bluuebunny/crossref_metadata_2025 huggingface dataset:
Public vs. Private: Time for an Honest Discussion That Could Benefit All Schools
Authors: DeBlois Robert
Published: March 2007

There are many worthwhile educational programs serving a cross section of students that have elements of both the public and private sectors. It might be very important for educators to correctly evaluate the nature of programs that cross between the public and private sectors and encourage honest debate about how they can work together to enhance education for all students.
Today Standards—Tomorrow Success
Authors: Romer Governor Roy
Published: March 2007

Preliminary results in Colorado imply that uniform standards not only raise student achievement, but also close gaps between various ethnic and socioeconomic groups. Setting standards, raising expectations, and assessing student progress in a meaningful way gives students the tools they need to thrive in the 21st century and the tools parents and teachers need to help them.
Are Academic Standards A Threat or an Opportunity?
Authors: Cross Christopher T. , Joftus Scott
Published: March 2007

According to Chinese philosophy, crisis and opportunity go hand in hand. The standards movement can be described as being in a state of crisis, a crucial time whose outcome will make a decisive difference for better or worse. On the one hand, a great deal of progress has been made; on the other, some of the standards-driven reforms represent significant threats to students, principals, and teachers.
The Standards Movement and The Emperor's New Clothes
Authors: Popham W. James
Published: March 2007

Then a small voice called out from the crowd, "But the emperor's not wearing new standards at all; he's wearing old objectives!"According to a classic but uncorroborated fairy tale, a ruler can be per suaded to parade around in the buff if he's made to believe he is wear ing wonderful but invisible garments. The moral of the fable, of course, is that a ruler is not apt to redress his state of undress unless some one forcefully informs him he's naked as a jaybird.
National and State Standards: The Problems and the Promise
Authors: Marzano Robert J. , Kendall John S.
Published: March 2007

How can schools, principals, and teachers address the daunting prob lem of implementing all the standards that have been promulgated in recent years? How can they ensure that their students are prepared to meet all the standards? Can it even be done?
Standards in the English Language Arts: Meeting the Challenge
Authors: Myers Miles
Published: March 2007

Literacy is one of the devices society uses to reproduce itself and to adapt to social changes. The form of literacy emphasized in schools is an effort to align school subjects with new markets and tools in the workplace, with processes of the electorate and democratic citizenship, and with family practices and personal growth.
Professional Development for Implementing Standards: Experimentation, Dilemma Management, and Dialogue
Authors: Monson Robert J. , Monson Michele Pahl
Published: March 2007

Many teachers struggle to develop an understanding of the purposes of standards and assessments. Are they tools to be used in the teaching process or are they measures of accountability? This dilemma is enhanced in states that provide loosely structured curricular frame works with curriculum standards while simultaneously holding high schools accountable for student performance standards through highly structured performance assessments.
Changing Roles: Coaching Models For Restructuring Schools
Authors: Kirby Peggy C. , Meza James
Published: March 2007

How do roles and relationships in schools change in restructuring schools? What problems are encountered by schools as a result of changing roles as schools attempt to implement restructuring? And how can the process be improved?
Kids Voting USA: Bringing Out the Vote
Authors: Golston Sydele E.
Published: March 2007

Kids Voting USA is a grassroots, community-driven voter education program. Educators will recognize the goals and methods of the Kids Voting USA curriculum not only in the service learning movement, but also in the character education agenda.
Florida Learn & Serve 1995-96: What Were the Outcomes?
Authors: Follman Joe , Muldoon Kate
Published: March 2007

This article is taken from a report on the second year of research on quantitative outcomes of K-12 students who participated in service learning projects in Florida in 1995-96. The study involved 29,000 students in 107 subgrants. It illustrates what one state has been able to accomplish.
Service Learning in Maryland: Making Academics More Relevant
Authors: Finney Marian Rouse
Published: March 2007

Maryland is the first state in the nation to require every student to per form service as a condition of receiving a high school diploma. During the last 15 years, a strong support system for service learning has emerged in Maryland. The diversity of opportunities for service are broad, challenging, and inviting.
Young Volunteers: Providing Service and Making An Impact on Communities
Authors: Marano Rocco
Published: March 2007

Service learning provides middle level and high school students with tremendous opportunities to grow and see firsthand the value of helping others. One program honoring volunteerism provides schools with the chance to develop role models for service and attract public recognition at the same time.
Obstacles to the Effective Teaching Of Writing: A 20-Year Follow-Up
Authors: Carter Ronnie D.
Published: March 2007

Has the effective teaching of writing changed for the better, remained much the same, or become worse in the last 20 years? Have the major obstacles to the effective teaching of writing been removed? This 20-year follow-up examines the question.
Student Reports of Time Spent on Homework: Results from 20 Years Of National Samples
Authors: Freedman-Doan Peter , Libsch Margaret
Published: March 2007

As part of the Monitoring the Future annual survey, researchers from the University of Michigan have been asking representative national samples of high school seniors about the number of hours they spend on homework each week. Here are the results for the past 20 years, from 1976 to 1995.
Expanding Learning Opportunities Through On-Line Technology
Authors: Gamas Warren , Nordquist Neil
Published: March 2007

