bluuebunny/crossref_metadata_2025 huggingface dataset:
Indicator pollen taxa of human-induced and natural vegetation in Northern China
Authors: Li Manyue , Xu Qinghai , Zhang Shengrui , Li Yuecong , Ding Wei , Li Jianyong
Published: January 2015

Research on modern pollen assemblages of human-induced vegetation is conducive to extracting human impact information, and provides basis for determining human impact intensity. The use of 189 surface soil pollen samples from human-induced and natural vegetation shows that there were significant discrepancies of indicator pollen taxa and human impact intensity between different vegetation types in Northern China. The results demonstrate that forest and grassland pollen assemblages are dominated by natural vegetation pollen taxa, which show little effect from human impact. Farmlands are dominated by Cereal Poaceae pollen. Cultivation methods, climate conditions and human impact intensity are the main reasons that cause discrepancy in different regions. Uncultivated lands could be effectively distinguished based on common human-companion plant pollen types and certain amount of crop pollen, which display the first step of secondary succession from human-induced to natural vegetation. Indicator species analysis shows that Cereal Poaceae, Trilete spore, Humulus and Brassicaceae indicate farmlands; weeds Poaceae, Chenopodiaceae, Ranunculaceae and Selaginella sinensis indicate uncultivated lands; grasslands have the largest number of indicator pollen taxa, in which Convolvulaceae, Artemisia, Asteraceae, Liliaceae, Polygonaceae, and Nitraria pollen have the highest indicator values; in forests, Betula, Larix and Quercus have the highest indicator values with statistical significance. Meanwhile, Human Influence Index (HII) values can be used to differentiate human-induced and natural vegetation. The calibration model of pollen-HII based on the weighted averaging plus partial least squares (WA-PLS) method exhibits a good statistical performance ( R2 = 0.69), and the HII values have the same trend of change with Cereal Poaceae percentage. Our results confirm that pollen from human-induced vegetation can provide reliable estimates of HII, which provides a good reference for restoring human impact intensity in fossil pollen assemblage.
Carbohydrate Intake, Glycemic Index, Glycemic Load, and Stroke
Authors: Cai Xianlei , Wang Chen , Wang Shan , Cao Gaoyang , Jin Chao , Yu Jiawei , Li Xiuyang , Yan Jing , Wang Fudi , Yu Wei , Ding Fang
Published: January 2015

The objective of this study was to investigate associations between carbohydrate intake/glycemic index (GI)/glycemic load (GL) and stroke risk. A literature search of MEDLINE, Embase, Web of Science, and CBM databases was performed to retrieve eligible studies published up to March 2014. Pooled relative risks (RRs) with 95% confidence intervals (CIs) were used to evaluate the strength of this association. Publication bias was assessed by the Egger’s regression asymmetry test and Begg’s rank correlation test with Begg’s funnel plot. All analyses were conducted using software STATA 12.0 (StataCorp LP, College Station, TX) and SAS version 9.1 (SAS Institute Inc, Cary, NC). We identified 7 prospective studies that met the inclusion criteria and processed data from cohort studies to update available evidence. There were 25 independent estimates and 225 000 participants free of diabetes from 6 different countries; 3046 stroke events were included; and the follow-up range was 5 to 18 years. High GI was not associated with risk of stroke events (pooled RR = 1.10; 95% CI: 0.99-1.21); GL was a risk factor for stroke (pooled RR = 1.19; 95% CI: 1.05-1.36). There was no significant association between high carbohydrate intake and stroke risk (RR = 1.12; 95% CI: 0.93-1.35). A daily high GL diet is the risk factor of stroke event, and further researches need to verify the meta-analyses results and study associated mechanisms.
Health-Related Quality of Life among Children and Adolescents during Hematopoietic Stem Cell Transplant Recovery
Authors: Rodgers Cheryl , Wills-Bagnato Patricia , Sloane Richard , Hockenberry Marilyn
Published: January 2015

Health-related quality of life (HRQoL) has been noted to fluctuate among children during hematopoietic stem cell transplant (HSCT) recovery; however, the specific timing and associations of these changes are poorly understood. This repeated-measures study aimed to describe HRQoL changes among children and adolescents during the first 6 months of HSCT recovery and estimate the associations of demographic factors, diagnosis, transplant information, and symptoms with HRQoL. Twenty-three children and adolescents who received an allogeneic HSCT were recruited from a pediatric teaching institution in the southern United States. Demographic, diagnosis, and transplant information was obtained from the medical record. The Memorial Symptom Assessment questionnaire and the Peds Quality of Life Cancer Module (PedsQL CM™) were completed at 1 month post-HSCT and then once monthly for 5 additional months. Mean HRQoL scores fluctuated during the study with the lowest mean HRQoL noted at 1 month post-HSCT and the highest mean HRQoL noted at 4 months post-HSCT. No significant differences in HRQoL scores were noted among demographic, diagnosis, or transplant factors. Feeling tired, sad, or worried or having insomnia at 1 month post-HSCT was negatively correlated to HRQoL. Nurses have opportunities to explore important issues with patients and need to be aware of fluctuations with HRQoL and factors associated with lower HRQoL during HSCT recovery.
Variation of wear behavior of H13 steel sliding against different-hardness counterfaces
Authors: Hua Huaping , Zhou Yin , Li Xinxing , Zhang Qiuyang , Cui Xianghong , Wang Shuqi
Published: January 2015

