bluuebunny/crossref_metadata_2025 huggingface dataset:
Making Hope and History Rhyme
Authors: Connolly Bríd , Finnegan Fergal
Published: June 2016

This article draws on our backgrounds as adult educators in Ireland and our experience at Highlander in 2014. We review our development as critical educators, exposed to deep inequalities in Irish society. We explore role of popular education in fostering social change, beginning with the commitment to equality and freedom, whereby, we produce emancipatory knowledge with students and participants. This learning process is more explicitly political and collective than individual psychological concepts of learning. The Highlander experience provided the opportunity to interrogate related assumptions that underpin the concept of leadership, pointing toward a more collective and political framework. The article uses feminist critical theories as lenses for this interrogation, holding that equality and freedom are mutually constitutive principles of critical practice. Popular educators foster critical thinking and reflection. The Other’s Tools, drawing on the precept that traditional thinking reinforces the status quo. These critical thinking tools are vital to question the assumptions that power and control in society as individualized or de-politicized. We take this learning into our practice in Ireland.
The Feasibility of Collecting School Nurse Data
Authors: Bergren Martha Dewey
Published: June 2016

School nurses cite barriers to collecting comprehensive data on the care they provide. This study evaluated the feasibility of collecting school nurse data on selected child health and education outcomes. Outcome variables included school health office visits; health provider, parent, and staff communication; early dismissal; and medications administered. On an average day, the school nurses cared for 43.5 students, administered 14 medications, and averaged of 17 daily communications. Day 1 data collection times averaged 15 min or less. By Day 5, 6.6 min was needed to complete the survey. Data collection was feasible for 76% of those who elected to participate. Feasibility is enhanced by limiting the number of data points and the number of days for data collection using a data collection web interface. Data collection across large numbers of nurses and a wide range of school nurse delivery models is necessary to measure the impact of school nurse presence and interventions on child health and education outcomes.
Well-Differentiated Liposarcoma With Hibernoma-Like Morphology
Authors: Hallin Magnus , Schneider Nina , Thway Khin
Published: June 2016

Well-differentiated liposarcoma (WDL) can show a morphologic spectrum, including lipoma-like, sclerosing and inflammatory subtypes. It does not metastasize but can dedifferentiate, acquiring metastatic potential. Hibernomas are benign neoplasms that show variable differentiation toward brown fat, and can sometimes occur in the abdomen or retroperitoneum. We illustrate a case of retroperitoneal WDL that showed extensive hibernoma-like morphology, with sheets of multivacuolated adipocytes of varying sizes, with abundant cytoplasm and numerous lipid vacuoles or granular eosinophilic cytoplasm. However, very focally there were fibrous septa containing spindle cells with enlarged, hyperchromatic, mildly pleomorphic nuclei. Further sampling showed areas of typical WDL, with lobules of mature fat intersected by fibrous septa containing atypical, enlarged spindle cells, as well as small foci of dedifferentiation. Immunohistochemistry for CDK4 and p16 showed strong and diffuse nuclear expression in the hibernoma-like areas, and fluorescence in situ hybridization showed MDM2 gene amplification, all in keeping with WDL. We highlight hibernoma-like morphology as part of the histologic spectrum of WDL, and recognition of this variant is important for correct treatment and prognostication.
The Researcher–Practitioner Partnership Study (RPPS): Experiences From Criminal Justice System Collaborations Studying Violence Against Women
Authors: Sullivan Tami P. , Price Carolina , McPartland Tara , Hunter Bronwyn A. , Fisher Bonnie S.
Published: June 2016

The benefits of researcher–practitioner (R-P) collaborations focused on violence against women (VAW) are many. Such projects support researchers and practitioners working together to create uniquely comprehensive projects that have the potential to change practices, policies, and services. Extant literature is limited in that it has (a) focused on the experiences of a very limited number of collaborations, (b) ignored collaborations conducted in the context of the criminal justice system, and (c) excluded as a focus the products that result from the collaborations and their dissemination. Therefore, the goal of this qualitative study is to identify the essential elements to consider for successful R-P collaborations on VAW research in the criminal justice system.
Treatment Fidelity Among Family Health Promoters Delivering a Physical Activity and Nutrition Intervention to Immigrant and Refugee Families
Authors: Bronars Carrie A. , Hanza Marcelo M. , Meiers Sonja J. , Patten Christi A. , Clark Matthew M. , Nigon Julie A. , Weis Jennifer A. , Wieland Mark L. , Sia Irene G.
Published: June 2016

Lack of treatment fidelity can be an important source of variation affecting the credibility and utility of outcomes from behavioral intervention research. Development and implementation of a well-designed treatment fidelity plan, especially with research involving underserved populations, requires careful conceptualization of study needs in conjunction with what is feasible in the population. The purpose of this article is to review a fidelity-monitoring plan consistent with the National Institutes of Health Behavior Change Consortium guidelines (e.g., design, training, delivery, receipt, and enactment) for an intervention trial designed to improve physical activity and nutrition among immigrant and refugee families. Description of the fidelity monitoring plan is provided and challenges related to monitoring treatment fidelity in a community-based participatory intervention for immigrant and refugee families are discussed.
Similarities and Differences across Cultures: Questions to Inform a Third Generation for Health Promotion Research
Authors: Pasick Rena J. , D'Onofrio Carol N. , Otero-Sabogal Regina
Published: June 2016