Opportunities to include electronic collaboration tools such as e-mail, web documents, and discussion forums within traditional classroom instruction are expanding. These electronic collaboration tools are out comes of the networking technologies that have arisen during the 1990s. They serve both as alternatives to personal interactions of teachers and students and as an extension of traditional classroom instruction.
Using Technology To Overcome the Challenges of Diversity
Authors: Tipton Pamela E. , Bennett Christene K. , Bennett Jerry A.
Published: March 2007

Technology provides educators with tools to address equity and access issues, to accelerate students' linguistic and conceptual development, to provide support for students who learn in different ways, and to cre ate authentic and meaningful learning experiences.
A Virtual Schoolhouse: Creating On-Line Resources for Schools
Authors: Leddo John
Published: March 2007

There are limitations to many of the technologies that schools now use. Use of computer software is limited to what is physically present in the school. Many "broadcast" distance learning technologies require stu dents to be available at the time of the broadcast. Cable and televi sion-based programming has similar scheduling constraints and is not customized to the needs of a particular school, let alone the needs of a particular student. What can be done?
Nationa Educational Technology Standards: Developing New Learning Environments for Today's Classrooms
Authors: Bitter Gary , Thomas Lajeane , Knezek Donald G. , Friske Joyce , Taylor Harriet , Wiebe James , Kelly M.G.
Published: March 2007

Goals 2000 launched the nation on a course of school improvement through a process that focuses on high standards for student perfor mance and development of local, state, and national plans for their achievement. Technology has been specifically identified as an area that must be addressed in these school improvement plans.
Thinking and Learning with Technology: Helping Students Construct Meaning
Authors: Alvarez Marino C.
Published: March 2007

When students are given tasks and lessons that have defined outcomes, opportunities to pursue inquisitive paths of inquiry are diminished for both teachers and students. Providing lessons and assignments that require students to think about how technology can resolve their uncertainty is one way for them to construct meaning.
Prisoners of Time: Implementing a Block Schedule in the High School
Authors: Mistretta Gerald M. , Polansky Harvey B.
Published: March 2007

For the past 20 years educators have learned a great deal about how to improve student learning. For a variety of reasons educators have not put these theories into practice. One of the major obstacles has been the limitations imposed by time. The block schedule is an effort to modify that impediment.
Eavesdropping on Change: Listening to Teachers During the First Year of an Extended Block Schedule
Authors: Bruckner Martha
Published: March 2007

More and more high schools are moving to a block scheduling arrange ment, which results in longer and fewer classes each day. Changes in teaching strategies are essential to the success of such programs, for without significant revisions in classroom time use, block scheduling results in lengthy lectures or multiple lessons forged together, some times without logic.
The 4 x 4 Block Scheduling Model: What Do Students Have To Say About It?
Authors: Hurley J. Casey
Published: March 2007

High school leaders need to explore both the advantages and disad vantages of the 4 x 4 schedule. If this innovation is implemented with out discussion of how to ensure rigor while using time flexibly, it may be sabotaged by those who fear the disadvantages and question the advantages. This article and its companion piece examine what stu dents and teachers think about the block schedule.
Technology-Supported Change: A Staff Development Opportunity
Authors: Bradshaw Lynn K.
Published: March 2007

In spite of significant staff development in technology, implementation is difficult. Even when hardware and software are accessible, teachers must be skilled in the use of technology and in its application to the instructional program. Staff development that responds to teachers' concerns and provides follow-up support will increase the likelihood of implementation.
Quasi Nondestructive Elemental Analysis of Solid Surface in Liquid by Long-pulse Laser Ablation Plume Spectroscopy
Authors: Sakka Tetsuo , Oguchi Hisayuki , Masai Satoru , Ogata Yukio H
Published: March 2007

Emission spectroscopy of laser ablation plume can be applied to in situ elemental analysis of solid surface in liquid, especially if the laser pulse with the pulse width of 150 ns is used. The long nanosecond pulse not only suppresses the disadvantageous broadening and deformation of spectral line profiles usually observed when short nanosecond pulses are used but also greatly suppresses the material removal from analyte surfaces. The latter is also an important advantage for the application to surface analysis.
Effect of Intramolecular Hydrogen Bonding on Thermolysis of Dioxetane: Unusual Instability of Bicyclic Dioxetanes Bearing a Hydroxynaphthyl Group with Vicinal Substitution Pattern
Authors: Hoshiya Naoyuki , Watanabe Nobuko , Ijuin Hisako K , Matsumoto Masakatsu
Published: March 2007

Dioxetanes bearing a 1-hydroxynaphthalen-2-yl group 4(OH) or 2-hydroxynaphthalen-1-yl group 5(OH) were found to be significantly unstable thermally in contrast to their methoxynaphthyl-analogs 4(OME) and 5(OME). The marked instability of 4(OH) and 5(OH) was attributed to the intramolecular hydrogen bonding of a hydroxy group on the naphthalene ring.
Linear Complementarity as a General Solution Method to Combinatorial Problems
Authors: Di Giacomo Laura , Patrizi Giacomo , Argento Emanuele
Published: March 2007

