.
Published: October 2024

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The crude prevalence of diabetes worldwide is on the rise. There are 26 million people living with diabetes in the U.S. and 382 million throughout the world. It is estimated that by 2035, 417 million people will be living with diabetes. Diabetes mellitus is one of the leading causes of death in the world, along with ischemic heart disease, stroke, chronic obstructive pulmonary disease, and HIV/AIDS. In 2012, the economic impact of diabetes was estimated at US$471 billion.

Heart disease, blindness, retinopathy, renal disease, neuropathy, and lower-limb amputation are several complications that can significantly challenge the course and outcomes of a patient with diabetes. Diabetic peripheral neuropathy leads to diabetic foot ulceration (DFU), which has been shown to increase morbidity and mortality. Reports have estimated that 15–25% of patients with diabetes will develop a diabetic foot ulcer in their lifetime. Foot complications or ulceration is the leading cause of hospitalization in this population. The initial presence of a foot ulcer not only has been recognized as a local comorbid manifestation of diabetes but also as a marker of the diabetic disease state and the overall health of a patient. Patients who develop a DFU are at a higher lifetime risk of death, lower-extremity amputation, and contralateral lower-extremity amputation and also have a 50–70% reulceration rate. Diabetes is the leading cause of nontraumatic lower-extremity amputation. A 2014 study found the cumulative incidence among 644 people with diabetes to be 26.6% for DFU, 5.8% for lower-extremity amputation, and 14.0% for death. They also found that DFU has an independent impact of lower-extremity amputation and mortality.
Diabetes Education and Ongoing Support in the Management of Diabetes
Authors: Funnell Martha M. , Mensing Carolé R.
Published: October 2024

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Diabetes self-management education (DSME) and diabetes self-management support (DSMS), have long been considered cornerstones of diabetes care. Because ∼98% of the glycemic outcomes in diabetes are patient-related, and the vast majority of the care is provided by the person with diabetes and his or her family members, effective care requires a partnership between an actively engaged patient and the health-care team. Education and ongoing support are critical for the patient to fully participate in shared decision-making and to make informed self-management decisions on a daily basis.

Most nurses think of diabetes education and ongoing support as a comprehensive program offered in an outpatient setting or by an inpatient diabetes nurse educator. In fact, each encounter with a person who has diabetes is an opportunity for education, and every nurse shares the responsibility for that education. Even when time is limited, nurses can both create and use “teachable moments” to provide and reinforce needed information. For example, giving insulin to a hospitalized patient is an excellent time to assess and review insulin injection technique, treatment of hypoglycemia, and the need to wear or carry diabetes identification and glucose tablets. Bathing a hospitalized, residential, or home care patient or performing a foot examination during an outpatient visit provides the opportunity to assess foot care self-management practices by asking, “What do you do to care for your feet at home?” and offering personalized foot care instruction based on the physical findings and the patient’s response. In a care management or nurse practitioner encounter, patients can be asked about financial concerns and offered information about programs to reduce costs or help pay for medications and other supplies. In every setting, nurses not only provide information, and demonstrate skills, but also help patients to develop strategies and overcome obstacles to effectively use that information to cope with and manage diabetes on a daily basis.
Behavioral Strategies for Improving Self-Management
Authors: Weinger Katie , MacNeil Tara , McMurrich Greenlaw Sheila
Published: October 2024

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Health education involves more than just providing information. Diabetes education is a perfect example. The goal of diabetes education is to help individuals with diabetes live well, thus maximizing health and quality of life while minimizing costs. This goal is met by assisting those with diabetes as they integrate diabetes care into their lifestyles and, when necessary, adapt their lifestyles to healthy living guidelines and treatment requirements.

Accordingly, diabetes care and education are built on behavior and lifestyle adjustments—that is, helping to reinforce some behaviors and to change others. Because learning new healthy habits can be slow and frustrating, nurses caring for individuals with diabetes face the important challenge of effectively supporting patients in their efforts to manage their diabetes. This chapter discusses several aspects of behavioral approaches in the treatment of diabetes, including general principles that apply to most interventions and strategies, useful tools and strategies for diabetes and education, four phases of psychological responses to living with diabetes, and examples of validated behavioral programs.
Cultural Context of Diabetes Prevention and Self-Management Education
Authors: Lew Kelley Newlin , Melkus Gail D’Eramo
Published: October 2024

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Diabetes has emerged as a national epidemic with ethnic minority populations disproportionately burdened by the disease and many of its complications. Currently, 15.9% of Native Americans/Alaskan Natives, 14.7% of Native Hawaiian/Pacific Islanders, 13.2% of non-Hispanic blacks, 12.8% of Hispanics, and 9.0% of Asian Americans have diabetes relative to only 7.6% of non-Hispanic whites. Additionally, ethnic minority populations remain unequally affected by numerous diabetes-related complications:
Complementary and Alternative Approaches*
Authors: Guthrie Diana W. , Shane-McWhorter Laura
Published: October 2024

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Complementary and alternative medicine (CAM) has existed throughout time. Practitioners and patients have used CAM to treat diabetes for thousands of years. An early Greek treatise, which described diabetes as a “melting down” into the urine, stated that diabetes was treated with fasting, specific food choices, water restriction, or herbs.