The increasing diversity of American communities raises an important question about the efficiency, appropriateness, and feasibility of tailoring messages and intervention strategies to target groups identified by race and ethnicity. To explore this issue, this article distinguishes race and ethnicity from culture and then discusses four questions: (1) What is the meaning of culture in health promotion? (2) What is the role of culture in understanding health behavior? (3) What is the role of culture in the design of interventions? and (4) What do the relationships of culture to behavior and to intervention mean for cultural tailoring? Based on this analysis, the authors suggest that effective health promotion will tailor interventions by culture as necessary but reach across cultures when possible and appropriate. A framework is presented to assess the need for cultural tailoring, and a new generation of health promotion research is proposed to facilitate cross-cultural comparisons.
Workshop Proceedings
Authors: Allamneni Krishna P. , Parker Suezanne , O’Neill Charles A. , Wright Teresa L. , King Sruthi , Andrews Laura
Published: June 2016

A workshop entitled “Streamlined Development of Safety Assessment Programs Supporting Orphan/Rare Diseases—Are We There Yet?” was held at the 36th Annual Meeting of the American College of Toxicology in Summerlin, Nevada. The workshop was sponsored by Shire and Ultragenyx and was designed to present the nonclinical considerations for the development of various products for rare diseases. A panel of experts from industry and government highlighted the nonclinical considerations in developing toxicology programs supporting rare disease therapeutics, challenges in preclinical safety assessment, reviewed the current guidance, and presented the progress that has been made to date. The main learning from the workshop was that nonclinical testing of therapeutics targeting rare disease warrants special considerations, and early collaboration between sponsors and health authorities may help optimize the scope and timing of the supportive studies. Specific examples for nonclinical development programs for enzyme replacement therapy (ERT) were presented. Although the symposium focused on ERTs, the concepts are broadly applicable.
“We Are So Pumped Full of Shit by the Media”
Authors: Waling Andrea
Published: June 2016

Men’s lifestyle magazines have long since been the focus of theorists in their examination of masculinity. However, research concerning men’s responses to such content, and whether these representations speak to their perceptions on embodying particular forms of masculinity in an Australian context, is largely absent. To understand how Australian men conceptualize their own ideas about masculinity and identity, interviews were conducted with twenty Australian men who were asked to peruse copies of men’s lifestyle magazines while pondering what it means to be masculine. Engaging with the theoretical frameworks of representational masculinity and masculine reformulation patterns, the results of this study found that the men interviewed identified four themes of social pressure perpetuated by these magazines regarding their own formation of a masculine identity. These include media representation and cultural consumption pressures, body image and muscularity pressures, performative sex and desirability expectations, and the fear of social judgment from both those who expect, and those who reject, particular performances of masculinity. Despite these articulations, however, the men maintained that these expectations affect other men and not themselves. While these men did not identify with these pressures, a textual analysis of their responses suggest otherwise, indicating a paradox in which they both accept and reject the mythscapes of aspirational masculinity presented before them.
Speaking of Stigma and the Silence of Shame
Authors: Hlavka Heather R.
Published: June 2016

This study addresses male sexual victimization as that which is both invisible and incomprehensible. Forensic interviews with young men following reports of suspected sexual assault reveal patterns of heteronormative scripts appropriated to make sense of sexual victimization. These scripts show that victimhood is largely incompatible with dominant notions of masculinity. Sexual coercion and assault embodied threat to boys’ (hetero)gendered selves, as they described feelings of shame and embarrassment, disempowerment, and emasculation. These masks of masculinity create barriers to disclosure and help to explain the serious underreporting of male sexual victimization. Questions of coercion and consent are addressed, as it relates to matters of legitimacy, sexuality, and power. With few exceptions, boys’ constructions of sexual violence have received little attention. This study adds the voices of young men to the developing empirical and theoretical research on male victims of sexual assault.
Digital Dermoscopy Photographs Outperform Handheld Dermoscopy in Melanoma Diagnosis
Authors: Mintsoulis Danielle , Beecker Jennifer
Published: June 2016

Background:

Pigmented lesion clinics (PLCs) that use technology such as digital dermoscopy and total-body photography are thought to confer a clinical advantage for patients at high risk of developing melanoma over general dermatology clinics (GDCs) with regular dermoscopy.

Objective:

To examine the difference between depths of melanomas diagnosed in a PLC and a GDC.

Methods:

Medical records from 257 patients at the PLC at The Ottawa Hospital and 441 patients from a GDC were reviewed.

Results:

Invasive melanoma was less frequent than in situ melanoma at the PLC (7.14% vs 38.27%; P = .02). The average Breslow depth for melanomas at the PLC was also smaller compared with the GDC (0.0371 vs 0.3450 mm; P = .02).

