bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessment of diet adherence in relation to long‐term follow up of non‐insulin‐dependent diabetics
Authors: Holmes J , Atkinson A B , Hadden D R , Kennedy A L , Wilson E A
Published: March 2007

A group of 223 newly diagnosed diabetic patients, onset age 40‐69 years, was enrolled in a prospective study of instensive dietary management of diabetes. During a six year period the patients were reviewed by doctor and dietitian at three‐monthly intervals. At each clinic visit the dietitian graded each patient according to dietary adherence. For a subgroup of 172 patients who were managed on diet only for the six year period, dietary compliance is considered in relation to diabetic control. Measurements of weights, insulin, glucose and serum lipids were made at each visit. Among the patients with poor dietary compliance the plasma glucose, insulin, triglyceride and cholesterol levels were significantly higher.
A cheap microcomputer network for diabetic clinic management
Authors: Higgins Elisabeth , Oakley N
Published: March 2007

A computer system has been developed for use in a teaching hospital diabetic I clinic. It concentrates on management functions, although the contents of the database can be used in conventional statistical analyses for research purposes.

The priorities identified when drawing up the functional specification were: avoidance of extra secretarial demands; multiuser on‐line data entry, elegant letter generation; and a powerful appointments module, operative at the clinic desk. Collection of more than minimal serial data was sacrificed to the interests of simplicity and economy. Over 500 patients have so for been entered into the system. Untrained medical staff have quickly learned to master the clinic entry technique and secretaries check and make appointments without difficulty Questionnaires were completed by patients attending the clinic to evaluate the on‐line data entry arrangements; by local GPs to assess their response to computer‐generated clinic letters; and by medical records officers throughout the country to find out what they felt about an independent clinic appointments system operated by doctors. Replies indicated that the system is well liked by both patients and GPs, and that fears as to the patient acceptability of on‐line systems are groundless. GPs were universally delighted by the speed and precision of communication Medical records officers generally favoured a computerised clinic appointments system but opinions were divided on the question of whether a clinic system could, or should, be independent from the main hospital patient appointment system (PAS) The on‐line appointments system is universally appreciated and it is suggested that this facility should be mandatory in the functional specification for any clinic contemplating computerisation, even if global PAS‐linked appointments systems are promised for future hospital installation.
Quality assessment of visual test strips for home blood glucose monitoring
Authors: Watts G F , Quiney J , Morris R W , Thaker P , Craddock S , Shaw K M
Published: March 2007

A quality control filter‐paper method was applied to the assessment of two glucose enzyme reagent strips — Type A and Type B — in the home environment. Forty insulin‐dependent diabetics, experienced in home blood glucose monitoring, took part in a randomised, cross‐over trial. Marked variation was observed in the accuracy of readings with both strips over a wide range of glucose concentrations. Overall, Type B was found to read consistently higher than the reference filter‐paper method, whereas Type A read consistently higher for reference glucose concentrations < 10 mmol/l, but lower for concentrations ≥10 mmol/l. In particular, both strips were equally poor at detecting filter‐paper concentrations in the hypoglycaemic range. Although both strips have been modified since the study was initiated, the principle of quality control is equally applicable to all other currently used and visually read strips. Recommendations are provided for the quality assessment of all reagent strips employed by patients for home blood glucose monitoring.
The use of an algorithm as a simple, practical guide to detect errors in the use of a Glucometer
Authors: Tsang W M , Levitt P E , Howell M J , Griffin H , Miller A L
Published: March 2007

Blood glucose meters are now in common use in many hospital wards, in casualty and emergency departments, and also for home‐monitoring of diabetic patients.

Recurring problems in blood glucose measurements have been reported, and we present here a simple algorithm to solve the most common errors encountered in the use of the Glucometer II (Ames, Slough UK), with explanations of the expected effects. Some of the checks, eg reagent strips and light window checks, will also be applicable to other blood glucose meters.
General characteristics of a community‐based diabetic population
Authors: Gatling Wendy , Mullee M , Hill R
Published: March 2007

All the known diabetics (917) registered with 40 general practitioners in the Poole area were identified. 842 (92%) attended a review examination conducted by a single observer. 202 (24%) were classified as insulin dependent diabetics (IDDs) and 640 (76%) as non‐insulin dependent diabetics (NIDDs). Mean age at review was 40.8 years for the IDDs and 67.3 pars for the NIDDs. Mean age at diagnosis of diabetes was 25.4 years for the IDDs and 58.9 years for the NIDDs. 333 (39.5%) diabetics were treated with insulin, 340 (40.4%) with oral hypoglycaemic agents and 169 (20.1%) with diet alone. The mean blood glucose and HbA1c for the IDDs were 9.5 mmol/l and 9.5% respectively and for the NIDDs, 9.0 mmol/l and 8.8% respectively (HbAlc normal range 5–9%). Serious retinopathy was found in 8.6% of the diabetics, proteinuria in 6.8% and 18.5% had a history of ischaemic heart disease. This information will be useful to those organising diabetic care services.
Screening for diabetes mellitus using a self‐administered blood spottest mailed for analysis
Authors: Falkenberg M , Schenck H Von
Published: March 2007