People have tried numerous remedies or treatments for various ailments, some with success and some without benefit. CAM therapy, as it is commonly known, and in combination with mainstream medicine, has increased in popularity for a variety of reasons, but a major reason is that consumers believe in the benefits derived from these therapies and in the emerging evidence that the perceived well-being is meaningful. The National Center for Complementary and Alternative Medicine (NCCAM) is officially devoted to the study of CAM treatments. NCCAM is an agency in the U.S. Department of Health and Human Services dedicated to helping define the usefulness and safety of complementary therapies through rigorous scientific research.
Living with Diabetes
Authors: Rhiley Diafa , Hood Korey K.
Published: October 2024

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Living with diabetes is a daily challenge. The nature of the regimen— frequent blood glucose monitoring, meal planning, exercising, and scheduling medication—creates the need for constant vigilance on the part of the person with diabetes. Clinicians and scientists emphasize the importance of these efforts so that people with diabetes can experience optimal health and quality of life. These efforts are not without cost, as patients often express a sense of loss of freedom or spontaneity and the feeling that diabetes management is taking over their lives. Diabetes may affect relationships, limit social interactions, and produce psychological distress. It is important to be aware of the complex and demanding nature of chronic treatment and care that people with diabetes face.
Diabetes Technologies
Authors: Tomky Donna
Published: October 2024

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Technology offers many solutions to improve diabetes care in delivering more precise dosing of insulin and measuring glucose. Nurses are challenged to keep up with the latest technological advances available to individuals with diabetes. This chapter addresses what nurses need to know for safe and effective care of patients with diabetes wearing currently available continuous subcutaneous insulin infusion (CSII) pumps and continuous glucose monitoring (CGM) systems. Few health-care providers (HCP) will have practical knowledge of the operation of all the devices available in the rapidly changing field of diabetes technologies. HCPs will need to rely on the individual with diabetes, their caregivers, and diabetes technology experts and the manufactures for up-to-date operational information for each device.

Insulin pumps have been in use for >35 years for insulin replacement therapy. Estimated use in patients with type 1 diabetes (T1D) is near 20–30% and <1% in insulin-treated type 2 diabetes (T2D). According to Tucker, “When used correctly, insulin pumps can provide more convenient insulin delivery for patients and may improve blood glucose control.” CGM systems have been in use just over 10 years. CGM devices are designed to augment self–blood glucose monitoring for individuals with diabetes. CGM devices measure interstitial glucose. Nurses need to understand basic information about these devices to safely and effectively care for patients in all health-care settings.
Women and Diabetes
Authors: Homko Carol J.
Published: October 2024

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Diabetes is a serious chronic illness that affects ∼29 million people in the U.S. Although men and women are equally affected by type 1 diabetes (T1D), the prevalence of type 2 diabetes (T2D) is higher in women than in men. More women die each year from diabetes and its complications than from breast cancer, making diabetes a significant “women’s health issue.” Women with diabetes face special health challenges throughout their lives. This chapter examines the available data concerning the impact of diabetes on women, beginning with the implications for childbearing and ending with its effects in later life on the risks of cardiovascular disease (CVD) and osteoporosis.
Children with Diabetes
Authors: Schreiner Barbara , Ponder Stephen W.
Published: October 2024

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Having diabetes during childhood and adolescence poses distinct challenges and requires unique solutions. Although the child with diabetes will typically have type 1 diabetes (T1D), increasing numbers of children and teens are developing type 2 diabetes (T2D).