Conclusions:

The use of digital dermoscopy and total-body photography together in a PLC appears to be an effective way to monitor patients at high risk of melanoma.
Altered intestinal permeability in patients with relapsing–remitting multiple sclerosis: A pilot study
Authors: Buscarinu Maria Chiara , Cerasoli Benedetta , Annibali Viviana , Policano Claudia , Lionetto Luana , Capi Matilde , Mechelli Rosella , Romano Silvia , Fornasiero Arianna , Mattei Gianluca , Piras Eleonora , Angelini Daniela Francesca , Battistini Luca , Simmaco Maurizio , Umeton Renato , Salvetti Marco , Ristori Giovanni
Published: June 2016

Background:

Alterations of intestinal permeability (IP) may contribute to the pathophysiology of immune-mediated diseases.

Objective:

We investigated the possible association between IP changes and multiple sclerosis (MS).

Methods:

We studied 22 patients with relapsing–remitting multiple sclerosis (RRMS) and 18 age- and sex-matched healthy donors (HDs), including five twin pairs (one concordant, and four discordant for disease). Measurement of lactulose (L) and mannitol (M; two non-metabolized sugars) levels in urine samples, after an oral load, allowed to quantify gut dysfunction.

Results:

The proportion of participants with increased IP was significantly higher in patients than in HDs (16/22 (73%) versus 5/18 (28%); p = 0.001). Accordingly, the L/M urinary ratio showed significantly higher values in patients than in controls ( p = 0.0284). Urinary mannitol concentration was significantly lower in patients than in controls ( p = 0.022), suggesting a deficit of absorption from intestinal lumen. Such changes did not appear related to patients’ clinical–radiological features.

Conclusion:

The relatively high proportion of IP changes in RR-MS patients seems to confirm our work hypothesis and warrants more work to confirm the result on a larger sample, and to understand the implications for related immunological disturbances and intestinal microbiota alterations. Our finding may also have relevance for oral treatments, recently introduced in clinical practice.
Making one-sided exercise decisions: The influence of exercise-related cognitive errors
Authors: Locke Sean R , Brawley Lawrence R
Published: June 2016

Exercise-related cognitive errors reflect biased processing of exercise-relevant information. The purpose of this study was to examine whether differences existed between individuals reporting low and high exercise-related cognitive errors on information processed about a relevant exercise decision-making situation. In all, 138 adults completed an online questionnaire. The high exercise-related cognitive error group primarily focused on negative content about the situation compared to the low exercise-related cognitive error group who focused on both positive and negative content. The high exercise-related cognitive error group displayed biased processing of exercise information, as suggested by the cognitive errors model. Future research should examine whether biasing information processing caused by exercise-related cognitive errors can be modified and attenuated.
An effective model for analysis of reinforced concrete members and structures under blast loading
Authors: Li Zhongxian , Zhong Bo , Shi Yanchao
Published: June 2016

The traditional fiber beam model has been widely used in the seismic analysis of reinforced concrete members and structures. However, the inability to capture shear failure restricts its application to blast loadings. In this article, a numerical model that considers both rate-dependent shear behavior and damage effect is proposed based on the traditional fiber beam element. This is achieved using the modified compression-field theory with a concrete damage model and bilinear steel model in the principal directions. Meanwhile, a condensed three-dimensional stress–strain relation from the isotropic hardening plasticity model is implemented to simulate longitudinal reinforcement bars, as large shear strain would be produced under severe blast loads. The proposed model is validated by comparing the numerical and test results. The high-fidelity physics-based finite element model, validated by the same experiment, is also used in the study to prove the efficiency of the proposed model. Case studies of a reinforced concrete beam and a six-story reinforced concrete frame structure subjected to blast loads are then carried out. The results indicate that the proposed model is reliable compared with the high-fidelity physics-based model. In addition to the accuracy, comparisons of the computational time show an excellent performance with respect to the efficiency of the proposed model.
Mediated Muslim martyrdom: Rethinking digital solidarity in the “Arab Spring”
Authors: Sumiala Johanna , Korpiola Lilly
Published: June 2016

In today’s world of networked, mobile, and global digital communication, Muslim martyrdom as a multi-layered communicative practice has experienced a new type of media saturation, thereby posing a challenge for the study of media, religion, and culture in a digital age. In this article, the analysis focuses on two cases of high symbolic relevance for the events later referred to as the “Arab Spring”—the deaths of a Tunisian fruit seller Mohammed Bouazizi and a young Egyptian man Khaled Saeed. Special focus is given to the discussion of digital solidarities and their construction in circulation and remediation of martyr narratives of Bouazizi and Saeed in diverse media contexts. In this global development of digital solidarities, we identify two categories of martyr images of particular relevance—a “living martyr” and a “tortured martyr”—and discuss their resonance with different historical, religious, cultural, and political frames of interpretation. In conclusion, we reflect on the question of the ethics of global mediation of Muslim martyrdom and its implications for the study field of media, religion, and culture in its digital state.
New paths in researching “alternative” consumption and well-being in marketing: alternative food consumption / Alternative food consumption: What is “alternative”? / Rethinking “literacy” in the adoption of AFC / Social class dynamics in AFC
Authors: Batat Wided , Manna Valerie , Ulusoy Emre , Peter Paula C. , Ulusoy Ebru , Vicdan Handan , Hong Soonkwan
Published: June 2016