Using self‐administered blood sampling on filter paper mailed for analysis of glucose, we evaluated the feasibility of home screening for diabetes mellitus (DM) and impaired glucose tolerance (IGT) in a specific target group, ie all people in a community aged 50–59. Of the 967 subjects we excluded 23 with known DM (2.4%), four with IGT, four having moved and four having died. Of the remaining 932, 688 participated. Fifty‐two people had a postprandial homeblood glucose value exceeding 7.1 mmol/l. Subjecting these to repeated oral glucose tolerance (OGTT) according to WHO 1985 we diagnosed DM in 12 and IGT in five more cases. Thus, for each known diabetic patient there may be another one undiagnosed in the age group studied.
Audit of an education programme for recently diagnosed Type II diabetic patients
Authors: Hampton K K , Bodansky H J , Stickland M , Wales J K
Published: March 2007

A structured two session education programme (2 × 2 hours) was introduced for newly diagnosed Type II diabetic patients who were invited to attend within one month of diagnosis. To assess its value, 59 consecutive new patients were divided into attenders (n = 49) and non‐attenders (n=10). At diagnosis, HbA1c was similar in the two groups (median, range); (attenders 12.3% (6.1–15.8) non‐attenders 13.1% (8.9–16.4)) and was significantly reduced in both groups six months after diagnosis; (attenders 7.9% (5.6–12.9), non‐attenders 8.5% (5.7–13.2)). Attenders lost weight during this period, while non‐attenders gained weight (attenders −3 kg (−12‐+3.5), non‐attenders +0.75 kg (−7.9‐+7) p=0.03). Although the initial therapy was diet alone in all 59 patients, at six months significantly fewer attenders required the addition of oral therapy than non‐attenders (20% v 60% p=0.01). All patients were tested after six months with a 17 point questionnaire of knowledge and compliance. Attenders scored higher than non‐attenders (median 85% v 65%, p=0.0003).

There was an inverse correlation between age and test score (rs= −0.28, p=0.03) in the whole patient group.

It is concluded that attendance at the education sessions improved patients' knowledge about diabetes and led to a reduced dependence on oral hypoglycaemic therapy.
Malignant otitis externa — a serious complication of diabetes mellitus
Authors: Vernham G A , Robinson D , Resouly A , Shaw K M
Published: March 2007

This paper reviews five cases of malignant otitis externa treated in Portsmouth between 1979 and 1986. These five patients constitute all the cases seen in the Portsmouth, South East Hampshire, Chichester and South West Sussex area during the period, indicating the condition to be rare. All cases showed a number of features in common: all were elderly (over 55 years); diabetic; the majority (4:1) being male. In all cases Pseudomonus aeruginosa was cultured from pus exuding from the external auditory canal. Each of the five cases was resident in the Chichester and South West Sussex part of the catchment area. Every case presented with otorrhoea and otalgia and all were treated with a combination of topical and intravenous antibiotics plus intensified diabetic control. Two cases followed ear syringing.

Neurological complications seen in this series of patients included facial palsy (three cases), fifth nerve palsy, dysphagia, vocal cord palsy, ataxia and Argyll‐Robertson pupil.
Effect of the NovoPen on glycaemic control and patient independence in diabetics with visual impairment
Authors: Hyer S L , Froyd H E , Kohner E M
Published: March 2007

Twelve patients with insulin‐dependent diabetes and visual acuity of 6/12 or worse in the best eye were transferred to three preprandial injections of human Actrapid insulin daily using the NovoPen (Novo Laboratories Ltd, Basingstoke, Hants, England) and a bedtime injection of human Ultratard insulin by syringe. There was a small but significant fall in mean HbAl (%) over the study period (11.4±3.14 at entry: 10.1±2.83 after six months: p<0.05). The NovoPen proved popular with the patients: flexibility in mealtimes was appreciated by all patients, and seven patients felt they were more relaxed about their diabetes. Half the patients felt they were now more active whilst the others were little changed or worse because of further visual deterioration (four patients) or other complications such as neuropathy (two patients). There were no technical problems with the NovoPen but four patients were not sure of getting the correct insulin dose when the cartridge was nearly empty. The NovoPen may be of particular value in visually impaired diabetic patients in whom it may increase patient independence.
Insulin resistance and insulin antibodies: Fact or hallowed fiction?
Authors: Armitage Marry , McCaughey E , Brooks A , Cove D , Betts P , Casey C , Wilkin T J
Published: March 2007

It is commonly stated that insulin antibodies (IA) cause insulin resistance. This is illogical as once insulin binding has reached equilibrium, the daily dose will circulate as free hormone. In order to pursue this question we studied three groups of patients: 30 patients treated with ‘dirty’ beef insulins over many years (Group l), 50 young patients who had received only porcine insulin (Group 2) and 12 patients with clinical ‘insulin resistance’ — requiring more than 150 units of insulin per day (Group 3). Insulin antibody binding was measured in a direct binding IgG class specific ELISA, and plotted against both the total daily insulin dose and the daily dose/kg body weight. Metabolic control did not differ significantly between the first two groups, but mean IA titre was significantly higher (p<0.001), and mean insulin dose significantly lower (p<0.001) in group 1 than group 2. There was no correlation between IA titre and either total daily insulin dose or dose/kg body weight. IA titre in the group with clinical insulin resistance was significantly less than in group 1 (p<0.05). We conclude that insulin antibodies do not cause insulin resistance.
Early warning symptoms of hypoglycaemia in ambulant diabetics
Authors: McLaren E H , Somerville J M
Published: March 2007