Children with T1D typically present with the classic symptoms of diabetes: polyuria, polydipsia, ketonuria, and weight loss. In the very young child, early symptoms of diabetes, such as lethargy, irritability, and dehydration, are often mistaken for flu or gastroenteritis. The child with T2D classically will have a BMI in the ≥85th percentile and have a strong family history of diabetes, display features of insulin resistance, or belong to a high-risk population (e.g., Latino, African American, Native American, or Pacific Islander). Overweight children should be screened for prediabetes and T2D using oral glucose tolerance test (OGTT), fasting plasma test (FPT), or A1C every 3 years if they meet these criteria.
Diabetes Care in Assisted Living and Long-Term Care Facilities
Authors: Childs Belinda P. , Burke Sandra Drozdz
Published: October 2024

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The aging of the baby boomer generation has led to what is being called a “silver tsunami.” As of 2014, there were nearly 46 million older adults in the U.S., and 10,000 members of the baby boom generation will turn 65 every day until 2030. By 2040, the number of older adults will surpass 80 million and constitute about 22% of the U.S. population.1 The vast majority of older adults live independently, but about 1.5 million reside in long-term care settings such as nursing homes. As much as 10% of those ≥85 years old live in institutional settings. Twenty-six percent of the population >65 years old has diabetes. Considering the aging of the population, the increased life expectancy, and the increase in diabetes prevalence, nurses will be asked to provide diabetes care and education in the home as well as in assisted and long-term care facilities. The nurse’s role as advocate, care provider, and educator of staff, patient, and family will be pivotal.
Common Comorbidities
Authors: Cypress Marjorie , Spollett Geralyn
Published: October 2024

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Diabetes can be associated with other disorders, particularly an excess or deficiency of endocrine hormones through a shared etiological mechanism. This can occur in three ways:
Diabetes and Cancer
Authors: Cypress Marjorie
Published: October 2024

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Besides the well-known complications of diabetes, such as cardiovascular disease, retinopathy, nephropathy and neuropathy, certain cancers have been associated with diabetes. Over recent years, numerous epidemiological studies have noted the increased risk of cancer among those with diabetes, and even prediabetes. Although much of the literature is recent, Elliot Joslin recognized the need to study this association citing earlier work (1910) that had linked the two diseases. Evidence of an association between diabetes, particularly type 2 diabetes (T2D), and certain cancers, specifically liver, pancreatic, kidney, endometrial, colorectal, bladder, breast, and non-Hodgkin’s lymphoma, seems to be unequivocal, with relative risk ranging for developing cancer from 1.12 to 2.50. The association is not totally understood, but it may result from shared risk factors between T2D and cancer and also may be due to diabetes-related factors, such as underlying disease physiology or diabetes treatments, although evidence for these links is scarce. The modifiable risk factors for diabetes in many instances mimic some of the risk factors for certain cancers, such as obesity, physical inactivity, unhealthy nutrition, smoking, and alcohol. Some patients can develop diabetes as a result of the type of cancer treatment. The challenges faced by patients with both diseases are compounded, and nurses have an opportunity to provide medical and lifestyle counseling and emotional support. The preventive strategies that nurses and other health-care professionals recommend for diabetes, also can be used in cancer prevention. This chapter will discuss some of the recent information on diabetes and cancer risk along with nursing implications.
Rüzgâr Türbini Yüksek Hızlı Şaft Rulmanının Sağlık Durumu Aşamalarının Derin Öğrenme İle Sınıflandırılması
Authors: Öcalan Gonca , Türkoğlu İbrahim
Published: October 2024

Değişken hava koşulları altında kararsız çalışma ortamına sahip rüzgâr türbinlerinde mekanik bileşenler oldukça yüksek yıpranma riski altındadır. Bu durum bileşenlerde ani beklenmedik duruşları ve yüksek bakım maliyetlerini beraberinde getirmektedir. Enerji üretiminde sürekliliği sağlamak, beklenmeyen plansız duruşların önüne geçmek ve bakım maliyetlerini en aza indirgemek amacıyla uygun bakım zamanlarının planlanması oldukça büyük öneme sahiptir. Bundan dolayı bileşende arıza meydana gelmeden önce sağlık sürecinin dikkatli bir şekilde takip edilmesi ve bakım periyotlarının yıpranma sürecine göre planlanması gerekir.
Bu makalede, gerçek bir rüzgâr türbini yüksek hızlı şaft rulmanının sağlık durumunun değerlendirilmesine yönelik derin öğrenme tabanlı bir sınıflandırma modeli önerilmiştir. Rüzgâr türbini yüksek hızlı şaftından elde edilen titreşim verilerinin kullanıldığı çalışma temel olarak; titreşim sinyallerinin zaman, frekans ve zaman-frekans özelliklerinin çıkarılması; sağlık sürecini etkin bir şekilde ortaya çıkacak özelliklerin seçilmesi; seçilen özelliklerin bütünleştirilerek sağlık indeksinin oluşturulması; sağlık indeksinin aşamalara bölünerek LSTM derin öğrenme modeli ile sınıflandırılması adımlarından oluşmaktadır. Dört farklı aşamanın sınıflandırıldığı çalışmada %99 oranında doğruluk başarımına ulaşılmıştır.
Energy Dispersive X-Ray Fluorescence (EDXRF)- Oxide Composition Analysis of Coarse Aggregates and Reclaimed Asphalt Pavement (RAP) as Construction Materials
Authors: Tiza Michael Toryila
Published: October 2024