This paper shows how many types of combinatorial problems can be embedded in continuous space and solved as nonconvex optimization problems. If the objective function and the constraints are linear, problems of this kind can be formulated as linear complementarity problems. An algorithm is presented to solve this type of problem and indicate its convergence properties. Computational comparisons are carried out using general solution codes.
Price as a Stimulus to Think: The Case for Willful Overpricing
Authors: Wathieu Luc , Bertini Marco
Published: March 2007

Consumers aware of a new benefit will often experience uncertainty about its personal relevance or usage value. This paper shows that the decision to deliberate further to resolve this uncertainty and reach a polarized judgment of personal relevance critically depends on the posted price. In particular, a price above the consumer’s initial willingness to pay might be thought provoking and enhance the perception of relevance with a certain probability. This behavioral mechanism is introduced formally and by way of an experiment with reference to the purchase of organic lettuce and fair-trade coffee. Accounting for the effect of price as a stimulus to think, a monopolistic firm should either over price (“transgressive pricing”) or under price (“regressive pricing”) in comparison to the consumer’s willingness to pay. Under certain circumstances, the firm should also empower consumers with means that reduce the effort of deliberation.
Cross-Market Network Effect with Asymmetric Customer Loyalty: Implications for Competitive Advantage
Authors: Chen Yuxin , Xie Jinhong
Published: March 2007

A cross-market network effect exists in many industries (e.g., newspaper publishing, media, software) in which a seller sells both a primary and a secondary product (e.g., a newspaper publisher sells newspapers to readers and advertising space to advertisers), and the value of the secondary product depends on the size of the user base of the primary product. This paper examines the competitive implications of asymmetric customer loyalty in such markets. In traditional markets, an advantage in customer loyalty generates a profit advantage. We show here, however, that in the presence of a cross-market network effect, a midlevel of loyalty advantage in the primary product market can lead to an overall profit disadvantage. This surprising result is derived from the interdependence of the two markets, whereby a profit in one market may be gained at the cost of the other, and by the positive relationship between a larger loyalty segment and a higher opportunity cost of price competition in the product of the primary market. Extending our model to a two-period entry game also shows that under certain conditions, the entrant with disadvantage in customer loyalty can outperform the incumbent in profit and market share. This result suggests that asymmetry in customer loyalty can be a source of “first-mover” advantage or disadvantage.
Multiple peroxisome proliferator-activated receptor β subtypes from Atlantic salmon (Salmo salar)
Authors: Leaver Michael J , Ezaz M Tariq , Fontagne Stephanie , Tocher Douglas R , Boukouvala Evridiki , Krey Grigorios
Published: March 2007

Peroxisome proliferator-activated receptors (PPARs) are ligand-activated transcription factors belonging to the nuclear hormone receptor superfamily that functions as critical regulators of lipid and energy homeostasis. Although intensively studied in mammals, their basic biological functions are still poorly understood. The objective of this work was to characterize PPARβ subtypes in a fish, the Atlantic salmon (Salmo salar), in order to address PPAR function and the regulation of lipid homeostasis in lower vertebrates. The screening of an Atlantic salmon genomic library revealed the presence of four genes for PPARβ subtypes. Based on comparisons of exons and exon-flanking regions, these genes were assigned into two families, ssPPARβ1 and ssPPARβ2, each family containing two isotypes: ssPPARβ1A and β1B and ssPPARβ2A and β2B. Two full-length cDNAs for ssPPARβ1A and ssPPPARβ2A were isolated. Transcripts for ssPPARβ1A and ssPPARβ2A have distinct tissue expression profiles, with ssPPARβ1A predominating in liver and ssPPARβ2A predominating in gill. Expression levels of mRNA of either isotypes were up to tenfold lower in kidney, heart, spleen, muscle, and brain. In cellular transfection assays, ssPPARβ1A is activated by monounsaturated fatty acids, 2-bromopalmitate, and mammalian PPARβ-specific ligand GW501516. In contrast, PPARβ2A was not activated by any of the compounds tested. Furthermore, ssPPARβ2A repressed both the basal reporter gene activity and the GW501516-induced activity of ssPPARβ1A. The results indicate unexpected levels of variety and complexity in PPAR subtype and mechanism of action in lower vertebrates.
Performance of Technical Skills of Diabetes Management: Increased Independence After a Camp Experience
Authors: Lebovitz Francine L , Ellis George J , Skyler Jay S
Published: March 2007

This study examines some educational effects of a camp experience on independent performance of tasks in the management of diabetes mellitus. One hundred and eleven children were studied with regard to insulin administration, urine glucose testing, recognition of hypoglycemic reactions, adherence to diet, and over-all independence. There was a significant increase in independent measurement of insulin dose, administration of insulin injections, and urine glucose testing. No significant differences were seen in dietary adherence or ability to recognize hypoglycemic reactions. Precamp data indicated that returning campers demonstrated greater independence in insulin administration prior to camp than did new campers. After camp, both new and returning campers showed significant increases in independent performance of dose measurement and injection. It is concluded that a camp educational experience contributes to both the knowledge and performance of self-care techniques required in the management of diabetes mellitus.
On Materials for Testing Glucose in the Urine
Authors: Kohler Elaine ,   The Committee on Materials and Therapeutic Agents, American Diabetes Association
Published: March 2007