One hundred and twenty five insulin‐taking patients and their relatives were asked to list the symptoms which they found most useful in the early recognition of hypoglycaemia. Those reported dared from those mentioned in thirteen text books and patient information books. Early warning symptoms varied with the duration of diabetes. Within the first five years automatic symptoms predominated but thereafter early symptoms were mainly neuroglycopaenic.
Diabetes in school: A study of teachers' knowledge and information sources
Authors: Warne Jennifer
Published: March 2007

This study was designed to investigate teachers' knowledge and sources of information about diabetes and the benefits of diabetes nurse specialists to teaching staff. Of a sample of secondary school teachers in Birmingham, only one third were found to have an adequate overall knowledge of diabetes. Just over one quarter were unaware that a pupil with whom they had contact had diabetes. The report offers suggestions for improvements using a multi‐team approach.
Diabetes mellitus in pregnancy: Implication in developmental abnormalities
Authors: Moley K H , DeCherney Ah , Diamond M P
Published: March 2007

An uncontrolled diabetic state during pregnancy results in serious medical complications to the fetus, occurring both in late gestation (ie hyaline membrane disease, hypoglycaemia) and in early gestation (ie abnormal organogenesis leading to malformations). Whether there are also deleterious effects of diabetes mellitus seen preconceptually, such as anovulation, or in early pregnancy, such as an increased rate of early fetal loss, is controversial. This report examines evidence that the diabetes may contribute to abnormalities in development beginning at these earlier stages of the developmental process.
A study of metabolic control and patient acceptability in adolescent diabetics using the NovoPen
Authors: Jenkins H R , Hinton J L , Williams H , Ansari B M
Published: March 2007

A regimen of three injections per day involving the NovoPen (Novo Laboratories Ltd, Basingstoke, Hants, UK) was assessed in eight adolescent diabetics (median age l3.5 years). Six months after the institution of this regimen there was an improvement in metabolic control (assessed by HbA1c measurements) and patient acceptability (assessed by questionnaire). This improvement was maintained for a further six‐month period.
Diabetes and incorrectly fitting shoes
Authors: Reddy P V , Vaid M A , Child D F
Published: March 2007

Shoe size was checked in 70 diabetics and 50 general medical patients. Thirty‐seven percent of the diabetics were wearing tight shoes compared with 24% of general medical patients (P=0.05). The wearing of tight shoes was associated with callosities in those with diabetic neuropathy. Callosities were present in three out of the six patients with neuropathy who wore tight shoes, but in none of the 16 who wore correct shoes (P<0.05).
Factors affecting weight loss in obese Type 2 diabetes — the vital role of the dietitian
Authors: Jones Kay , Bone Anne , Gill G , Martin Sharon , Padmore Eileen , Dolan Maria , Keenan Berna , Kelly Joan , McEvoy Maria , McTernon Julie
Published: March 2007

We investigated 56 newly presenting Type 2 diabetics who were significantly overweight (BMI >27.0). Patients were given standard management and observed for a six month period. They were then divided into ‘good weight losers’ (13 patients who lost 10% or more of initial body weight) and ‘poor weight losers’ (19 patients who lost 3% or less of initial body weight). When the two groups were compared, there was no dimrence in age, sex ratio, initial body weight, marital status, sociai class, smoking, drinking, exercise and use of oral hypoglycaemic agents. Good weight losers, however, had significantly more visits to clinic (4.0 ± 1.0 v. 3.1 ± 1.1, p<0.05), and particularly to the dietitian (5.2 ± 2.3 v. 2.9 ± 1.2, p<0.005) during the six month period. Obese Type 2 diabetics should thus ideally see dietitians on a monthly basis during the immediate post‐diagnosis period.
Conversion, control and complications: A good prognosis for complications developing with tightening of control
Authors: Benn J J , Smith S A , Macleod A F , Sonksen P H
Published: March 2007

The flare up of retinopathy and neuropathy at a the of improvement in diabetic control is recognized but the subsequent clinical course of these patients is not well described. We report the case of a 26 year old insulin‐dependent diabetic in whom retinopathy and neuropathy presented at a time when his control was improved after a long period of pr control. There was a well documented and progressive improvement in retinopathy, peripheral and autonomic neuropathy over the subsequent years and he is now clinically free of complications seven years later. This case suggests a benign course for complications which present at a time of tightening of diabetic control.
Safe changeover to Human Protaphane from porcine Semitard MC insulin
Authors: Brooks Andrew P , Boss Anders Hasager
Published: March 2007

We investigated the effects on glycaemic control of transferring 20 Type 1 diabetics on twice‐daily (b.d.) treatment with Semitard MC (Novo Laboratories, Basingstoke, England) and Actrapid MC (Novo Laboratories) to a b.d. treatment substituting Semitard MC with Human Protaphane (Novo Laboratories). Patients entered a two month run‐in period and were then changed to the new regimen and followed monthly for three months.

Mean insulin requirements were unchanged. Total hypoglycaemic episodes fell somewhat in the first two months on the new regimen. Mean fasting blood glucose fell from 7.7 ± 2.28 mmoM to 6.86 f 1.85 mmolil (p<0.05).

