bluuebunny/crossref_metadata_2025 huggingface dataset:
Improved Assessment of Significant Activation in Functional Magnetic Resonance Imaging (fMRI): Use of a Cluster‐Size Threshold
Authors: Forman Steven D. , Cohen Jonathan D. , Fitzgerald Mark , Eddy William F. , Mintun Mark A. , Noll Douglas C.
Published: March 2007

The typical functional magnetic resonance (fMRI) study presents a formidable problem of multiple statistical comparisons (i.e, > 10,000 in a 128 x 128 image). To protect against false positives, investigators have typically relied on decreasing the per pixel false positive probability. This approach incurs an inevitable loss of power to detect statistically significant activity. An alternative approach, which relies on the assumption that areas of true neural activity will tend to stimulate signal changes over contiguous pixels, is presented. If one knows the probability distribution of such cluster sizes as a function of per pixel false positive probability, one can use cluster‐size thresholds independently to reject false positives. Both Monte Carlo simulations and fMRI studies of human subjects have been used to verify that this approach can improve statistical power by as much as fivefold over techniques that rely solely on adjusting per pixel false positive probabilities.
Navigated Diffusion Imaging of Normal and Ischemic Human Brain
Authors: De Crespigny Alex J. , Marks Michael P. , Enzmann Dieter R. , Moseley Michael E.
Published: March 2007

The principal barrier to clinical application of diffusion‐weighted MR imaging is the severe image degradation caused by patient motion. One way to compensate for motion effects is the use of a “navigator echo” phase correction scheme. In this work, a modification of this technique is introduced, in which the phase correction step is performed in the frequency domain (i.e., after the readout Fourier transform). This significantly improves the robustness of the navigator echo approach and, when combined with cardiac gating, allows diagnostic quality diffusion‐weighted images of the brain to be routinely obtained on standard clinical scanner hardware. The technique was evaluated in phantom studies and in 23 humans (3 normal volunteers and 20 patients). Diffusion anisotropy and apparent diffusion coefficient maps were generated from the image data and showed decreased apparent diffusion in acute stroke lesions and, in several cases, increased apparent diffusion in chronic stroke lesions.
Functional Mapping of the Human Somatosensory Cortex with Echo‐Planar MRI
Authors: Sakai Kuniyoshi , Watanabe Eiju , Onodera Yukari , Itagaki Hiroyuki , Yamamoto Etsuji , Koizumi Hideaki , Miyashita Yasushi
Published: March 2007

The somatotopical organization of the human somatosensory cortex was analyzed with echo‐planar imaging at 1.5 Tesla, utilizing deoxyhemoglobin as an endogenous contrast medium. Scrubbing stimulation at a frequency of 3 Hz was applied to one of three cutaneous areas: toes, fingertips, and tongue tip. Parasagittal echo‐planar slices were obtained every 2 s. We found focal bands of increased signal intensity (4% on average) during the stimulation, with a rise time of 2–6 s. These activated bands were located on the contralateral postcentral gyrus. The cortical responses from the three stimulation sites were anatomically distinct and organized medially‐to‐laterally in the order of toes, fingertips, and tongue tip.
1H MR Spectroscopy in Patients with Metastatic Brain Tumors: A Multicenter Study
Authors: Sijens Paul E. , Knopp Michael V. , Brunetti Arturo , Wicklow Karsten , Alfano Bruno , Bachert Peter , Sanders John A. , Stillman Arthur E. , Kett Hans , Sauter Rolf , Oudkerk Matthijs
Published: March 2007

In a cooperative study involving six clinical MR centers, localized 1H MR spectroscopy was used to characterize untreated metastatic brain tumors (40 cases, 45 lesions). Cubic volumes (3.4 or 8 cm3) filled for more than 50% by metastatic brain tissue were examined by single‐voxel double spin echo MRS, by using chemical shift selective imaging (CHESS) pulses for water suppression and TE = 135 ms. Choline (Cho), creatine (Cr) and N‐acetyl aspartate (NAA) levels in brain metastases of mammary carcinoma (n = 13), lung cancer (n = 11) and melanoma (n = 10) were similar. Metastasis NAA/Cho signal intensity ratio varied between 0.00 and 1.17, compared with 2.68 ± 0.56 (SD) in lobus occipitalis and 1.94 ± 0.63 in corpus nuclei caudati region (P < 0.0001, both). 1H MR spectroscopy, although not suited to recognize the primary tumor of metastases, could serve as a clinical test for excluding (metastatic) tumor as cause of solitary focal brain disorders that are hard to diagnose with current imaging methods.
Increased MR Image Contrast by Correlation of Tissue Relaxation Properties
Authors: Mastikhin Igor V. , Lukzen Nikita N. , Zelentzov Eugeny L. , Sagdeev Renad Z.
Published: March 2007

An image postprocessing technique that is based on the relaxation properties of tissues and that can produce MR images with increased contrast is proposed. The technique involves no a priori assumptions concerning the form of the relaxation decay. An arbitrary number of postprocessed images, each emphasizing a selected tissue type, is obtained from the original images of a multiecho acquisition. It is shown with examples that the technique allows more complete utilization of relaxation information for tissue differentiation.
The intravascular contribution to fmri signal change: monte carlo modeling and diffusion‐weighted studies in vivo
Authors: Boxerman Jerrold L. , Bandettini Peter A. , Kwong Kenneth K. , Baker John R. , Davis Timothy L. , Rosen Bruce R. , Weisskoff Robert M.
Published: March 2007