Dry sliding tests for H13 steels sliding against different-hardness counterfaces were performed in air under a load of 50–300 N at 25–600 ℃ on a pin-on-disk elevated temperature tester. The hardness of the counterface was noticed to appreciably affect the wear behavior of H13 steel. When H13 steel slid against a hard counterface (55 HRC), the wear rate increased with an increase of temperature. As the load increased, the wear rate marginally increased at 25 ℃ and 200 ℃ but rapidly increased at 400 ℃ and 600 ℃. When H13 steel slid against a softer counterface (42 HRC), the wear rate roughly decreased with an increase of temperature besides 600 ℃. As the load increased, the wear rate rapidly increased at 25 ℃ but slightly increased at 200 ℃, 400 ℃ and 600 ℃. The large variation of the wear behavior of H13 steel was attributed to the competition of the wear-reduced function and the delamination of tribo-oxide layers. At elevated temperature, the tribo-oxide layer readily delaminated under the abrasive action of the hard counterface; conversely, it stably stayed on worn surfaces to take a wear-reduced function for the soft counterface. Adhesive wear prevailed for the hard counterface at 25–200 ℃ and the soft counterface at 25 ℃. For the soft counterface at 200–600 ℃, oxidative mild wear prevailed, but for the hard counterface, at 400–600 ℃, a mild-to-severe wear transition of oxidative wear occurred.
Comparing end-of-life practices in different policy contexts: a scoping review
Authors: Boivin Antoine , Marcoux Isabelle , Garnon Geneviève , Lehoux Pascale , Mays Nicholas , Prémont Marie-Claude , Chao Yi-Sheng , van Leeuwen Evert , Pineault Raynald
Published: January 2015

Objectives

End-of-life policy reforms are being debated in many countries. Research evidence is used to support different assumptions about the effects of public policies on end-of-life practices. It is however unclear whether reliable international practice comparisons can be conducted between different policy contexts. Our aim was to assess the feasibility of comparing similar end-of-life practices in different policy contexts.

Methods

This is a scoping review of empirical studies on medical end-of-life practices. We developed a descriptive classification of end-of-life practices that distinguishes practices according to their legal status. We focused on the intentional use of lethal drugs by physicians because of international variations in the legal status of this practice. Bibliographic database searches were supplemented by expert consultation and hand searching of reference lists. The sensitivity of the search strategy was tested using a set of 77 articles meeting our inclusion criteria. Two researchers extracted end-of-life practice definitions, study methods and available comparisons across policy contexts. Canadian decision-makers were involved to increase the policy relevance of the review.

Results

In sum, 329 empirical studies on the intentional use of lethal drugs by doctors were identified, including studies from 19 countries. The bibliographic search captured 98.7% of studies initially identified as meeting the inclusion criteria. Studies on the intentional use of lethal drugs were conducted in jurisdictions with permissive (62%) and restrictive policies (43%). The most common study objectives related to the frequency of end-of-life practices, determinants of practices, and doctors’ adherence to regulatory standards. Large variations in definitions and research methods were noted across studies. The use of a descriptive classification was useful to translate end-of-life practice definitions across countries. A few studies compared end-of-life practice in countries with different policies, using consistent research methods. We identified no comprehensive review of end-of-life practices across different policy contexts.

Conclusions

It is feasible to compare end-of-life practices in different policy contexts. A systematic review of international evidence is needed to inform public deliberations on end-of-life policies and practice.
Health-related quality of life and sense of coherence among Polish immigrants in Germany and indigenous Poles
Authors: Morawa Eva , Erim Yesim
Published: January 2015

Immigrants are faced with several impediments in the host country that may affect their quality of life (QoL), but little is known about the impact of these stressors as well as about the protective role of sense of coherence (SoC) in the context of Polish immigration to Germany. Health Related QoL (Short Form Health Survey SF-36) and SoC (Sense of Coherence Scale SOC-29) were assessed in a total sample consisting of 511 participants aged between 18 and 84 years (260 Polish immigrants in Germany and 251 indigenous Poles). Polish immigrants reported a significantly lower mental and physical health-related QoL than the German norm population, but they were comparable to native Poles. This result remained the same when the model was adjusted for age but physical health status was better for immigrants compared with indigenous Poles. Both groups scored significantly lower for SoC than Germans, but did not differ from each other. The main differences concerning the examined variables were with respect to the German norm population and are putatively shaped by culture.
Critical rationalists much too narrow contribution to Der Positivismusstreit: Alternative political theories which conform to fallibilist, individualist methodologies were needed then and are needed today
Authors: Wettersten John
Published: January 2015

The very dubious results of Der Positivismusstreit are explained as consequences of a methodological breakdown between two schools. But this debate is nevertheless relevant for today’s discussions due to its historical role in setting today’s framework. The methodological breakdown between the schools is overcome to a partial degree by presuming some overlap in methods. The misunderstandings of the past are set in today’s context, where critical realists have abandoned much of their previous doctrines, and the failure of critical rationalists to acquire more influence than they have is explained as in large part due to their failure to avoid identification with conservative economic-cum-political theory, above all that of Hayek. This mistake is corrected by explaining how improved critical rationalist methods are consistent with a variety of political alternatives and may be used to critically examine them.
Ang (1–7) is a modulator of the vasoconstrictor actions of Ang I and Ang II
Authors: Flores-Monroy Jazmín , Valencia-Hernández Ignacio , Martínez-Aguilar Luisa
Published: January 2015

Introduction:

The role of angiotensin (Ang) (1–7) on the vasoconstrictor effect induced by angiotensins could be different in the presence of an ACE inhibitor or an ARB because Ang II is formed through several pathways. Therefore, the role of Ang (1–7) in Ang I and Ang II contraction was evaluated in aortas from Wistar rats after 48-hour coronary occlusion treated with captopril or losartan.