Semiquantitative methods for measurement of glucose in the urine are useful for monitoring glucose homeostasis in subjects with diabetes mellitus where quantitative blood and urine glucose measurements are not available. The use of a “plus” scale for glucose measurement is confusing because the same plus values are assigned to different quantities of glucose with different methods. The two-drop Clinitest method is the most quantifiable and readable test for urine sugar, particularly if there is high sugar spill. Therefore, it is the most useful method for monitoring insulin-dependent juvenile diabetes. Its major disadvantages are its potential toxicity, the cumbersome methodology, the cost, and the possibility of interference from other reducing substances. The enzyme “dipstick” methods are most sensitive for detecting the presence of glucose. Among the available “dipstick ” methods, Diastix is the most quantifiable and readable. These methods are inhibited by the presence of ketones and a number of other substances. Tes-Tape is the least expensive and, where there are inhibiting substances, the most useful, because it can be read at the liquid front where the glucose reaction is chromatographically separated. Clinistix and Chemstrip are essentially screening methods for the presence of glucose and not useful for quantification. Basing therapy on these and other plus values is irrational and should be discontinued.
Home Blood Glucose Monitoring As an Aid in Diabetes Management
Authors: Skyler Jay S , Lasky Ilene A , Skyler Denise L , Robertson Euan G , Mintz Daniel H
Published: March 2007

Home blood glucose monitoring, using Dextrostix and an Eyetone meter, has been utilized in several subcategories of patients with insulin-dependent diabetes mellitus. These include pregnant patients, anephric patients, patients undergoing weight reduction, patients with altered renal threshold for glucose reabsorption, and patients in whom diabetic regulation is difficult. Patients monitored home blood glucose continually (on a daily basis), intermittently, or only for particular problems or symptoms. Such monitoring can be practically accomplished in a manner acceptable to patients. Motivation, compliance with protocol, and an understanding of the objectives of the program are essential on the part of the patient. Home blood glucose monitoring, however, can provide an insight diabetes regulation that cannot be attained in any other way and can greatly facilitate regulation of diabetes. Such home blood glucose monitoring may increase the likelihood of achievement of a degree of control approximating euglycemia.
Service and Education for the Insulin-dependent Child
Authors: Hoffman Willaim H , O'Neill Peeg , Khoury Catherine , Bernstein Samuel S
Published: March 2007

A pilot program of service and education was designed to actively involve the inner-city, insulin-dependent child in his own diabetes management. Atelephone service for questions and advice, managed by a pediatric nurse specialist, was responsible for a significant reduction in hospital admissions. The project was enthausiastically received and utilized by inner-city residents and resulted in an increased referral rate from the entire metropolitan area.
Birth of a Clearinghouse
Authors: Lipsett Lois F
Published: March 2007

In 1976 the National Commission on Diabetes recommended the establishment of a diabetes information and education clearinghouse on a national level. This undertaking was initiated by the Director, National Institute of Arthritis, Metabolism, and Digestive Diseases, National Institutes of Health, and plans were developed in 1977. Printed diabetes materials for patients, professionals, and the public are being gathered and will be annotated and then published as subject bibliographies. In addition, The Diabetes Clearinghouse will coordinate and encourage diabetes-related education and information activities and efforts throughout the United States.
Current Patterns of Neonatal Morbidity and Mortality in Infants of Diabetic Mothers
Authors: Gabbe Steven G , Lowensohn Richard I , Wu Paul Y , Guerra Guerra
Published: March 2007

Recent advances in antepartum fetal evaluation have contributed to a marked reduction in fetal deaths in pregnancies complicated by overt diabetes mellitus. To determine the effect of these changes on neonatal morbidity and mortality, a retrospective analysis of complications in 322 infants of diabetic mothers (IDM) in White classes B–R was undertaken. The majority (89 per cent) of the IDM were delivered at term with a mean gestational age of 38 weeks. Neonatal morbidity correlated significantly with gestational age, occurring in 80 per cent of the preterm and 40 per cent of the term infants. The overall incidence of complications was: hyperbilirubinemia 37 per cent, hypoglycemia 31 per cent, hypocalcemia 13 per cent, polycythemia 8 per cent, and necrotizing enterocolitis 2 per cent. Respiratory distress syndrome (RDS) occurred in 9 per cent and congenital malformations in 6 per cent of the infants. Nine infants died, and four of these deaths were due to anomalies. These data indicate that (1) a reduction in fetal mortality has been accompanied by a reduction in neonatal mortality; (2) neonatal morbidity has been decreased but remains significant in the IDM; and (3) congenital anomalies have replaced RDS as a major cause of neonatal death for the IDM.
Neonatal Morbidity Among Infants of Diabetic Mothers
Authors: Soler Norman G , Soler Susan M , Malins John M
Published: March 2007