In line with the Fifth Transformative Consumer Research Conference held at Villanova University, USA, in 2015, we chaired a dialogical track that involved seven international researchers working on “alternative food system.” Among many other subjects that emerged from brainstorming, three overarching themes were identified as significantly important for furthering research on “alternative” consumption and well-being. Manna, Ulusoy, and Batat explore the meanings behind alternative food consumption and discuss the role of ideology and anti- and post-sociocultural structures in shaping AFC meanings. Peter, Batat, and Ulusoy propose to rethink “literacy” in the adoption of AFC and offer a framework that represents a blueprint in the definition of literacy considering the adoption of other sustainable alternative behaviors (e.g. vegetarian diet, car pooling, recycling). Finally, Vicdan, Batat, and Hong explore social class dynamics in AFC. The three essays suggest potential areas of research with a focus on alternative modes of consumption and well-being and contribute to the theoretical conceptualization in marketing theory.
Zinc-Responsive Necrolytic Acral Erythema in a Patient With Psoriasis
Authors: Hou Yi-Chun , Wu Chen-Yi
Published: June 2016

Necrolytic acral erythema (NAE) is a recently recognized dermatosis almost exclusively associated with hepatitis C virus (HCV) infection, and closely related to zinc deficiency. We present the case of a 60-year-old man with a history of psoriasis and chronic HCV infection, who developed new lesions of NAE extending from previous elephantine psoriatic plaques on bilateral lower legs. According to previous reports, resolution of NAE has been successfully achieved by treatment of the underlying HCV infection, or the use of oral zinc therapy. Our patient exhibited good response to zinc therapy. By reporting this case, we would like to raise the awareness of physicians to this unique acrally distributed dermatosis, which is distinct from psoriasis by its pathological feature of aggregated necrotic keratinocytes and its good response to zinc therapy rather than topical corticosteroids.
Providing Students With Severe Disabilities Access to the General Education Curriculum
Authors: Olson Amy , Leko Melinda M. , Roberts Carly A.
Published: June 2016

This case study explored how multiple educational personnel in a middle school identified as an exemplar of inclusive education defined and provided students with severe disabilities access to the general education curriculum. Data sources including a questionnaire, interviews, observations, observation reflections, and artifacts were collected from 12 participants who worked as administrators, general education teachers, special education teachers, or paraprofessionals. Findings point to educational personnel who are committed to providing access to the general education curriculum in general education classrooms and carry out this mission through shared responsibility, collaboration, peer supports, and multi-faceted learning structures. These findings are discussed in relation to future research and practice in the areas of inclusion and severe disabilities.
Utility of Baroreflex Sensitivity as a Marker of Stress
Authors: Anderson Amanda A. , Keren Nir , Lilja Andrew , Godby Kevin M. , Gilbert Stephen B. , Franke Warren D.
Published: June 2016

Presently, adaptive systems use various cognitive and cardiovascular measures to evaluate the functional state of the operator. One marker that has been largely ignored as an assessment tool is baroreflex sensitivity (BRS). This study examined the extent to which BRS changed in response to acute psychological and physical stressors. A total of 20 participants underwent 6-min exposures to a psychological stressor and a physical stressor. Baroreceptor sensitivity, blood pressure, heart rate, heart rate variability, stroke volume, cardiac output, mean blood pressure, total peripheral resistance, left ventricular ejection time, and pre-ejection period were continuously measured at rest and throughout the testing period. Compared to rest, BRS significantly decreased during both the psychological and physical stressors. BRS was reduced more with the psychological stressor than the physical stressor. Heart rate and systolic blood pressure significantly increased above rest during the psychological stressor but not during the physical stressor. There were no significant differences from rest or between stressors for the other physiological markers. BRS was more robustly responsive than other cardiovascular measures commonly used to assess the psychophysiological response to stress, suggesting BRS is a useful marker for evaluating operator functional state during psychological and physical tasks.
Improving Identification of Strangulation Injuries in Domestic Violence: Pilot Data From a Researcher–Practitioner Collaboration
Authors: Pritchard Adam J. , Reckdenwald Amy , Nordham Chelsea , Holton Jessie
Published: June 2016

Efforts to partner researchers and practitioners have the potential to significantly improve both research and response to non-fatal strangulation within the context of domestic violence. Non-fatal strangulation is far more common than most formal data suggest and is a highly gendered form of domestic assault often used to control or intimidate a partner; however, depending on how the assault takes place, it can leave little obvious physical evidence to an untrained investigator. The present study estimates the occurrence of strangulation cases and possible strangulation cases that may not be explicitly classified as such in official police reports due to inadequacies in law enforcement training. We offer a description of these types of cases as they compare with domestic violence police reports from non-strangulation cases. Results highlight the gendered nature of strangulation as well as the importance of practitioners and researchers critically reflecting on issues within the criminal justice system in an effort to redress inadequacies, hold offenders accountable, and save lives.
Acceptance of technology-based tools in a sample of Parkinson’s patients
Authors: Duroseau Nathalie , Abramson Tobi , Pergament Kathleen , Chan Vivian , Govindavari John Paul , Ciraco Christina , Tegay David , Krishnamachari Bhuma
Published: June 2016

Objectives

Parkinson’s disease is the second most common neurodegenerative movement disorder in the United States. Patients’ opinions of technology-based tools for education and communication as related to Parkinson’s disease are unclear with little documented research addressing the issue. The goal of this research was to investigate patient opinions about technology-based tools with a focus on differences between patients of different age groups.