Methods:

Concentration-response curves to Ang I or Ang II were conducted in the absence or presence of Ang (1–7) and A779: a) sham group; b) 48-hour coronary occlusion; c) treated with captopril or d) losartan (3.1 mg/kg, i.m.).

Results:

Captopril caused a significant increase in the contractile effect of Ang I and Ang II, while losartan reduced it. The presence of Ang (1–7) in the captopril group showed a reduction of the contraction compared to the sham group, while the treatment with losartan did not show a significant difference. Ang (1–7) presents effects different from Ang I or Ang II.

Conclusion:

Ang (1–7) showed a modulatory role, suggesting Ang I did as well after treatment with an ACE inhibitor but not with an AT1 receptor antagonist.
Cavitation tunnel acoustic characterisation and application to model propeller radiated noise measurements at different functioning conditions
Authors: Tani Giorgio , Viviani Michele , Armelloni Enrico , Nataletti Marco
Published: January 2015

In present work, an acoustic characterisation of the University of Genoa cavitation tunnel is presented, with the aim to obtain suitable transfer functions in order to take into account (at least partially) the effects of the confined environment, particularly important for small-scale facility like the one considered. The acoustic characterisation is performed considering two hydrophones in significantly different positions (inside the tunnel and in an external tank), typical, for different reasons, of noise measurements in cavitation tunnel; the procedure is based on the logarithmic sine sweep signal. The obtained transfer functions have been applied to a series of measurements of model propellers in correspondence to considerably different functioning conditions, in terms of cavitation number and propeller loading, showing the applicability of the procedure and the improvement of the measurement quality, in view of predictions in full scale.
How Presidential Running Mates Influence Turnout
Authors: Court Whitney L. , Lynch Michael S.
Published: January 2015

Primaries frequently exacerbate ideological divisions within a party. When parties select more moderate candidates whom they believe will appeal to a broader audience, the nominee must find a way to win over their party’s base. We investigate the potential rewards of using the vice presidential nominee to increase voter turnout among those ideologically alienated by a party’s moderate nominee. We also examine the risks of a more extreme vice presidential nominee costing a president the support of moderate voters. To perform this analysis, we examine how voters’ ideologies and attitudes toward Sarah Palin affected their voter turnout and their vote choice. By doing this, we are able to assess the effectiveness of the attempt to activate the base and find that while vice presidential nominees may provide the opportunity to effectively target ideological groups, they may also contribute to a loss of support from moderately inclined voters.
Word on the Street
Authors: Schoenfeld Elinor R. , Francis Linda E.
Published: January 2015

African American men face the highest rates of prostate cancer, yet with no consensus for screening and treatment, making informed health care decisions is difficult. This study aimed to identify approaches to empowering African American men as proactive participants in prostate cancer decision making using an established community–campus partnership employing elements of community-based participatory research methods. Community stakeholders with an interest in, and knowledge about, health care in two local African American communities were recruited and completed key informant interviews ( N = 39). Grounded theory coding identified common themes related to prostate cancer knowledge, beliefs, attitudes, and responses to them. Common barriers such as gender roles, fear, and fatalism were identified as barriers to work-up and treatment, and both communities’ inadequate and inaccurate prostate cancer information described as the key problem. To build on community strengths, participants said the change must come from inside these communities, not be imposed from the outside. To accomplish this, they suggested reaching men through women, connecting men to doctors they can trust, making men’s cancer education part of broader health education initiatives designed as fun and inexpensive family entertainment events, and having churches bring community members in to speak on their experiences with cancer. This study demonstrated the success of community engagement to identify not only barriers but also local strengths and facilitators to prostate cancer care in two suburban/rural African American communities. Building collaboratively on community strengths may improve prostate cancer care specifically and health care in general.
Has Their Son Been Vaccinated? Beliefs About Other Parents Matter for Human Papillomavirus Vaccine
Authors: Schuler Christine L. , Coyne-Beasley Tamera
Published: January 2015