While the modern approach to management of diabetic pregnancy has reduced the perinatal mortality significantly, the neonatal morbidity remains high. This study has investigated factors which may account for the persisting high neonatal morbidity when birth trauma has been virtually eliminated and the incidence of respiratory distress syndrome (RDS) considerably reduced. Major congenital malformations emerge not only as the leading cause of perinatal losses but also as an important cause of morbidity. Delivery before 37 weeks increased the incidence of RDS and hypocalcemia, and it is suggested that, when strict metabolic control is used and with the help of facilities to monitor the fetus closely in the last weeks of pregnancy, the number of infants delivered at this early date can be further reduced. The present study also indicates that normoglycemia should also be encouraged on the day of delivery as maternal hyperglycemia at this stage increases the incidence of neonatal hypoglycemia. Jaundice, which very commonly affects newborn infants of diabetic mothers, is influenced by the use of oxytocin for vaginal delivery and by infant overweight (> 90th percentile) at birth, factors which are not beyond control. Finally, route of delivery per se may not be important in relation to neonatal morbidity.
Vibration Sensory Thresholds Depend On Pressure of Applied Stimulus
Authors: Lowenthal Leslie M , Derek T , Hockaday R
Published: March 2007

Vibration sensory thresholds (VSTs) were estimated in 40 healthy subjects and 8 with diabetic peripheral neuropathy. A vibrameter and a biothesiometer were used at four sites and at differing pressures. In normal subjects, with the vibrameter at 200 g, mean VST ± SE for all sites was 1.87 μm ± 0.22 and at 400 g dropped to 1.08 μm ± 0.15 (P < .0001). In 20 of these subjects with a biothesiometer at 200 and 400 g, mean VST fell from 12.8 ± 1.5 to 11.1 ± 1.1 (arbitrary units) (P = .01) when the greater pressure was applied. In the 8 subjects with peripheral neuropathy, with the vibrameter at 200 and 400 g, respectively, mean VST fell from 70.7 ± 26 to 7.2 ± 1.8. VST in these subjects was estimated again after 1 mo and showed strong correlations with the previous values. Biothesiometer results correlated with vibrameter results at all sites. Thus, VST decreases as the pressure of the applied stimulus is increased and this effect appears to be more marked in peripheral neuropathy. This has important consequences in monitoring this condition.
Prevalence of Fasting Hyperglycemia and Known Non-Insulin-Dependent Diabetes Mellitus Classified by Plasma C-Peptide: Fredericia Survey of Subjects 60–74 Yr Old
Authors: Damsgaard Else M , Faber Ole K , Frøland Anders , Green Anders , Hauge Mogens , Holm Niels V , Iversen Steffen
Published: March 2007

A Danish population of 5699 individuals (60–74 yr old) was screened by fasting blood glucose (FBG) and interviewed about known diabetes. The distribution of FBG in individuals not known to have diabetes showed no sex difference or significant variation with age. Fasting hyperglycemia (FH), defined as FBG ≥ 7 mM in subjects without a history of diabetes, was found in 1.7% of men and women. Known diabetes (KD) had a prevalence of 3.9 and 5.0% in men and women, respectively. The prevalence rates of FH and KD increased significantly with age. In the two subgroups, plasma C-peptide was measured after overnight fasting and subsequently 6 min after an intravenous injection of glucagon. Based on the distribution of the C-peptide concentrations in non-insulin-treated KD subjects, lower limits for non-insulin-dependent diabetes mellitus (NIDDM) of 0.30 pmol/ml for fasting C-peptide and 0.60 pmol/ml for stimulated C-peptide were arbitrarily chosen. According to these cutoff points, only 38.5% of KD subjects treated with insulin had insulin-dependent diabetes mellitus, corresponding to 9.3% of all KD subjects. After exclusion of these patients, the prevalence of recognized NIDDM was 3.5% in men and 4.5% in women. All FH subjects except one had C-peptide values in the NIDDM interval. A close agreement between fasting and glucagon-stimulated C-peptide was seen. In epidemiological studies with an expected high prevalence of NIDDM, we propose to use fasting C-peptide for classification of patients with insulin-treated diabetes.
Changes in Insulin Resistance With Long-Term Insulin Therapy
Authors: Sharp Patrick S , Mohan Viswanathan , Vitelli Federico , Maneschi Franco , Kohner Eva M
Published: March 2007

Thirteen newly diagnosed diabetic subjects, 5 with insulin-dependent diabetes mellitus (IDDM) and 8 with non-insulin-dependent diabetes mellitus, mean age 37.1 yr (range 25–64 yr), underwent glucose-clamp studies at diagnosis of diabetes at plasma glucose 200 mg/dl. Each subject was then treated twice daily with insulin for 6 mo with improvement in glycemic control, and the glucose-clamp studies repeated. Changes in glucose uptake at an insulin infusion rate of 1.0 mU · kg−1 · min−1 varied greatly from diagnosis to 6 mo. There were significant negative correlations between change in glucose uptake and diabetes type (r = −.78, P < .002), C-peptide secretion (r = −.66, P < .05), and age (r = −.62, P < .05). At an insulin infusion rate of 10 mU · kg−1 · min−1 there was improvement in glucose uptake from diagnosis to 6 mo that did not reach statistical significance. During the steady-state periods of the glucose-clamp studies at diagnosis, growth hormone (GH) rose above basal, which reached statistical significance at the higher insulin infusion rate. This increase in GH was not apparent at the time of the glucose-clamp studies after insulin therapy. Our results indicate that in the clinical situation, only patients with IDDM can expect an improvement in their sensitivity to physiologic insulin levels with long-term insulin therapy. In all subjects, improvement in glycemic control leads to abolition of GH secretion in the presence of hyperglycemia.
Effects of Relaxation Therapy on Patients With Type I Diabetes Mellitus
Authors: Feinglos Mark N , Hastedt Priscilla , Surwit Richard S
Published: March 2007