Methods

A cross-sectional survey was used to assess views on using multiple different electronic methods for receiving instructions and communicating with healthcare providers in 109 Parkinson’s disease patients.

Results

Approximately 28% (n = 28) of the subjects reported having unmet needs related to Parkinson’s disease. Those 65 and over were less likely to believe that using technology to communicate with the healthcare center would result in themselves having a better understanding of their care (odds ratio = 0.36, 95% confidence interval: 0.14, 0.95). Those over 75 had a lower odds of being willing to use electronic methods (odds ratio = 0.33, 95% confidence interval: 0.14, 0.79), a lower odds of believing that technology would result in better self-understanding of medical needs (odds ratio = 0.27, 95% confidence interval: 0.12, 0.63) and a lower odds of believing that technology would result in their healthcare providers better understanding their needs (odds ratio = 0.32, 95% confidence interval: 0.14, 0.73).

Discussion

The results of this study indicate that older Parkinson’s disease patients report a less favorable view regarding the role of technology in communicating with healthcare providers and for understanding their care.
New Directions in Law and Narrative
Authors: Wharton Robin , Miller Derek
Published: June 2016

This commentary assesses the state of scholarship on law and narrative and argues for a more holistic approach to the topic. Narrative and law do not encounter each other accidentally but are ineluctably intertwined. Law is a dominant narrative form in the modern world; narrative suffuses not just testimony but all legal practice. We urge scholarship that recognizes law and narrative as part of the same socio-cultural project of making the world.
Assessment of hydrothermal performance by thermophysical characterization of a crimped glass wool building insulation
Authors: Marmoret Laurent
Published: June 2016

There is a need for experimental determination of thermophysical properties to bridge the gap between theoretically prediction and performance of insulating materials in buildings. This investigation concerns the study of hydrothermal performance of glass wool, a widely used insulation on the world market. It has been shown the low sensitivity of glass wool to water vapor, low hygroscopicity, and low permeability. On the other hand, the liquid permeability of glass wool is important. Obviously, the presence of liquid is generally accidental and should be prevented by good workmanship. Thermal characterization (conductivity and diffusivity) by hot disk, a transient technique, has been determined as a function of water. The effect of vapor phase water on thermal properties is not significant. Thermal conductivity increases by a factor 2 when liquid water is present in the insulation. It is shown that the hot disk method is useful to determine thermal characterization of insulation materials. Variations of thermal conductivity with water content have been explained from hydric characterization.
The memorial at Srebrenica: Gender and the social meanings of collective memory in Bosnia-Herzegovina
Authors: Jacobs Janet
Published: June 2016

This research examines the way in which the collective memory of the 1990s conflict in Bosnia-Herzegovina has been established and preserved at the memorial to genocide at Srebrenica. Based on extensive fieldwork at the site and in other regions of Bosnia-Herzegovina, the study explores the ways in which gender is represented at Srebrenica in the narratives and texts that commemorate Serbian aggression against Bosnian Muslim populations. Within the structures of memory that Srebrenica represents, the findings reveal the ways in which fathers and sons are recalled as victims of Serbian genocide and the importance of maternal tropes of memory for post-war nation building. Furthermore, the study reveals the absence of a rape discourse in the memorialization of war and genocide in Bosnia-Herzegovina and the challenges of commemorating sexual atrocities in the aftermath of mass trauma. The work that is presented here contributes to the emerging literature on gender and collective memory and the ways in which women’s experiences are represented in structures of memorialization.
Use of the My Health Record by people with communication disability in Australia
Authors: Hemsley Bronwyn , Georgiou Andrew , Carter Rob , Hill Sophie , Higgins Isabel , van Vliet Paulette , Balandin Susan
Published: June 2016

Background:

People with communication disability often struggle to convey their health information to multiple service providers and are at increased risk of adverse health outcomes related to the poor exchange of health information.

Objective:

The purpose of this article was to (a) review the literature informing future research on the Australian personally controlled electronic health record, ‘My Health Record’ (MyHR), specifically to include people with communication disability and their family members or service providers, and (b) to propose a range of suitable methodologies that might be applied in research to inform training, policy and practice in relation to supporting people with communication disability and their representatives to engage in using MyHR.

Method:

The authors reviewed the literature and, with a cross-disciplinary perspective, considered ways to apply sociotechnical, health informatics, and inclusive methodologies to research on MyHR use by adults with communication disability.