The goal of this study was to determine if parents’ beliefs about social norms of human papillomavirus (HPV) vaccination for sons were associated with knowledge of HPV, intention to vaccinate sons, or beliefs about side effects. A cross-sectional, survey-based study of parents with sons was performed in 2010. Fisher’s exact tests were used to examine associations between demographics and responses about social norms. Multivariate logistic regression models examined beliefs about social norms of male HPV vaccination and primary outcomes. Few parents agreed that others were vaccinating sons ( n = 31/267, 12%), including 1% responding strongly agree and 11% responding agree. Most parents, 52%, disagreed that others were vaccinating (40% disagree, 11% strongly disagree), and 37% chose prefer not to answer regarding others’ vaccination practices. Hispanic parents and those with a high school education or less were significantly more likely to choose prefer not to answer than their respective counterparts regarding vaccination norms. In multivariate models, parents agreeing others were vaccinating sons had greater odds of having high knowledge of HPV (adjusted odds ratio [aOR] high vs low knowledge 3.15, 95% confidence interval [CI] 1.13, 8.77) and increased intention to vaccinate sons ( n = 243, aOR = 4.41, 95% CI = 1.51, 12.89). Beliefs about side effects were not significantly associated with beliefs about social norms. Parents’ beliefs about others’ vaccination practices are important with regard to knowledge of HPV and intention to vaccinate sons. Studying how various public messages about HPV vaccine may influence normative beliefs could be relevant to improving vaccination coverage.
Spontaneous resorption of calcification at the long head of the biceps tendon
Authors: Amri Adriansyah , Yukata Kiminori , Nakai Sho , Hara Michiharu , Yamanaka Issei , Hamawaki Jun-ichi
Published: January 2015

Calcific tendinitis of the long head of the biceps tendon is a rare cause of shoulder pain. Calcium deposits are often spontaneously resorbed or reduced in size in the rotator cuff tendons, which represent the most common sites of calcific tendinitis around the shoulder. To our knowledge, no case of spontaneous resorption of calcification in the long head of the biceps tendon has been reported in the literature. Here, we report one such case and describe its successful treatment using a conservative approach.
Management of BRAF and MEK inhibitor toxicities in patients with metastatic melanoma
Authors: Welsh Sarah J. , Corrie Pippa G.
Published: January 2015

Following the discovery that nearly half of all cutaneous melanomas harbour a mutation in the BRAF gene, molecular targeted kinase inhibitors have been developed for the treatment of metastatic melanoma and have dramatically improved outcomes for those patients with BRAF mutant disease, achieving high levels of objective response and prolonging survival. Since 2011, the specific BRAF targeted agents, vemurafenib and dabrafenib, and the MEK inhibitor, trametinib, have been licensed for the treatment of patients with unresectable or metastatic BRAF mutant melanoma. As with other biological targeted agents, these drugs are associated with predictable patterns of adverse events. Proactive toxicity management is important to ensure maximum treatment benefit and avoid unnecessary treatment discontinuation. We review the most common and serious adverse events associated with BRAF targeted agents and suggest management algorithms to guide practitioners in using these drugs effectively in the clinic.
Diagnosis and therapeutic options for peripheral vasculitic neuropathy
Authors: Blaes Franz
Published: January 2015

Vasculitis can affect the peripheral nervous system alone (nonsystemic vasculitic neuropathy) or can be a part of primary or secondary systemic vasculitis. In cases of pre-existing systemic vasculitis, the diagnosis can easily be made, whereas suspected vasculitic neuropathy as initial or only manifestation of vasculitis requires careful clinical, neurophysiological, laboratory and histopathological workout. The typical clinical syndrome is mononeuropathia multiplex or asymmetric neuropathy, but distal-symmetric neuropathy can frequently be seen. Standard treatments include steroids, azathioprine, methotrexate and cyclophosphamide. More recently the B-cell antibody rituximab and intravenous immunoglobulins have shown to be effective in some vasculitic neuropathy types.
Using Simulation Technology to Teach Diabetes Care Management Skills to Resident Physicians
Authors: Sperl-Hillen JoAnn , O'Connor Patrick , Ekstrom Heidi , Rush William , Asche Stephen , Fernandes Omar , Appana Deepika , Amundson Gerald , Johnson Paul
Published: January 2015

Background:

Simulation is widely used to teach medical procedures. Our goal was to develop and implement an innovative virtual model to teach resident physicians the cognitive skills of type 1 and type 2 diabetes management.

Methods:

A diabetes educational activity was developed consisting of (a) a curriculum using 18 explicit virtual cases, (b) a web-based interactive interface, (c) a simulation model to calculate physiologic outcomes of resident actions, and (d) a library of programmed feedback to critique and guide resident actions between virtual encounters. Primary care residents in 10 U.S. residency programs received the educational activity. Satisfaction and changes in knowledge and confidence in managing diabetes were analyzed with mixed quantitative and qualitative methods.

Results:

Pre- and post-education surveys were completed by 92/142 (65%) of residents. Likert scale (five-point) responses were favorably higher than neutral for general satisfaction (94%), recommending to colleagues (91%), training adequacy (91%), and navigation ease (92%). Finding time to complete cases was difficult for 50% of residents. Mean ratings of knowledge (on a five-point scale) posteducational activity improved by +0.5 ( p < .01) for use of all available drug classes, +0.9 ( p < .01) for how to start and adjust insulin, +0.8 ( p < .01) for interpreting blood glucose values, +0.8 ( p < .01) for individualizing treatment goals, and +0.7 ( p < .01) for confidence in managing diabetes patients.

Conclusions:

A virtual diabetes educational activity to teach cognitive skills to manage diabetes to primary care residents was successfully developed, implemented, and well liked. It significantly improved self-assessed knowledge and confidence in diabetes management.
Model-Based Closed-Loop Glucose Control in Type 1 Diabetes: The DiaCon Experience
Authors: Schmidt Signe , Boiroux Dimitri , Duun-Henriksen Anne Katrine , Frøssing Laurits , Skyggebjerg Ole , Jørgensen John Bagterp , Poulsen Niels Kjølstad , Madsen Henrik , Madsbad Sten , Nørgaard Kirsten
Published: January 2015

Background:

To improve type 1 diabetes mellitus (T1DM) management, we developed a model predictive control (MPC) algorithm for closed-loop (CL) glucose control based on a linear second-order deterministic-stochastic model. The deterministic part of the model is specified by three patient-specific parameters: Insulin sensitivity factor, insulin action time, and basal insulin infusion rate. The stochastic part is identical for all patients but identified from data from a single patient. Results of the first clinical feasibility test of the algorithm are presented.