We investigated the effect of treatment with biofeedback-associated progressive muscle relaxation on 10 patients with poorly controlled type I diabetes mellitus compared with 10 equivalent untreated patients. In contrast to previous studies of patients with type II diabetes, no improvement occurred in glucose tolerance after 1 wk of intensive in-hospital relaxation training or in glycohemoglobin and total daily insulin dose after 6 wk of practicing relaxation techniques at home. This and other studies suggest that this type and amount relaxation therapy may not be as useful for enhancing blood glucose control in patients with type I diabetes as in those with type II diabetes. However, subpopulations of type I diabetic patients who have demonstrated stress-induced hyperglycemia should be further investigated.
Hyperbaric Oxygen in Diabetic Gangrene Treatment
Authors: Baroni Giancarlo , Porro Tommaso , Faglia Ezio , Pizzi Gianluigi , Mastropasqua Arturo , Oriani Giorgio , Pedesini Giorgio , Favales Favales
Published: March 2007

We treated a group of 18 hospitalized adult diabetic patients (all with retinopathy, 17 with symptomatic neuropathy, and 6 with macroangiopathy) presenting with gangrenous lesions of the foot by a combined regime consisting of strict metabolic control, daily debridement of necrotic tissues, and daily hyperbaric oxygen (HBO) treatments given in a multiplace oxygen chamber. Another group of 10 adult subjects with comparable foot lesions (all with retinopathy, 9 with symptomatic neuropathy, and 4 with macroangiopathy) was treated in exactly the same way except for HBO. In the test treatment group, 16 patients were healed, and the remaining 2 showed no improvement and later underwent amputation.

The number of HBO treatments required for healing was significantly related to the size of gangrenous lesions. In the non-HBO-treated group, only 1 patient improved, 5 of 10 showed no change, and 4 of 10 worsened until leg amputation was unavoidable. Comparison of the two groups by X2-test revealed a highly significant difference (P = .001). In practical terms, HBO treatment drastically reduced leg amputations in patients so treated in the last 3 yr compared with earlier and current figures for patients not receiving HBO treatment.
Black West Indian and Matched White Diabetics in Britain Compared With Diabetics in Jamaica: Body Mass, Blood Pressure, and Vascular Disease
Authors: Kennedy Cruickshank J , Alleyne Sylvan A
Published: March 2007

This study was designed to compare the prevalence of obesity, high blood pressure, diabetic vascular disease, and risk factors 1) in Black West Indians who had emigrated to Britain (WIB) with those in Whites in England and 2) among diabetic Jamaicans in Jamaica. Seventy-seven consecutive WIB patients were matched for age, sex, known duration of diabetes, and type of treatment of diabetes with 74 Whites from the same diabetes clinic in England. In Jamaica, a systematic random sample (95 women, 36 men) was studied. There was no difference in age at diagnosis between WIBs and Jamaicans.

Effort chest pain (possible angina) was less frequent in WIBs (9%) or Jamaicans (3%) than in Whites (25%). Cigarette smoking was more common in WIBs than in Whites but still low in Jamaicans. Body mass index was greatest in WIB women (85%), significantly more than in matched White (52%) or Jamaican women (45%); 40% of White men and WIB men were obese, significantly more than Jamaicans (15% obese). Systolic blood pressure was similar, but diastolic blood pressure was significantly greater in WIBs than in matched White subjects. The prevalence of casual hypertension was high (>40%) in all groups, often despite treatment.

Cataracts were significantly more frequent in WIB and Jamaican groups than in Whites. Total background retinopathy after correcting for duration of diabetes did not differ between groups, and there were no significant differences in other complication rates. Levels of HbA1 were lower in Whites than in the other groups. Regression analysis showed that systolic blood pressure was most consistently related to complications, particularly retinopathy, independent of ethnic group and duration.

These results suggest variation in large-vessel rather than small-vessel disease between groups and that high blood pressure and obesity remain the major challenges to management.
Less Expensive, Reliable Blood Glucose Self-Monitoring
Authors: Spraul Maximilian , Sonnenberg Gabriele E , Berger Michael
Published: March 2007

We examined the reliability of split test strips for blood glucose self-monitoring. One hundred visual readings were performed with each of the following test strips: original Haemoglukotest 20–800 (HGT 1/1; Boehringer-Mannheim, Mannheim, FRG) and Haemoglukotest 20–800 halved either by a splitting device (HGT 1/2 SP) or by a pair of scissors (HGT 1/2 SC). Within the plasma glucose range of 20–360 mg/dl, there was a close correlation between the results of all three test-strip readings and the values obtained by the reference method (Beckman glucose analyzer): HGT 1/1, r = .950; HGT 1/2 SP, r = .966; and HGT 1/2 SC, r = .966. Absolute deviations from the reference values were 17 ± 2, 17 ± 1, and 17 ± 1 mg/dl (mean ± SE). Analysis of variance did not reveal any significant differences between the values of each of the three procedures compared with the reference method (P = .98). These results indicate that visual reading of split test strips is as reliable as the reading of original test strips. A special splitting device is not necessary. Diabetic patients should be advised to use split test strips for blood glucose self-monitoring to reduce costs.
Home Monitors of Blood Glucose: Comparison of Precision and Accuracy
Authors: North Donald S , Steiner Joseph F , Woodhouse Kellie Murphy , Maddy James A
Published: March 2007