Research outcomes:

This article outlines a range of research methods suitable for investigating the use of MyHR by people who have communication disability associated with a range of acquired or lifelong health conditions, and their family members, and direct support workers.

Conclusion:

In planning the allocation of funds towards the health and well-being of adults with disabilities, both disability and health service providers must consider the supports needed for people with communication disability to use MyHR. There is an urgent need to focus research efforts on MyHR in populations with communication disability, who struggle to communicate their health information across multiple health and disability service providers. The design of studies and priorities for future research should be set in consultation with people with communication disability and their representatives.
Evaluation of the Performance of a Novel System for Continuous Glucose Monitoring
Authors: Zschornack Eva , Schmid Christina , Pleus Stefan , Link Manuela , Klötzer Hans-Martin , Obermaier Karin , Schoemaker Michael , Strasser Monika , Frisch Gerhard , Schmelzeisen-Redeker Günther , Haug Cornelia , Freckmann Guido
Published: June 2016

Background:

The performance of a continuous glucose monitoring (CGM) system in the early stage of development was assessed in an inpatient setting that simulates daily life conditions of people with diabetes. Performance was evaluated at low glycemic, euglycemic, and high glycemic ranges as well as during phases with rapid glucose excursions.

Methods:

Each of the 30 participants with type 1 diabetes (15 female, age 47 ± 12 years, hemoglobin A1c 7.7% ± 1.3%) wore two sensors of the prototype system in parallel for 7 days. Capillary blood samples were measured at least 16 times per day (at least 15 times per daytime and at least once per night). On two subsequent study days, glucose excursions were induced. For performance evaluation, the mean absolute relative difference (MARD) between CGM readings and paired capillary blood glucose readings and precision absolute relative difference (PARD), i.e., differences between paired CGM readings were calculated.

Results:

Overall aggregated MARD was 9.2% and overall aggregated PARD was 7.5%. During induced glucose excursions, MARD was 10.9% and PARD was 7.8%. Lowest MARD (8.5%) and lowest PARD (6.4%) were observed in the high glycemic range (euglycemic range, MARD 9.1% and PARD 7.4%; low glycemic range, MARD 12.3% and PARD 12.4%).

Conclusions:

The performance of this prototype CGM system was, particularly in the hypoglycemic range and during phases with rapid glucose fluctuations, better than performance data reported for other commercially available systems. In addition, performance of this prototype sensor was noticeably constant over the whole study period. This prototype system is not yet approved, and performance of this CGM system needs to be further assessed in clinical studies.
Susceptibility of Interstitial Continuous Glucose Monitor Performance to Sleeping Position
Authors: Mensh Brett D. , Wisniewski Natalie A. , Neil Brian M. , Burnett Daniel R.
Published: June 2016

Background:

Developing a round-the-clock artificial pancreas requires accurate and stable continuous glucose monitoring. The most widely used continuous glucose monitors (CGMs) are percutaneous, with the sensor residing in the interstitial space. Inaccuracies in percutaneous CGM readings during periods of lying on the devices (e.g., in various sleeping positions) have been anecdotally reported but not systematically studied.

Methods:

In order to assess the impact of sleep and sleep position on CGM performance, we conducted a study in human subjects in which we measured the variability of interstitial CGM data at night as a function of sleeping position. Commercially available sensors were placed for 4 days in the abdominal subcutaneous tissue in healthy, nondiabetic volunteers (four sensors per person, two per side). Nocturnal sleeping position was determined from video recordings and correlated to sensor data.

Results:

We observed that, although the median of the four sensor readings was typically 70–110 mg/dl during sleep, individual sensors intermittently exhibited aberrant glucose readings (>25 mg/dl away from median) and that these aberrant readings were strongly correlated with subjects lying on the sensors. We expected and observed that most of these aberrant sleep-position-related CGM readings were sudden decreases in reported glucose values, presumably due to local blood-flow decreases caused by tissue compression. Curiously, in rare cases, the aberrant CGM readings were elevated values.

Conclusions:

These findings highlight limitations in our understanding of interstitial fluid physiology in the subcutaneous space and have significant implications for the utilization of sensors in the construction of an artificial pancreas.
Clinical Inertia during Postoperative Management of Diabetes Mellitus: Relationship between Hyperglycemia and Insulin Therapy Intensification
Authors: Coan Kathryn E. , Schlinkert Andrew B. , Beck Brandon R. , Haakinson Danielle J. , Castro Janna C. , Apsey Heidi A. , Schlinkert Richard T. , Cook Curtiss B.
Published: June 2016

Objective:

Our objective was to assess the application of insulin regimens in surgical postoperative patients with diabetes.

Methods:

A chart review was conducted of patients with diabetes who were hospitalized postoperatively between January 1 and April 30, 2011. Analysis was restricted to patients hospitalized for ≥3 days and excluded cases with an endocrinology consult. Insulin regimens were categorized as “basal plus short acting,” “short acting only,” or “none,” and the pattern of use was evaluated by hyperglycemia severity according to tertiles of both mean glucose and the number of glucose measurements >180 mg/dl.