Methods:

We conducted two randomized crossover studies. Study 1 compared CL with open-loop (OL) control. Study 2 compared glucose control after CL initiation in the euglycemic (CL-Eu) and hyperglycemic (CL-Hyper) ranges, respectively. Patients were studied from 22:00–07:00 on two separate nights.

Results:

Each study included six T1DM patients (hemoglobin A1c 7.2% ± 0.4%). In study 1, hypoglycemic events (plasma glucose < 54 mg/dl) occurred on two OL and one CL nights. Average glucose from 22:00–07:00 was 90 mg/dl [74–146 mg/dl; median (interquartile range)] during OL and 108 mg/dl (101–128 mg/dl) during CL (determined by continuous glucose monitoring). However, median time spent in the range 70–144 mg/dl was 67.9% (3.0–73.3%) during OL and 80.8% (70.5–89.7%) during CL. In study 2, there was one episode of hypoglycemia with plasma glucose <54 mg/dl in a CL-Eu night. Mean glucose from 22:00–07:00 and time spent in the range 70–144 mg/dl were 121 mg/dl (117–133 mg/dl) and 69.0% (30.7–77.9%) in CL-Eu and 149 mg/dl (140–193 mg/dl) and 48.2% (34.9–72.5%) in CL-Hyper, respectively.

Conclusions:

This study suggests that our novel MPC algorithm can safely and effectively control glucose overnight, also when CL control is initiated during hyperglycemia.
Accuracy Evaluation of Five Blood Glucose Monitoring Systems: The North American Comparator Trial
Authors: Halldorsdottir Solveig , Warchal-Windham Mary Ellen , Wallace Jane F. , Pardo Scott , Parkes Joan Lee , Simmons David A.
Published: January 2015

Background:

This study evaluated differences in accuracy between the CONTOUR® NEXT EZ (EZ) blood glucose monitoring system (BGMS) and four other BGMSs [ACCU-CHEK® Aviva (ACAP), FreeStyle Freedom Lite® (FFL), ONE TOUCH® Ultra®2 (OTU2), and TRUEtrack® (TT)].

Methods:

Up to three capillary blood samples ( N = 393) were collected from 146 subjects with and without diabetes. One sample per subject was tested with fresh (natural) blood; the other samples were glycolyzed to lower blood glucose to <70 mg/dl. Meter results were compared with results from plasma from the same sample tested on a Yellow Springs Instruments (YSI) 2300 STAT Plus™ glucose analyzer. Blood glucose monitoring system accuracy was compared using mean absolute relative difference (MARD; from laboratory reference method results) and other analyses. Separate analyses on fresh (natural) samples only were conducted to determine potential effects of glycolysis on MARD values of systems utilizing glucose-oxidase-based test strip chemistry.

Results:

Across the tested glucose range, the EZ had the lowest MARD of 4.7%; the ACAP, FFL, OTU2, and TT had MARD values of 6.3%, 18.3%, 23.4%, and 26.2%, respectively. For samples with glucose concentrations <70 mg/dl, the EZ had the lowest MARD (0.65%), compared with the ACAP (2.5%), FFL (18.3%), OTU2 (22.4%), and TT (33.2%) systems.

Conclusions:

The EZ had the lowest MARD across the tested glucose ranges when compared with four other BGMSs when all samples were analyzed as well as when natural samples only were analyzed.
Analysis of “Accuracy Evaluation of Five Blood Glucose Monitoring Systems: The North American Comparator Trial”
Authors: Fournier Paul A.
Published: January 2015

In an article in Journal of Diabetes Science and Technology, Halldorsdottir and coauthors examined the accuracy of five blood glucose monitoring systems (BGMSs) in a study sponsored by the manufacturer of the BGMS CONTOUR NEXT EZ (EZ) and found that this BGMS was the most accurate one. However, their findings must be viewed critically given that one of the BGMSs (ACCU-CHEK Aviva) was not compared against the reference measurement specified by its manufacturer, thus making it likely that it performed suboptimally. Also, the accuracy of the glucose-oxidase-based ONE TOUCH Ultra2 and TRUEtrack BGMS is likely to have been underestimated because of the expected low oxygen level in the glycolysed blood samples used to test the performance of these BGMSs under hypoglycemic conditions. In conclusion, although this study shows that EZ is an accurate BGMS, comparisons between this and other BGMSs should be interpreted with caution.
A Novel Insulin Combination of Insulin Degludec and Insulin Aspart Achieves a More Stable Overnight Glucose Profile Than Insulin Glargine: Results from Continuous Glucose Monitoring in a Proof-of-Concept Trial
Authors: Liebl Andreas , Davidson Jaime , Mersebach Henriette , Dykiel Patrik , Tack Cees J. , Heise Tim
Published: January 2015

Purpose:

Insulin degludec coformulated with insulin aspart (as IDegAsp) can cover 24 h basal insulin and postprandial insulin requirements after a main meal with one injection. We compared glycemic stability following IDegAsp or insulin glargine (IGlar) given before the evening meal in patients with type 2 diabetes.