Fructosamine and glycosylated HbA1 values were not significantly changed. We conclude that Human Protaphane can replace Semitard MC in twice‐daily insulin regimens on a dose‐for‐dose basis without loss of control or increased risk of hypoglycaemic episodes. The significant improvement in fasting blood glucose may represent the rather longer duration of action of the human isophane insulin in comparison with the semi‐lente preparation.

We are grateful to Mrs D Richardson. Principal Biochemist at the Royal Hampshire County Hospital. Winchester for performing the serum fructosamine assays, and Dr David Rowe. Principal Biochemist at the Southampton General Hospital for performing the glycosylated % HbA1 assays.
Near‐simultaneous onset of IDD in three brothers — strong evidence for an environmental factor in the aetiology of the disease?
Authors: Patrick A W , Collier A , Clarke B F
Published: March 2007

We describe three brothers who were diagnosed as having Type I diabetes mellitus within a three month period. The relative importance of genetic and environmental factors in the aetiology of the disease are considered.
Hypoglycaemic coma in a non‐diabetic: Organic illness or self‐administration of insulin?
Authors: Tymms D J , Reckless J P D
Published: March 2007

Unexplained hypoglycaemia occurring in a non‐diabetic who has access to insulin through contacts or at work, must raise the possibility of self‐administration of insulin (Ref 1). Self‐administration is usually surreptitious and is likely to be denied by the patient when challenged. Further investigations may be needed to establish the diagnosis and to exclude organic illness. We report a case in which investigations established the diagnosis of self‐ administration and led to the patient finally admitting to having injected an overdose of his wife's insulin.
Methods of estimating losses to follow‐up from a diabetic clinic
Authors: Jones R B , Medley A J
Published: March 2007

Continuity of follow‐up is extremely important for the diabetic, to ensure that treatable complications such as retinopathy are detected at an early stage. Therefore, it is important to ensure that patients are not lost to follow‐up and to know when they have been. Defining what is meant by lost to follow‐up, and identifying patients who have been lost, from traditionally organised outpatient clinics is not always easy. We have retrospectively studied 3537 patients who at some time attended a diabetes outpatient clinic over a seven year period, to assess how many were lost to follow‐up. During this period, a computer system was established which included the booking of appointments and the maintenance of a register of patients.

We have compared losses from the traditional clinic (19 per month) with the new computer‐assisted clinic (seven per month). Estimates of the proportion of those who were lost to follow‐up vary depending on the criteria adopted. Data from a patient survey suggest that in excess of 17% were lost from the traditional clinic. An audit of case notes suggests that the proportion of those leaving the computer‐assisted clinic who were lost was lower after the implementation of the computer system (29% vs 7%) (X2 = 4.1; Idf; p<0.05). Of those last seen at a clinic more than three years ago, 30% had not had an eye examination within three years.

The process of identifying and following‐up patients who had left the traditional clinic took nine person‐months compared to a few days for patients leaving the computer‐assisted clinic. Even in the absence of special efforts for the maintenance of the continuity of care, an appropriately designed clinical information system and improved clinic organisation will reduce losses to follow‐up. However, our aim should be to eliminate losses to follow‐up, and such systems should be used to promote a population approach to the maintenance of continuity of care through, for example, community‐based registers and purpose designed shared‐care schemes.
The prevalence of factitious hypoglycaemia due to sulphonylurea abuse in the UK: A preliminary report
Authors: Teale J D , Starkey B J , Marks V , Hampton Shelagh M , Robinson J , Fisher R A , Levine D F
Published: March 2007

The general availability of potent sulphonylurea preparations and the ease with which they can be taken, may explain the increase in both the iatrogenic and factitious hypoglycaemia caused by them (Refs 1,2). Whereas insulin‐induced hypoglycaemia is relatively easy to diagnose in the laboratory, that caused by a sulphonylurea may not be, mainly because its biochemical features in many respects resemble those observed in insulinoma. In both conditions plasma insulin and C‐peptide concentrations are inappropriately high during hypoglycaemia and B‐hydroxybutyrate levels are low. The only sure way to distinguish between them in the absence of a positive history of ingestion, is by detection of sulphonylurea in the patient's blood. We describe here a typical case presentation and a preliminary assessment of the incidence of sulphonylurea‐induced factitious hypoglycaemia from a survey of 151 cases of “spontaneous” hypoglycaemia.
An investigation into the need for shared care/mini clinics for people with diabetes in Stockport
Authors: Richmond Jennefer
Published: March 2007

Investigations were carried out by means of a questionnaire sent to 70 general practices to discover the number of identified persons with diabetes attending GP surgeries in Stockport. In addition, it was hoped to find out how many mini clinics were already in existence and how many GP's were interested in starting their own clinics for people with diabetes. The survey yielded a 70% response rate on the questionnaires. There were 10 mini clinics in existence and 24 practices interested in starting their own clinics.
Personality characteristics in diabetic patients
Authors: Robinson Nicola , Stevens Lynda K , Bush Lynette J , Fuller J H
Published: March 2007