Results:

Among cases selected for analysis ( n = 119), examination of changes in insulin use based on tertiles of mean glucose showed that use of basal plus short-acting insulin increased from 10% in the lowest tertile (mean glucose, 120 mg/dl) to 18% in the highest tertile (mean glucose, 198 mg/dl; p < .01); however, 70% of patients in the highest tertile continued to receive short-acting insulin only, with 12% receiving no insulin. Intensification of insulin to a basal plus short-acting regimen was also seen when changes were evaluated by the number of measurements >180 mg/dl ( p < .01), but 70% and 12% of patients in the highest tertile still remained only on short-acting insulin or received no insulin, respectively.

Conclusions:

Use of basal plus short-acting insulin therapy increased with worsening hyperglycemia, but many cases did not have therapy intensified to the recommended insulin regimen—evidence of clinical inertia. Strategies should be devised to overcome inpatient clinical inertia in the treatment of postoperative patients with diabetes.
PREDIRCAM eHealth Platform for Individualized Telemedical Assistance for Lifestyle Modification in the Treatment of Obesity, Diabetes, and Cardiometabolic Risk Prevention: A Pilot Study (PREDIRCAM 1 >
Authors: González Cintia , Herrero Pau , Cubero José M. , Iniesta José M. , Hernando M. Elena , García-Sáez Gema , Serrano Alvaro J. , Martinez-Sarriegui Iñaki , Perez-Gandia Carmen , Gómez Enrique J. , Rubinat Esther , Alcantara Valeria , Brugués Eulalia , Chico Ana , Mato Eugenia , Bell Olga , Corcoy Rosa , de Leiva Alberto
Published: June 2016

Background:

Healthy diet and regular physical activity are powerful tools in reducing diabetes and cardiometabolic risk. Various international scientific and health organizations have advocated the use of new technologies to solve these problems. The PREDIRCAM project explores the contribution that a technological system could offer for the continuous monitoring of lifestyle habits and individualized treatment of obesity as well as cardiometabolic risk prevention.

Methods:

PREDIRCAM is a technological platform for patients and professionals designed to improve the effectiveness of lifestyle behavior modifications through the intensive use of the latest information and communication technologies. The platform consists of a web-based application providing communication interface with monitoring devices of physiological variables, application for monitoring dietary intake, ad hoc electronic medical records, different communication channels, and an intelligent notification system. A 2-week feasibility study was conducted in 15 volunteers to assess the viability of the platform.

Results:

The website received 244 visits (average time/session: 17 min 45 s). A total of 435 dietary intakes were recorded (average time for each intake registration, 4 min 42 s ± 2 min 30 s), 59 exercises were recorded in 20 heart rate monitor downloads, 43 topics were discussed through a forum, and 11 of the 15 volunteers expressed a favorable opinion toward the platform. Food intake recording was reported as the most laborious task. Ten of the volunteers considered long-term use of the platform to be feasible.

Conclusions:

The PREDIRCAM platform is technically ready for clinical evaluation. Training is required to use the platform and, in particular, for registration of dietary food intake.
Importance of Manually Entering Blood Glucose Readings When Wireless-Compatible Meters are Not Being Used with an Insulin Pump
Authors: Driscoll Kimberly A. , Johnson Suzanne Bennett , Wang Yuxia , Gill Elizabeth C. , Mitchell Adela , Wright Nancy , Deeb Larry C.
Published: June 2016

Background:

The objective was to determine if there were differences in blood glucose monitoring (BGM) data downloaded from insulin pumps of patients who use meters that wirelessly transmit data to their insulin pumps (i.e., wireless group) and those who do not (i.e., nonwireless group).

Methods:

Blood glucose monitoring data were downloaded from the meters and insulin pumps of 47 children and adolescents with type 1 diabetes mellitus. Independent and paired t tests compared BGM data downloaded from meters and BGM data downloaded from insulin pumps.

Results:

There were significant differences in BGM data downloaded from the insulin pumps of patients using wireless meters compared to those using nonwireless meters. Wireless patients appeared to engage in more BGM, had more low and in-range BG readings and fewer very high BG readingss than nonwireless patients. However, a comparison of BGM data downloaded from meters and insulin pumps of nonwireless patients indicated that their insulin pump data significantly underestimated the number of BGM readings conducted, as well as the number of low and in-range readings, while overestimating the number of very high BGM readings.

Conclusions:

Because patients who use nonwireless-compatible meters do not manually enter their low and in-range BGM readings into the insulin pump, BGM data downloaded only from pumps may provide an incomplete representation of BGM frequency or results. It is recommended that patients use meters that directly communicate with pumps or perform bolus calculations. Patients should be educated about the importance of manually entering all BGM readings if they do not use a wireless-compatible meter with their insulin pump.
A Composite Model of Glucagon-Glucose Dynamics for In Silico Testing of Bihormonal Glucose Controllers
Authors: Herrero Pau , Georgiou Pantelis , Oliver Nick , Reddy Monika , Johnston Desmond , Toumazou Christofer
Published: June 2016

Background:

The utility of simulation environments in the development of an artificial pancreas for type 1 diabetes mellitus (T1DM) management is well established. The availability of a simulator that incorporates glucagon as a counterregulatory hormone to insulin would allow more efficient design of bihormonal glucose controllers. Existing models of the glucose regulatory system that incorporates glucagon action are difficult to identify without using tracer data. In this article, we present a novel model of glucagon-glucose dynamics that can be easily identified with standard clinical research data.