Methods:

A subset of 112 insulin-naïve type 2 diabetes patients from a randomized, parallel-group trial (IDegAsp versus IGlar, each added to metformin) underwent 72 h continuous interstitial glucose (IG) monitoring after 16 weeks of treatment. End points included mean IG concentrations, 2 h postprandial IG increments and postprandial peak, IG fluctuation (summed area above and below mean IG), within-subject coefficient of variation (day-to-day variation) in mean nocturnal IG, and episodes of low (<3.5 mmol/liter) and high (>10 mmol/liter) IG. Values were derived for the entire 72 h, with the nocturnal interval (0001–0559 h) also assessed.

Results:

The postdinner IG increment observed with IGlar did not occur with IDegAsp [IDegAsp — IGlar, −1.42 (−2.15, −0.70) mmol/liter]. Nocturnal IG fluctuation was 21% lower with IDegAsp [IDegAsp/IGlar, 0.79 (0.66, 0.96) mmol/liter], with 48% fewer nocturnal high IG episodes [ratio IDegAsp/IGlar, 0.52 (0.32, 0.87)].

Conclusions:

IDegAsp given with the evening meal reduces postdinner glucose excursion and provides more stable nocturnal glycemia as compared with IGlar.
Nocturnal Continuous Glucose and Sleep Stage Data in Adults with Type 1 Diabetes in Real-World Conditions
Authors: Feupe Stephanie Feudjio , Frias Patrick F. , Mednick Sara C. , McDevitt Elizabeth A. , Heintzman Nathaniel D.
Published: January 2015

Background:

Sleep plays an important role in health, and poor sleep is associated with negative impacts on diabetes management, but few studies have objectively evaluated sleep in adults with type 1 diabetes mellitus (T1DM). Nocturnal glycemia and sleep characteristics in T1DM were evaluated using body-worn sensors in real-world conditions.

Methods:

Analyses were performed on data collected by the Diabetes Management Integrated Technology Research Initiative pilot study of 17 T1DM subjects: 10 male, 7 female; age 19–61 years; T1DM duration 14.9 ± 11.0 years; hemoglobin A1c (HbA1c) 7.3% ± 1.3% (mean ± standard deviation). Each subject was equipped with a continuous glucose monitor and a wireless sleep monitor (WSM) for four nights. Sleep stages [rapid eye movement (REM), light, and deep sleep] were continuously recorded by the WSM. Nocturnal glycemia (mg/dl) was evaluated as hypoglycemia (<50 mg/dl), low (50–69 mg/dl), euglycemia (70–120 mg/dl), high (121–250 mg/dl), and hyperglycemia (>250 mg/dl) and by several indices of glycemic variability. Glycemia was analyzed within each sleep stage.

Results:

Subjects slept 358 ± 48 min per night, with 85 ± 27 min in REM sleep, 207 ± 42 min in light sleep, and 66 ± 30 min in deep sleep (mean ±standard deviation). Increased time in deep sleep was associated with lower HbA1c ( R2 = 0.42; F = 9.37; p < .01). Nocturnal glycemia varied widely between and within subjects. Glycemia during REM sleep was hypoglycemia 5.5% ± 18.1%, low 6.6% ± 18.5%, euglycemia 44.6% ± 39.5%, high 37.9% ± 39.7%, and hyperglycemia 5.5% ± 21.2%; glycemia during light sleep was hypoglycemia 4.8% ± 12.4%, low 7.3% ± 12.9%, euglycemia 42.1% ± 33.7%, high 39.2% ± 34.6%, and hyperglycemia 6.5% ± 20.5%; and glycemia during deep sleep was hypoglycemia 0.5% ± 2.2%, low 5.8% ± 14.3%, euglycemia 48.0% ± 37.5%, high 39.5% ± 37.6%, and hyperglycemia 6.2% ± 19.5%. Significantly less time was spent in the hypoglycemic range during deep sleep compared with light sleep ( p = .02).

Conclusions:

Increased time in deep sleep was associated with lower HbA1c, and less hypoglycemia occurred in deep sleep in T1DM, though this must be further evaluated in larger subsequent studies. Furthermore, the consumer-grade WSM device was useful for objectively studying sleep in a real-world setting.
Different Injection Frequencies of Basal Insulins in Type 2 Diabetes Patients under Real-Life Conditions: A Retrospective Database Analysis
Authors: Rathmann Wolfgang , Dippel Franz W. , Kostev Karel
Published: January 2015

Aims:

Little is known about routine use of basal insulins [glargine, detemir, neutral protamine Hagedorn (NPH)] in primary care patients with type 2 diabetes. The aim was to compare injection frequencies of basal insulins in type 2 diabetes in primary care practices, both for basal-supported oral therapy (BOT) and basal-bolus treatment [intensified conventional therapy (ICT)] regimens.

Methods:

Primary care data from 4211 glargine (BOT/ICT, 2247/1964), 1290 detemir (490/800), and 3876 NPH (1331/2425) insulin users were retrospectively analyzed (Disease Analyzer database, May 2009-April 2012). Logistic regression (>1 daily injection) and propensity scores were used to adjust for various confounders (age, sex, type of physician, dosage, body mass index, glycosylated hemoglobin).