Various personality characteristics have been associated with coronary heart disease (CHD) in non‐diabetic populations. Diabetics have an increased risk of developing CHD, but the role of psychosocial factors in this excess risk remains unclear. This cross‐sectional study examines the relationship between Type A behaviour, neuroticism, extraversion and depression to the presence of diabetic complications and current diabetic control in 56 West Indian and 74 Caucasian, insulin‐dependent and non‐insulin‐dependent diabetics (IDDM & NIDDM). Female NIDDM's exhibited significantly lower neuroticism scores compared with those on insulin ( − 1.38 vs 0.8, p=0.3) and significantly higher Type A scores. Significantly higher neuroticism scores were correlated with regular smoking (p=0.03). There were no significant relationships between any personality characteristics and duration of diabetes, the relevance of specific diabetic complications or measures of control, e.g. blood glucose, HbA1. Subjects with depression were more likely to have high neuroticism scores (p=.0001). Personality characteristics appeared to be unrelated to the presence of diabetic complications and control.
Nifedipine and bendrofluazide in the treatment of hypertension in non‐insulin‐dependent diabetics
Authors: Beable Anne , Ghurye R S , Micallef‐Eynaud P , Baksi A K
Published: March 2007

Twenty‐six non‐insulin‐dependent diabetic patients with hypertension completed a double‐blind, cross‐over comparison of nifedipine 20 mg bd with bendrofluazide 5 mg om, following a four week placebo run‐in phase. Treatment phases on each active drug lasted 12 weeks. Diabetic control was stable on entry to the trial.

There was no treatment‐order effect with nifedipine or bendrofluazide on supine or erect systolic (SBP) or diastolic blood pressure (DBP) or heart rate (HR). When supine, there was no significant difference between the antihypertensive effects of either active agent after 12 weeks therapy, but when erect, SBP (p<0.025) and DBP (p<0.005) were significantly reduced by nifedipine when compared to bendrofluazide.

Mean C‐peptide, two hour post‐prandial blood glucose (BSC) and glycosylated haemoglobin A (GHb) were not significantly affected by nifedipine.

Bendrofluazide did not influence mean C‐peptide and GHb, although mean BSC was raised throughout the treatment period, the rise was significant only after four weeks (p<0.05).

When bendrofluazide was administered post‐nifedipine therapy, mean serum uric acid (p<0.005) and blood urea (p<0.005) levels were significantly increased after 12 weeks therapy. The reverse treatment order had no statistically significant effect on these parameters. Serum potassium was significantly reduced (p<0.005) by bendrofluazide when compared to nifedipine.
A generalised allergic reaction to human insulin in spite of prior desensitisation
Authors: van der Wiel H E , van Haeften T W
Published: March 2007

We report a patient who suffered from a severe local allergic reaction to human insulin and who developed a systemic allergic reaction, in spite of prior desensitisation. Therapeutic options are discussed.
My pen ran cold (Horace Walpole)
Authors: Patel S , Crowley S
Published: March 2007

We report an unusual case of recurrent diabetic ketoacidosis caused by failure of a pen‐injector system.
The effect of sweet wine and sherry as opposed to dry wine and sherry on acute glycaemic control in non‐insulin‐dependent diabetes
Authors: Chellingsworth M C , Henderson E , Gavey C , Connor H
Published: March 2007

To determine whether sweet wine and sherry had a greater effect on plasma glucose than did dry wine and sherry, we studied nine patients with non‐insulin‐ dependent diabetes mellitus. They were given a standard meal with 50 ml sherry and 260 ml wine on each of two evenings. On one occasion they received dry drinks and on the other, sweet drinks. Blood was collected at half hourly intervals for measurement of glucose and alcohol concentrations.

The mean area under the plasma glucose concentration/time curve after sweet drinks (31.4 ± 2.37 mmol/l.h) was not significantly different from that after dry drinks (29.01 ± 1.32 mmol/l.h) p=0.25. Neither was there any significant difference in the AUC for blood alcohol on the two evenings.

We conclude that patients with well controlled non‐insulin‐dependent diabetes mellitus could consume these moderate amounts of sweet wine and sherry without detriment to their glycaemic control.
Low cost (or do‐it‐yourself) computer‐assisted cardiovascular autonomic function tests
Authors: Ryder R E J
Published: March 2007

A low cost computer‐assisted system to perform cardiovascular autonomic function tests is described. It is commercially available or may be built wholly or in part on a DIY basis. Any microcomputer may be used though the cheapest will suffice. The ECG ‘R’ wave is obtained by modifying an old ECG monitor or using a purpose built ‘R’ wave amplified. The ‘R’ wave closes a relay switch which shorts the terminals of one of the computer's keys via the joystick port.

Thus each ‘R’ wave is sensed by the computer as the pressing of a key. The principles of the software to time the interval between ‘R’ waves are discussed as well as those of the data analysis software with particular reference to a system which has been developed and is in use.
Importance of routine screening for diabetic eye disease and the advantages of using an ophthalmologically trained physician
Authors: Tindall H , Wales J K , King A M , Stickland M , Martin B M
Published: March 2007

The notes of 200 consecutive diabetic patients were reviewed to assess the presence of unsuspected eye disease present at the first visit to a routine eye screening clinic run by an ophthalmologically trained cinical assistant. Twenty‐three patients on oral hypoglycaemic drugs (21%) and 17 patients on insulin therapy (22%) had significant retinopathy. Twenty‐one patients (one on diet, 13 on oral hypoglycaemic drugs and seven on insulin therapy) complained of visual symptoms, but in only seven patients was this due to retinopathy. In five of the patients, untreatable advanced diabetic eye disease was found. Thus the majority (83%) of patients with retinopathy were asymptomatic. After cataracts, glaucoma was the next most common co‐incidental eye disease found. Using an ophthalmologically‐trained clinical assistant to screen for diabetic eye disease allows other eye conditions to be identified and promptly treated.
Diabetes management: Viewpoint of the patient
Authors: Parrott A
Published: March 2007