This study utilizes Energy Dispersive X-Ray Fluorescence (EDXRF) to conduct a detailed elemental analysis of Recycled Asphalt Pavement (RAP) and coarse aggregates, focusing on their role in sustainable construction. Elements such as SiO₂, Al₂O₃, CaO, CuO, and ZnO were analyzed, revealing their significant influence on concrete strength, durability, and overall performance. RAP was manually processed and combined with aggregates from Mkar hill in Gboko Local Government Area. The findings show that concrete mixes with 50% RAP replacement achieved the highest compressive strength, while those with 75% RAP replacement excelled in split tensile and flexural strength. These results highlight RAP's effectiveness in enhancing mechanical properties, advocating for its increased use in eco-friendly infrastructure development.
Incomplete Excision Rate for Lentigo Maligna and Associated Risk Factors
Authors: Modin Maja , Svensson Helena , Bergsten Wanders Ylva , Neittanmäki Noora , Siarov Jan , Paoli John
Published: October 2024

Standard treatment for lentigo maligna (LM) is surgical excision, yet insights into the frequency of and risk factors for incomplete excisions remain limited. The primary objectives were to assess the incomplete excision rate (IER) in primary LM and to explore potential risk factors for incomplete excisions. A retrospective analysis was conducted encompassing consecutive histopathologically confirmed LMs from 2014–2020. Descriptive statistics were used for LM characteristics and IER, while uni- and multivariate analyses were used for calculating risk factors. The study included 395 LMs with an IER of 16.7% (n = 66). Risk factors for higher incomplete excision rates included: head and neck lesions (p = 0.0014), clinical excision margins < 5 mm (p = 0.040), and utilization of preoperative partial biopsies (p = 0.023). Plastic surgeons had higher IERs than dermatologists (p = 0.036). Lesion diameter (p = 0.20) and surgeon experience (p = 0.20) showed no associations with incomplete excisions, yet LMs with a diameter ≥ 20 mm exhibited higher incomplete excision rates (23.2%) compared witho those < 10 mm (12.9%). LMs should be excised with at least 5-mm clinical margins, especially in the head and neck area. LMs ≥ 20 mm may be more surgically challenging. High-er incomplete excision rates associated with the use of preoperative biopsies and/or plastic surgeons may reflect challenging anatomical locations, larger lesion diameter, and/or ill-defined borders.
Narcissistic and Antisocial Personality Profiles of the Person(s) of Interest in the Murder of Vincent van Gogh
Authors: Krier Leon
Published: October 2024

On May 20, 1890, Vincent arrived in Auvers-sur-Oise, near Paris after his asylum discharge “cured.” Auvers was recommended by his brother Theo so he could be watched by Dr. Paul-Ferdinand Gachet, a homeopathic doctor and friend to many of the new artists. Vincent was described as happy and very productive in his new life. Sadly, Vincent was shot in the belly and was reported as a suicide by his doctor and friend. Recent forensic studies provide an alternative narrative. It was not possible for Vincent to shoot himself in the belly without the telltale black powder burn ring around his entry wound description. Dr. Gachet and his son, Paul, Jr, have been implicated as the primary persons of interest in the murder of Vincent van Gogh. This article offers a retrospective assessment of Dr. Gachet as a medical practitioner, his personality traits and associated behaviors that transformed an initially favorable and optimistic relationship with Vincent into a dark and tragic situation resulting in Vincent’s death. Paul Jr., likewise exhibited his father’s self-serving personality profile. They both manifested characteristics of Antisocial and Narcissistic Personality Disorders. Would these personality disorders be sufficient for them to commit murder? The answer is clearly a solid YES! There are several significant motives: an opportunity, a weapon, and proximity to each other on the day Vincent was shot. This proximity was confirmed when Paul, Jr. and his sister, Marguerite, were interviewed years later by a well- known Van Gogh expert. Doing this detailed personality profile for criminal behavior and intent checks all the boxes of these primary persons of interest and further strengthens the case for murder, not suicide, as this personality profile comfortably brings together all the missing pieces and finally connects all the dots and even dots the "i’s" and crosses the "t’s." The Doctor Did Do It!!!.