Results:

Overall, >1 daily injections were observed in 7.5% of glargine users (BOT, 6.2%; ICT, 9.0%), which was lower than for detemir (overall, 25.4%; BOT, 22.0%; ICT, 27.4%) and NPH (25.4%; BOT, 23.9%; ICT, 27.2%) insulin (all p < .001). The adjusted odds of having >1 injection was lower for glargine compared with detemir (odds ratio, 0.26; 95% CI 0.22–0.32) and NPH-insulin (0.20; 0.17–0.23). Similar results were found for BOT or ICT and after propensity score matching.

Conclusions:

Glargine is associated with significantly lower injection frequencies than other basal insulins. These findings might impact patient-reported outcomes, quality of life, treatment satisfaction, and economic aspects of diabetes treatment.
A New Test Strip Technology Platform for Self-Monitoring of Blood Glucose
Authors: Bernstein Robert , Parkes Joan Lee , Goldy Amy , Brown Daniel , Harrison Bern , Chu Amy , Pflug Brian K. , Simmons David A. , Pardo Scott , Bailey Timothy S.
Published: January 2015

In the management of diabetes, accuracy of devices used for self-monitoring of blood glucose (SMBG) is critical because SMBG results can affect patient diabetes-related health outcomes. A new blood glucose monitoring system (BGMS) platform has been developed that is based on the new CONTOUR® NEXT (CN) test strip. This BGMS platform uses a proprietary electron mediator and algorithm to minimize errors at different steps in the testing process, thus minimizing outliers and significantly improving accuracy from prior-generation blood glucose meter systems. As demonstrated by questionnaire results from clinical studies with the new BGMS platform, accuracy and ease of use are important considerations for people with diabetes and their health care professionals when selecting an SMBG device. This article provides an overview of laboratory studies and clinical trials in the hands of lay users involving the performance of the portfolio of blood glucose meters that uses the new test strip. Each BGMS in the platform, which includes the CONTOUR XT (CONTOUR NEXT EZ in the United States), CONTOUR NEXT LINK, CONTOUR NEXT USB, and CN systems, demonstrated advanced accuracy both in the laboratory and in the hands of subjects (people with diabetes) and trained health care professionals. All systems met and exceeded International Organization for Standardization accuracy criteria (both ISO 15197:2003 and ISO 15197:2013). Each system in the new BGMS platform delivers advanced accuracy, which is essential to people who utilize SMBG for improved management.
Validation of Plantar Pressure Measurements for a Novel in-Shoe Plantar Sensory Replacement Unit
Authors: Ferber Reed , Webber Talia , Everett Breanne , Groenland Marcel
Published: January 2015

Background:

Research concerning prevention of diabetic foot complications is critical. A novel in-shoe plantar sensory replacement unit (PSRU) has been developed that provides alert-based feedback derived from analyzing plantar pressure threshold measurements in real time. The purpose of this study was to compare the PSRU device to a gold standard pressure-sensing device (GS-PSD) to determine the correlation between concurrent measures of plantar pressure during walking.

Methods:

The PSRU had an array of eight sensors with a range of 10–75 mm Hg and collected data at 4 Hz, whereas the GS-PSD had 99 sensors with a range of 1–112 mm Hg and collected data at 100 Hz. Based on an a priori power analysis, data were collected from 10 participants (3 female, 7 male) while walking over ground in both devices. The primary variable of interest was the number of data points recorded that were greater than 32 mm Hg (capillary arterial pressure—the minimum pressure reported to cause pressure ulcers) for each of the eight PSRU sensors and corresponding average recordings from the GS-PSD sensor clusters. Intraclass correlation coefficient (2,1) was used to compare data between the two devices.

Results:

Compared with the GS-PSD, we found good-to-very-good correlations ( r-value range 0.67–0.86; p-value range 0.01–0.05) for six of the PSRU's eight sensors and poor correlation for only two sensors ( r = 0.41, p = .15; r = 0.38, p = .18) when measuring the number of data points recorded that were greater than 32 mm Hg.

Conclusions:

Based on the results of the present study, we conclude the PSRU provides analogous data when compared with a GS-PSD.
The Degree of Autonomic Modulation Is Associated With the Severity of Microvascular Complications in Patients With Type 1 Diabetes
Authors: Fleischer Jesper , Cichosz Simon Lebech , Jakobsen Poul Erik , Yderstraede Knud , Gulichsen Elisabeth , Nygaard Hans , Eldrup Ebbe , Lervang Hans Henrik , Tarnow Lise , Ejskjaer Niels
Published: January 2015

Objective: The objective of this study was to elucidate whether the degree of autonomic modulation is associated with the degree of microvascular complications in patients with type 1 diabetes. Methods: A total of 290 type 1 individuals with diabetes were randomly recruited during normal visits to outpatient clinics at 4 Danish hospitals. The degree of autonomic modulations was quantified by measuring heart rate variability (HRV) during passive spectral analysis and active tests (valsalva ratio [VT], response to standing [RT], and deep breathing [E:I]). To describe possible associations between severity of microvascular complications and measures of autonomic modulation, multivariate analysis was performed. Results: After adjusting for diabetes duration, sex, age, pulse pressure, heart rate, and smoking, autonomic dysfunction remained significantly correlated with severity of retinopathy, nephropathy, and peripheral neuropathy in individuals with type 1 diabetes patients. Conclusions: Autonomic dysfunction is present in early stages of retinopathy, nephropathy, and peripheral neuropathy in patients with type 1 diabetes.
Performance and Acceptability of a Combined Device for Insulin Infusion and Glucose Sensing in the Home Setting
Authors: Nørgaard Kirsten , Shin John , Welsh John B. , Gjessing Hans
Published: January 2015