Home monitors of blood glucose (HMBGs) are gaining acceptance as part of the standard of care for ambulatory self-monitoring and treatment of diabetic patients. Currently there are several HMBGs marketed in the United States, each claiming reliability, accuracy, and “user friendliness,” with most of these claims largely unsubstantiated. The objective of our study was to analyze and statistically compare the accuracy and precision of the HMBGs produced by the major competitors in this everexpanding medical field. Accuracy of each monitor was studied by comparing the glucose value reported by each HMBG with that determined by a reference method (YSI 23A). Precision or reproducibility of results was performed by testing a single, known whole-blood glucose sample 20 times on each monitor. The precision of each device was tested on known low, normal, and elevated samples. Actual and absolute deviations from the reference standard demonstrate that the Accuchek bG and Glucoscan 2000 monitors provide relatively unbiased estimates of blood glucose, whereas the Glucokey, Glucochek II, Glucometer II, and Trendsmeter generally underestimate the true values. The Diascan and Accuchek II monitors, in a separate evaluation, demonstrated acceptable accuracy and precision. We conclude that the Accuchek bG and Glucoscan 2000 statistically are the most accurate and precise HMBGs.
Small- and Large-Fiber Involvement in Early Diabetic Neuropathy: A Study With the Medial Plantar Response and Sensory Thresholds
Authors: Levy David M , Abraham R Ralph , Abraham Raju M
Published: March 2007

Small- and large-fiber function in diabetic neuropathy was studied in 68 patients (mean age 45.4 ± 12.9 yr; 27 type I and 41 type II diabetics) with psychophysical tests of vibration and thermal sensation and neurophysiological measurements, including the medial plantar sensory action potential (MPSAP). Thermal sensitivity at the dorsolateral aspect of the foot (Pfizer thermal tester) correlated significantly with vibration thresholds (Somedic vibrameter) at three sites in the foot and two in the hand. Forty patients had normal sensory thresholds, but 18 of these lacked an MPSAP. Smaller groups had a single abnormal sensory threshold: 12 (18%) had an abnormal vibration threshold, and 24 (35%) had abnormal thermal sensitivity; 8 of the former group and 17 of the latter group lacked an MPSAP response. Only 8 (12%) had both abnormal vibration and thermal sensation (6 without an MPSAP). Fifteen of the 17 symptomatic patients had lost the MPSAP, but there was no consistent pattern of sensory loss. In this relatively young group of diabetics, more patients showed absent MPSAP responses than an abnormality in either sensory test on its own. The MPSAP is frequently absent in patients with no abnormalities in psychophysical tests of peripheral large-fiber function (vibration sensation) and small-fiber function (thermal sensitivity).
Effect of Glipizide on Insulin Secretion and Insulin Metabolism in Obese Type II Diabetic Patient
Authors: Bonora Enzo , Pisani Franco , Micciolo Rocco , Corgnati Angela , Muggeo Michele
Published: March 2007

this study was designed to explore the short-term effect of glipizide on insulin secretion and metabolism. Plasma insulin and C-peptide levels in the fasting state and after a 100-g oral glucose load were measured in 17 obese newly diagnosed type II (non-insulin-dependent) diabetic subjects before and after 1 mo of treatment with glipizide (15 mg/day). Plasma glucose levels decreased significantly after treatment with glipizide. Plasma insulin and C-peptide concentrations in the fasting state did not change after glipizide treatment. Also, postglucose plasma insulin levels did not change after glipizide, whereas postglucose plasma C-peptide concentrations significantly increased. A significant relationship was found between the increase in C-peptide plasma levels and the decrease in glycemic profile after glucose load following glipizide treatment. The relation between plasma C-peptide and insulin incremental areas after the oral glucose load significantly increased after treatment. These results suggest that in obese type II diabetic patients, 1 mo of treatment with glipizide potentiates the (β-cell response to oral glucose load and increases insulin metabolism, probably within the liver.
Modification of Therapy From Insulin to Chlorpropamide Decreases HDL Cholesterol in Patients With Non-Insulin-Dependent Diabetes Mellitus
Authors: Schmitt James K , Harriman Karen , Poole Joel R
Published: March 2007

In 27 patients with non-insulin-dependent diabetes mellitus, we determined fasting serum glucose, hemoglobin A,, body weight, serum triglycerides, cholesterol, low-density lipoprotein cholesterol (LDL-chol), high-density lipoprotein cholesterol (HDL-chol), and very-low-density lipoprotein cholesterol during treatment with insulin and several months after changing treatment to chlorpropamide. In five patients, diabetic control deteriorated to the point where insulin was reinitiated. In the remaining 22 patients, despite a significant decrease in weight (122 ± 5 vs. 114 ± 5% ideal body wt; P < .025) on chlorpropamide, HDL-chol fell from 49 ± 4 to 40 ± 4 mg/dl (P < .01) when therapy was modified from insulin to the sulfonylurea. There was a concomitant increase in LDL-chol:HDL-chol from 3.6 ± 0.3 to 4.4 ± 0.5 (P < .05). In the 5 patients in whom insulin was reinstituted, HDL-chol increased to its previous level on insulin (P < .05). Changing antidiabetic medication from insulin to sulfonylureas may alter the lipoproteins in a manner that increases cardiovascular risk.
Glucose and Insulin Responses in Relation to Insulin Dose and Caloric Intake 12 h After Acute Physical Exercise in Men With IDDM
Authors: Campaigne Barbara N , Wallberg-Henriksson Harriet , Gunnarsson Rolf
Published: March 2007