Several topics of interest to the diabetic patient will be covered. The structure of the diabetic clinic, and how it might be reorganised to fulfill more clearly defined objectives. The aims and objectives of the medical consultation, and how it shduld have greater emphasis on health and successful coping skills. The difficulty of assessing glycaemic control, a problem both for clinical research into diabetes, as well as for everyday management. Lastly, the effects of insulin upon feeling states and behaviour, and how alterations in feeling state could be used as a self‐monitored index of glucose level. The traditional diabetic clinic can be divided into three groups: physicians, patients, and nurses, with each group in a state of stress. The physician is stressed through excessive work load and unclear aims/objectives. The patient is stressed through inactivity, boredom, and uncertainty over the usefulness of the consultation. The nurse is stressed by doing unskilled menial tasks. Any solution to this state of inefficiency must involve a workload reduction for the physician. This could occur through the greater use of trained nursing specialists. However in order for this restructuring to be undertaken, the aims and objectives of the medical consultation need to be considered. Current consultations seem to be medical/ motivational, concerned with urging tighter glycaemic control over the illness ‘diabetes’. A more useful consultation for the patient would be medicall educational, concerned primarily with being ‘diabetic’. It would need to become more positively orientated, concerned with life skills, and strategies to deal with the problems typically faced by diabetics. The central aim of the consultation should be to aid the diabetic to develop a more successful lifestyle.
An assessment of the benefits of pre‐mixed insulins in childhood diabetes
Authors: McEvilly E A , Eccles L , Rayner P H W
Published: March 2007

Twice daily injections using soluble and isophane insulins which are withdrawn from two separate vials and mixed in the syringe are widely used in children with diabetes mellitus. This is a technically difficult task for children and parents to perform. We have found that errors in the dose given and in contamination of soluble insulin by isophane are common.

We have conducted a prospective study to assess the effects of changing children from a soluble and isophane regime, using separate vials, to a ready‐mixed single vial combination. Thirty two children aged between 6.9 and 11.3 years were studied concurrently at intervals for three months.

Ninety seven per cent were able to draw up their insulin dose accurately after three months (50% at outset) and 81% were able to give their own injections (62% at outset). The involvement, independence and self‐confidence of the children improved which permitted a less restricted social life. There was no change in glycosylated haemoglobin or fructosamine levels. Mixtures of soluble 20% isophane 80% and soluble 30% isophane 70% were found to be the most suitable. Eighty four per cent were able to use the same mixture for both morning and evening injections.
The effects of attempting to limit plasma glucose estimation in a busy diabetic clinic
Authors: Thomas D J B , Hounslow M , Smallman K , Howell M
Published: March 2007

We have studied the effect of limiting plasma glucose estimations in a busy diabetic clinic. Forty nine patients recorded their time of arrival, the time they saw the doctor, and the time they left the diabetic clinic, before and after the implementation of a plasma glucose policy. At the first visit all patients had a plasma glucose estimation. This was repeated at the second attendance in 24 (48%) patients. The remaining patients had glycosylated haemoglobin and home blood monitoring results available. The mean waiting times to see the doctor and the time spent at the clinic at the second visit were reduced (p < 0.02 and p < 0.01 respectively). A retrospective case‐note survey identified 10 treatment changes during the study period but only two patients had had clinic plasma glucose estimations. In contrast five high clinic plasma glucose results (> 12 mmol/l) did not alter patient management. We conclude that the traditional diabetic clinic blood test delays the clinic and rarely contributes to patient management.
Phaeochromocytoma presenting with diabetes
Authors: Lewis F , Reddy P V K , Child D F
Published: March 2007

A 42 year old man presented with a three month history of thirst, polyuria and balanitis. Blood glucose on diet alone varied between 14 and 21 mmol/L. Blood pressure was 180/110. Further history revealed that he had been troubled by sweating and headaches for two years. Urinary VMAs and catecholamines were elevated and a CT Scan revealed an adrenal tumour. Pre‐operative treatment with phenoxybenzamine and atenolol had no effect on his diabetes. Glucose tolerance returned to normal after surgical removal of the phaeochromocytoma.
Big babies and control in pregnancy. “A little learning is a dang'rous thing” (A. Pope—1688–1744)
Authors: Steel Judith M , Leslie P J , Johnstone F D
Published: March 2007

Even well controlled diabetics may have macrosomic babies. We describe an anxious well controlled diabetic patient whose first baby was not macrosomic, in her second pregnancy, her guilt reaction to a “large for dates” fetus led to repeated hypoglycaemia from misguided attempts to improve her control.
Insulin pen for administration of isophane insulin
Authors: Engström Lars H K
Published: March 2007