Background:

The use of sensor-augmented insulin pump (SAP) therapy is increasing. Currently, glucose sensors and insulin infusion cannulas are inserted separately. A new device, MiniMed Duo, combines sensing and infusion capabilities on the same platform and is intended to simplify device insertion and site management. We evaluated the device’s performance with respect to insulin delivery and glucose sensing, and its acceptability with patients.

Methods:

Forty-five patients (mean ± SD age, 45.5 ± 10.9 years, 48% female) with type 1 diabetes and previous use of SAP participated. Each subject was to wear 5 devices connected to insulin pumps over 15 days (3 days/device) and test capillary blood glucose (SMBG) 7 times/day. The primary endpoint was the percentage of sensor-SMBG paired values within 20% of one another. Subject experiences were assessed via questionnaires.

Results:

Overall, 74.8% of sensor-SMBG paired values were within 20%, meeting the primary accuracy endpoint, and the mean absolute relative difference was 15.5 ± 17.1%. Consensus error grid analysis showed that >95% of points were within the A+B zones, exceeding the threshold for adequate clinical accuracy. Insulin dosage and SMBG values did not change significantly compared to prestudy values. The functional survival of the device entering day 3 was 90.5%. There were no serious adverse events. Mean questionnaire results indicated overall satisfaction with the device.

Conclusion:

Duo provided insulin infusion and glucose sensing capabilities in a single device, which provided accurate glucose readings during routine use, was safe to wear, and was acceptable to most patients. It may improve satisfaction and convenience for patients using sensor-augmented insulin pumps.
Performance of the First Combined Smartwatch and Smartphone Diabetes Diary Application Study
Authors: Årsand Eirik , Muzny Miroslav , Bradway Meghan , Muzik Jan , Hartvigsen Gunnar
Published: January 2015

Background: Wearable computing has long been described as the solution to many health challenges. However, the use of this technology as a diabetes patient self-management tool has not been fully explored. A promising platform for this use is the smartwatch—a wrist-worn device that not only tells time but also provides internet connection and ability to communicate information to and from a mobile phone. Method: Over 9 months, the design of a diabetes diary application for a smartwatch was completed using agile development methods. The system, including a two-way communication between the applications on the smartwatch and mobile phone, was tested with 6 people with type 1 diabetes. A small number of participants was deliberately chosen due to ensure an efficient use of resources on a novel system. Results: The designed smartwatch system displays the time, day, date, and remaining battery time. It also allows for the entry of carbohydrates, insulin, and blood glucose (BG), with the option to view previously recorded data. Users were able to record specific physical activities, program reminders, and automatically record and transfer data, including step counts, to the mobile phone version of the diabetes diary. The smartwatch system can also be used as a stand-alone tool. Users reported usefulness, responded positively toward its functionalities, and also provided specific suggestions for further development. Suggestions were implemented after the feasibility study. Conclusions: The presented system and study demonstrate that smartwatches have opened up new possibilities within the diabetes self-management field by providing easier ways of monitoring BG, insulin injections, physical activity and dietary information directly from the wrist.
Adherence to Glycemic Monitoring in Diabetes
Authors: Patton Susana R.
Published: January 2015

Glucose monitoring either by self-monitoring of blood glucose (SMBG) or continuous glucose monitoring (CGM) plays an important role in diabetes management and in reducing risk for diabetes-related complications. However, despite evidence supporting the role of glucose monitoring in better patient health outcomes, studies also reveal relatively poor adherence rates to SMBG and CGM use and numerous patient-reported barriers. Fortunately, some promising intervention strategies have been identified that promote at least short-term improvements in patients’ adherence to SMBG. These include education, problem solving, contingency management, goal setting, cognitive behavioral therapy, and motivational interviewing. Specific to CGM, interventions to promote greater use among patients are currently under way, yet one pilot study provides data suggesting better maintenance of CGM use in patients showing greater readiness for behavior change. The purpose of this review is to summarize the literature specific to glucose monitoring in patients with diabetes focusing specifically on current adherence rates, barriers to monitoring, and promising intervention strategies that may be ready to deploy now in the clinic setting to promote greater patient adherence to glucose monitoring. Yet, to continue to help patients with diabetes adhere to glucose monitoring, future research is needed to identify the treatment strategies and the intervention schedules that most likely lead to long-term maintenance of optimal glycemic monitoring levels.
Clinical disease due to enterovirus D68 in adult hematologic malignancy patients and hematopoietic cell transplant recipients
Authors: Waghmare Alpana , Pergam Steven A. , Jerome Keith R. , Englund Janet A. , Boeckh Michael , Kuypers Jane
Published: January 2015

Key Points

Enterovirus D68 can infect adult patients with hematologic malignancy and HCT recipients and lead to severe respiratory disease. Current diagnostic assays for enterovirus D68 are limited, and further studies on improved rapid diagnostic tools are needed.