Acute exercise in insulin-dependent diabetic patients may perturb glycemic control, and adjustments of insulin and diet might be required to avoid postexercise hypoglycemia. The aim of this study was to assess the role of alterations in insulin dose or caloric intake on blood glucose and free-insulin levels during 12 h after an evening bout of exercise. Nine insulin-dependent diabetic men (28–42 yr of age) receiving two daily injections with a combination of intermediate-acting and soluble insulin participated in the study. Patients were randomly assigned to four treatment protocols: A, 50% reduction in intermediate-acting insulin dose; B, 50% reduction in soluble insulin dose; C, extra caloric intake (1700 kj) 1 h after exercise; and D, no change. Exercise consisted of 45 min of cycling at 60% of maximal oxygen uptake at each occasion. Glucose and insulin responses were similar for the four protocols. There was a significant (P < .001) time effect found regardless of treatment, with lowest blood glucose values 75 min after exercise. Hypoglycemia occurred in six of the nine patients at some time during the study, with half of the occurrences on the control night (protocol D). Consistent individual plasma insulin and glucose patterns were observed independent of protocol used. In some patients, hypoglycemia was evident after reductions in insulin dose, and in others it was evident on the night increases in caloric intake were to occur; thus, none of the interventions were totally adequate in preventing exercise-induced hypoglycemia. In conclusion, general recommendations on how to adjust insulin or diet before exercise are difficult to give. Individualized recommendations for treatment modification appear most appropriate.
Model of Associations Between Psychosocial Variables and Health-Outcome Measures of Adolescents with IDDM
Authors: Hanson Cindy L , Henggeler Scott W , Burghen George A
Published: March 2007

The purpose of this study was to develop a model that describes the contributions of key psychosocial variables to the health outcome of adolescents with insulin-dependent diabetes mellitus (IDDM). Subjects were 93 adolescents with IDDM and their parents. Health-outcome measures included adherence and metabolic control (HbA1c). Psychosocial variables included adolescent age, chronic life stress, social competence, family relations, and family knowledge about IDDM. Multiple regression analyses showed that adherence (P < .029) and stress (P < .052) were directly related to metabolic control and that knowledge about IDDM (P < .029), family relations (P < .099), and adolescent age (P < .086) had direct effects on adherence. Combined, the independent variables accounted for 14.5% of the variance in predicting HbA1c and 18.5% of the variance in predicting adherence. In general, these findings are consistent with extant theory. The direct link between stress and metabolic control, however, contrasts with the current view that psychosocial variables affect metabolic control indirectly through their influence on adherence behavior. The methodological limitations of the findings are noted, directions for future research are suggested, and the implications for clinical interventions are described.
Factors Related to Discontinuation of Continuous Subcutaneous Insulin-Infusion Therapy
Authors: Guinn Terin S , Bailey Gloria J , Mecklenburg Robert S
Published: March 2007

To determine the factors related to discontinuation of continuous subcutaneous insulin-infusion (CSII) therapy in patients with insulin-dependent diabetes mellitus, we analyzed clinical data from a group of 177 patients followed for up to 5 yr. Fifty-one (29%) of the patients made a decision to terminate CSII during the study. Of the clinical characteristics present before the onset of treatment with an insulin pump, the most important variable to predict a future decision to terminate CSII was pregnancy, followed by female gender. In addition, there was a greater percentage of smokers, single or divorced patients, and patients with a history of treatment for mental illness in the dropout group, although none of these differences was statistically significant. There was no correlation between discontinuation of CSII and age, duration of diabetes, or prepump concentrations of HbA1c. Events occurring during CSII were also analyzed for predictive value. Patients who discontinued CSII had a higher incidence of ketoacidosis and a lower incidence of hypoglycemic coma while using a pump. The most common reason reported by patients for terminating CSII therapy, cited by 24 (47%) of the 51, was discomfort, irritation, or infection at the infusion site.
Quantitative Importance of Dietary Constituents Other Than Glucose as Insulin Secretagogues in Type II Diabetes
Authors: Nuttall Frank Q , Gannon Mary C
Published: March 2007

In seven type II (non-insulin-dependent) diabetic patients, given either 50 g glucose or a mixed meal potentially containing 61 g glucose as starch and sucrose, the postmeal plasma glucose area integrated over 4 h was less after the mixed meal. The insulin area was considerably greater (2.1-fold). The greater increase in insulin could be explained largely, but not entirely, by the protein and fructose in the mixed meal (85%) which, in addition to glucose, are known insulin secretagogues. The residual unexplained increase may be due to a synergistic interaction of these secretagogues, an unidentified insulin secretagogue, or by a reduced insulin removal rate. These possibilities remain to be explored.