This study was made in order to evaluate the acceptability and convenience of using the NovoPenTM with NPH‐insulin (Protaphane HMTM) and to investigate whether NPH‐insulin was properly suspended when used in the NovoPen. Forty patients with insulin‐dependent diabetes mellitus, all on multiple injection therapy, were randomly allocated to one of two treatment groups starting with either the NovoPen or conventional syringes for their injections of NPH‐insulin as basal insulin. No differences were found between the groups in HbA1c, blood glucose profiles, total insulin dosage or number of hypoglycaemic events. When the NovoPen with NPH‐insulin was used total soluble insulin doses were significantly higher (31.3 vs 29.9 U/day, p = 0.02) as was the pre‐breakfast dose (11.1 vs 10.6 U/day, p = 0.04). Out of 40 patients 39 were confident of achieving dose accuracy, 39 found it easy to resuspend NPH‐insulin in PenfillTM (insulin cartridge for the NovoPen) and 38 chose to continue using the NovoPen for basal insulin when the study was finished. The conclusion is that the NovoPen is a safe, convenient and acceptable device for administering NPH‐insulin.
Experience of diabetic children and their families in relation to diet at school
Authors: Kauffman L , Bradbury A J , Comer L
Published: March 2007

A study was undertaken to assess how families coped with meals and snacks for their diabetic children at school, and to discover any problems they experienced. The families of 67 (93%) of the 72 school age diabetic children attending the South Manchester hospitals were questioned. The questions covered morning and afternoon snacks, lunch, and general points about food at school. The majority of parents were satisfied with the arrangements for their children, although we identified some areas, particularly lack of supervision, which could be a cause for concern. A small number of families did experience problems with timing and content of meals, and with communication with school staff. None of these problems are insurmountable, but they demonstrate the need for improved education of families of diabetic children and staff at their schools.
Does an intensive residential course on diabetes for general practitioners improve the care of diabetes in the practice?
Authors: Houghton G , Wall D
Published: March 2007

We describe a two and a half day residential course on diabetes mellitus for general practitioners in terms of organisation, cost and educational assessment. Standards of diabetic care in general practice have been shown to vary widely but there has been little evaluation of the postgraduate education required for good continuing care.

The course concentrated on the use of small group tutorials with experienced general practitioner tutors working in tandem with hospital physicians specialising in diabetes. The course proved to be useful, relevant and enjoyable. The costs, both in financial terms and tutor time and commitment hold implications for continuing education in general practice under the 1990 Contract. The follow‐up study of the candidates one year later showed that they had increased their knowledge and confidence in dealing with diabetes, and improved the organisation of structured care for diabetic patients in their practices.
Thermal stability studies of fully silicided NiSi on Si-oxynitride and Hf-based high-κ gate stacks
Authors: Zhao P. , Kim M. J. , Gnade B. E. , Wallace R. M.
Published: March 2007

The thermal stability of fully silicided (FUSI) NiSi∕Hf-based high-κ gate stacks upon exposure to a typical back-end-of-line (BEOL) N2 annealing or forming gas annealing is investigated. Our results demonstrate that there is no new phase formation during postsilicidation N2 annealing for blanket FUSI NiSi stack films. However, new phases are formed once the stack is exposed to forming gas annealing for 1h at 445°C. After a typical BEOL thermal budget annealing (350°C, 60min), Ni diffusion is observed into the Si channel through a thin 1.3nm Si-oxynitride layer, and increases with annealing temperature and time. The Ni penetration from the FUSI NiSi gate electrode structure is completely inhibited with thicker 5nm gate dielectric layers upon exposure to a similar BEOL annealing. The relatively weaker Ni–Ni bonds associated with Ni-rich phases coupled with grain boundary diffusion of liberated Ni likely contribute to Ni diffusion through dielectrics into the Si channel.
Molecular diffusion on a time scale between nano- and milliseconds probed by field-cycling NMR relaxometry of intermolecular dipolar interactions: Application to polymer melts
Authors: Kehr Markus , Fatkullin Nail , Kimmich Rainer
Published: March 2007

A formalism is presented permitting the evaluation of the relative mean-squared displacement of molecules from the intermolecular contribution to spin-lattice relaxation dispersion of dipolar coupled spins. The only condition for the applicability is the subdiffusive power law character of the time dependence of the mean-squared displacement as it is typical for the chain mode regime in polymer liquids. Using field-cycling NMR relaxometry, an effective diffusion time range from nano- to almost milliseconds can be probed. The intermolecular spin-lattice relaxation contribution can be determined with the aid of isotopic dilution, that is, mixtures of undeuterated and deuterated molecules. Experiments have been performed with melts of polyethyleneoxide and polybutadiene. The mean-squared segment displacements have been evaluated as a function of time over five decades. The data can be described by a power law. The extrapolation to the much longer time scale of ordinary field-gradient NMR diffusometry gives good coincidence with literature data. The total time range thus covers nine decades.
Mn-doped AlN nanowires with room temperature ferromagnetic ordering
Authors: Yang Y. , Zhao Q. , Zhang X. Z. , Liu Z. G. , Zou C. X. , Shen B. , Yu D. P.
Published: March 2007

Mn-doped AlN nanowires were synthesized by in situ doping of Mn using a chemical vapor deposition method. Analyses of microstructure and chemical compositions indicate that the as-prepared samples were homogenously Mn-doped AlN nanowires. The low temperature photoluminescence, and magnetization as a function applied magnetic field of the Mn-doped AlN nanowires were investigated. A Curie temperature higher than 300K was observed from the as-doped nanowires. The room temperature ferromagnetic properties of the synthesized Mn-doped AlN nanowires make it an excellent candidate for applications in future spintronic nanodevices.
Collisional damping for ion temperature gradient mode driven zonal flow
Authors: Xiao Yong , Catto Peter J. , Molvig Kim
Published: March 2007