Methods:

The minimal model of plasma glucose and insulin kinetics was extended to account for the action of glucagon on net endogenous glucose production by incorporating a new compartment. An existing subcutaneous insulin absorption model was used to account for subcutaneous insulin delivery. The same model of insulin pharmacokinetics was employed to model the pharmacokinetics of subcutaneous glucagon absorption. Finally, we incorporated an existing gastrointestinal absorption model to account for meal intake. Data from a closed-loop artificial pancreas study using a bihormonal controller on T1DM subjects were employed to identify the composite model. To test the validity of the proposed model, a bihormonal controller was designed using the identified model.

Results:

Model parameters were identified with good precision, and an excellent fitting of the model with the experimental data was achieved. The proposed model allowed the design of a bihormonal controller and demonstrated its ability to improve glycemic control over a single-hormone controller.

Conclusions:

A novel composite model, which can be easily identified with standard clinical data, is able to account for the effect of exogenous insulin and glucagon infusion on glucose dynamics. This model represents another step toward the development of a bihormonal artificial pancreas.
Analysis of Intravenous Glucose Tolerance Test Data Using Parametric and Nonparametric Modeling: Application to a Population at Risk for Diabetes
Authors: Marmarelis Vasilis Z. , Shin Dae C. , Zhang Yaping , Kautzky-Willer Alexandra , Pacini Giovanni , D'Argenio David Z.
Published: June 2016

Background:

Modeling studies of the insulin-glucose relationship have mainly utilized parametric models, most notably the minimal model (MM) of glucose disappearance. This article presents results from the comparative analysis of the parametric MM and a nonparametric Laguerre based Volterra Model (LVM) applied to the analysis of insulin modified (IM) intravenous glucose tolerance test (IVGTT) data from a clinical study of gestational diabetes mellitus (GDM).

Methods:

An IM IVGTT study was performed 8 to 10 weeks postpartum in 125 women who were diagnosed with GDM during their pregnancy [population at risk of developing diabetes (PRD)] and in 39 control women with normal pregnancies (control subjects). The measured plasma glucose and insulin from the IM IVGTT in each group were analyzed via a population analysis approach to estimate the insulin sensitivity parameter of the parametric MM. In the nonparametric LVM analysis, the glucose and insulin data were used to calculate the first-order kernel, from which a diagnostic scalar index representing the integrated effect of insulin on glucose was derived.

Results:

Both the parametric MM and nonparametric LVM describe the glucose concentration data in each group with good fidelity, with an improved measured versus predicted r2 value for the LVM of 0.99 versus 0.97 for the MM analysis in the PRD. However, application of the respective diagnostic indices of the two methods does result in a different classification of 20% of the individuals in the PRD.

Conclusions:

It was found that the data based nonparametric LVM revealed additional insights about the manner in which infused insulin affects blood glucose concentration.
Evaluation of a Blood Glucose Monitoring System with Automatic High- and Low-Pattern Recognition Software in Insulin-Using Patients: Pattern Detection and Patient-Reported Insights
Authors: Grady Mike , Campbell Denise , MacLeod Kirsty , Srinivasan Aparna
Published: June 2016

Background:

This study aimed to evaluate the performance of a glucose pattern recognition tool incorporated in a blood glucose monitoring system (BGMS) and its association with clinical measures, and to assess user perception and understanding of the pattern messages they receive.

Methods:

Participants had type 1 or type 2 diabetes mellitus and were self-adjusting insulin doses for ≥1 year. During a 4-week home testing period, participants performed ≥6 daily self-tests, adjusted their insulin regimen based on BGMS results, and recorded pattern messages in the logbook. Participants reflected on usability of the pattern tool in a questionnaire.

Results:

Study participants ( n = 101) received a mean ± standard deviation of 4.5 ± 1.9 pattern messages per week (3.6 ± 1.8 high glucose patterns and 0.9 ± 1.3 low glucose patterns). Most received ≥1 high (96.5%) and/or ≥1 low (46.0%) pattern message per week. The average number of high- and low-pattern messages per week was associated with higher and lower, respectively, baseline hemoglobin A1c ( p < .01) and fasting plasma glucose ( p < .05). Participants found high- and low-pattern messages clear and easy to understand (84.2% and 83.2%, respectively) and considered the frequency of low (82.0%) and high (63.4%) pattern messages about right. Overall, 71.3% of participants indicated they preferred to use a meter with pattern messages.

Conclusions:

The on-device Pattern tool identified meaningful blood glucose patterns, highlighting potential opportunities for improving glycemic control in patients who self-adjust their insulin.