Zonal flow helps reduce and control the level of ion temperature gradient turbulence in a tokamak. The collisional damping of zonal flow has been estimated by Hinton and Rosenbluth (HR) in the large radial wavelength limit. Their calculation shows that the damping of zonal flow is closely related to the frequency response of neoclassical polarization of the plasma. Based on a variational principle, HR calculated the neoclassical polarization in the low and high collisionality limits. A new approach, based on an eigenfunction expansion of the collision operator, is employed to evaluate the neoclassical polarization and the zonal flow residual for arbitrary collisionality. An analytical expression for the temporal behavior of the zonal flow is also given showing that the damping rate tends to be somewhat slower than previously thought. These results are expected to be useful extensions of the original HR collisional work that can provide an effective benchmark for numerical codes for all regimes of collisionality.
Tolerance of microfabricated wedge for the generation of geometrical stable optical vortex at focal vicinity
Authors: Ahluwalia B. P. S. , Yuan X.-C. , Bu J. , Moh K. J. , Tao S. H. , Burge R. E. , Niu H. B. , Peng X.
Published: March 2007

The geometrical stability of the optical vortices generated by an optical wedge at the focal vicinity is investigated. It is found that an optical wedge generates an optical vortex beam in the free-space propagation for a wide range of imparted phase shift, however, it possesses a smaller tolerance zone of induced phase shift within which it generates structurally stable optical vortex at focal vicinity. Furthermore, the wedge was employed for the generation of the femtosecond optical vortex beam free from appreciable spatial chirp.
Electrowetting devices with transparent single-walled carbon nanotube electrodes
Authors: Hu Liangbing , Gruner George , Gong Jian , Kim Chang-Jin “CJ” , Hornbostel Bjoern
Published: March 2007

Microfluidic devices based on the electrowetting principle, more specifically electrowetting on dielectric, were fabricated using transparent single-walled carbon nanotube films as electrodes. The films were spray coated on glass and polyethylene terephalate substrates. The transmittance and sheet resistance remain unchanged after patterning the films using typical photolithography and plasma etching. Operation of water droplets over the patterned nanotube electrodes was demonstrated, and the performance was found to be comparable to that over the usual metal electrodes. The requirement of transparent electrodes is estimated for displays based on electrowetting machanism, and nanotube films indicate promise for such a type of devices.
Nonequilibrium GW approach to quantum transport in nano-scale contacts
Authors: Thygesen Kristian S. , Rubio Angel
Published: March 2007

Correlation effects within the GW approximation have been incorporated into the Keldysh nonequilibrium transport formalism. We show that GW describes the Kondo effect and the zero-temperature transport properties of the Anderson model fairly well. Combining the GW scheme with density functional theory and a Wannier function basis set, we illustrate the impact of correlations by computing the I-V characteristics of a hydrogen molecule between two Pt chains. Our results indicate that self-consistency is fundamental for the calculated currents, but that it tends to wash out satellite structures in the spectral function.
Nonlinear dust acoustic waves in a nonuniform magnetized complex plasma with nonthermal ions and dust charge variation
Authors: El-Taibany W. F. , Wadati Miki , Sabry R.
Published: March 2007

Propagations of nonlinear dust acoustic (DA) solitary waves and shock waves in a nonuniform magnetized dusty plasma are investigated. The incorporation of the combined effects of nonthermally distributed ions, nonadiabatic dust charge fluctuation, and the inhomogeneity caused by nonuniform equilibrium values of particle density, charging variable, and particle potential on the waves leads to a significant modification to the nature of nonlinear DA solitary waves. The nonlinear wave evolution is governed by a modified Zakhavov-Kusnetsov-Burgers (MZKB) equation, whose coefficients are space dependent. Using a generalized expansion method, new solutions for the MZKB equation are obtained. The form of solutions consists of two parts; one of them is the amplitude factor and the other is a superposition of bell-shaped and kink-type shock waves. New solutions are classified into three categories. A type of the solution is determined depending on the nonthermal parameter. Findings in this investigation should be useful for understanding the ion acceleration mechanisms close to the Moon and also enhancing our knowledge on pickup ions around unmagnetized bodies, such as comets, Mars, and Venus, including medium inhomogeneities with nonadiabatic dust charging processes.
Influence of target system on the charge state, number, and spectral shape of ion beams accelerated by femtosecond high-intensity laser pulses
Authors: Schnürer M. , Ter-Avetisyan S. , Nickles P. V. , Andreev A. A.
Published: March 2007

Specific ion spectra have been obtained by irradiating spherical and planar targets with 40fs Ti:Sa laser pulses at intensities of ∼1019W∕cm2. From the mass-limited spherical target, strong modulations in the proton/deuteron spectra and a high laser to ion energy conversion originate, whereas the planar target provides higher cutoff energies of protons. We compare qualitatively models in which the acceleration field is assigned to a multitemperature electron distribution and alternatively where multispecies ion acceleration is important, which both can account for the observed modulations in the spectra. The abundance of ion species and especially the observed strong suppression of the heavy ion species during the ion acceleration from planar targets are estimated on the basis of the interplay of ions with different mass during their ultrafast acceleration and the further ion-bunch propagation.