Understanding the relationship between fMRI signal changes and activated cortex is paramount to successful mapping of neuronal activity. To this end, the relative extravascular and intravascular contribution to fMRI signal change from capillaries (localized), venules (less localized) and macrovessels (remote, draining veins) must be determined. In this work, the authors assessed both the extravascular and intravascular contribution to blood oxygenation level‐dependent gradient echo signal change at 1.5 T by using a Monte Carlo model for susceptibility‐based contrast in conjunction with a physiological model for neuronal activation‐induced changes in oxygenation and vascular volume fraction. The authors compared our Model results with experimental fMRI signal changes with and without velocity sensitization via bipolar gradients to null the intravascular signal. The model and experimental results are in agreement and suggest that the intravascular spins account for the majority of fMRI signal change on T2*‐weighted images at 1.5 T.
A robust single‐shot partial sampling scheme
Authors: Glover Paul , Tokarczuk Pawel F. , Bowtell Richard W.
Published: March 2007

A method of reducing the amount of data required to reconstruct an image is described. In this scheme, fully sampled low spatial frequency data are acquired up to a given cutoff frequency and above this point, only alternate lines are sampled. Two images are produced, one of low definition and one of high definition but aliased. The proposed algorithm unwraps the aliased data, which are then used to enhance the low pass image, yielding a best estimate of the true image. The reduced sampling technique is shown to afford biological images that are almost indistinguishable from those obtained from a complete data set.
A phased array coil for human cardiac imaging
Authors: Constantinides Chris D. , Westgate Charles R. , O'Dell Walter G. , Zerhouni Elias A. , Mcveigh Elliot R.
Published: March 2007

A prototype cardiac phased array receiver coil was constructed that comprised a cylindrical array and a separate planar array. Both arrays had two coil loops with the same coil dimensions. Data acquisition with the cylindrical array placed on the human chest, and the planar array placed under the back, yielded an overall enhancement of the signal‐to‐noise ratio (SNR) over the entire heart by a factor of 1.1–2.85 over a commercially available flexible coil and a commercially available four‐loop planar phased array coil. This improvement in SNR can be exploited in cardiac imaging to increase the spatial resolution and reduce the image acquisition time.
Optimized isotropic diffusion weighting
Authors: Wong Eric C. , Cox Robert W. , Song Allen W.
Published: March 2007

The authors introduce several sets of time‐efficient gradient waveforms for applying isotropic diffusion weighting in NMR experiments. This creates signal attenuation that depends on the trace of the diffusion tensor and is therefore rotationally invariant. Numerical methods for the calculation of such gradient sets are outlined, and results are shown for isotropic and anisotropic gradient hardware and first order flow moment nulled diffusion weighting gradients. Preliminary experimental results from the human brain validate this new technique.
NMR relaxation rates and blood oxygenation level
Authors: Meyer M.‐E , Yu Olivier , Eclancher Bernard , Grucker Daniel , Chambron Jacques
Published: March 2007

A linear relationship between the proton relaxation rates and the fraction of deoxyhemoglobin of circulating whole blood (fHb) has been established in vitro at 4.7 T. These results have been interpreted on the basis of the additivity of relaxation rates. The slope of the lines of transverse relaxation rates (R2) versus fHb was found to increase with interpulse delay in Carr‐Purcell Meiboom‐Gill (CPMG) experiments. The Luz‐Mei‐boom relation applied to this interpulse delay dependence of R2 suggests a two‐site chemical exchange rather than a diffusion mechanism. The 1‐ms water proton exchange time derived from these observations has been interpreted in terms of exchange between exchangeable protons close to the paramagnetic center of hemoglobin and protons of bulk water.
The application of magnetization transfer to MR angiography with reduced total power
Authors: Parker Dennis L. , Buswell Henry R. , Goodrich K. Craig , Alexander Andrew L. , Keck Nanette , Tsuruda Jay S.
Published: March 2007

Magnetization transfer (MT) techniques have been shown to significantly reduce background soft‐tissue signal in time‐of‐flight magnetic resonance angiography. To achieve sufficient suppression, radio frequency (RF) pulses with tip angles on the order of 1000 degrees are typically used, resulting in significant RF power deposition in the patient. Although these power deposition levels do not exceed the FDA guidelines, they are significantly higher than those used in typical imaging techniques. The use of these same magnetization transfer pulses in applications at field strengths higher than 1.5 T will require MT power levels which exceed FDA safety standards. This report demonstrates that the total power deposition required to achieve background tissue suppression can be significantly reduced by the application of the saturation pulses only during the phase‐encoding steps corresponding to the central portion of “k space.” This technique allows equivalent soft tissue suppression with approximately 10% of the energy deposition of conventional magnetization transfer techniques.
High contrast and fast three‐dimensional magnetic resonance imaging at high fields
Authors: Lee Jing‐Huei , Garwood Michael , Menon Ravi , Adriany Gregor , Andersen Peter , Truwit Charles L. , Uǧurbil Kǎmil
Published: March 2007

A new three‐dimensional imaging strategy based on magnetization prepared ultrafast gradient recalled echo technique that demonstrates pronounced T1 contrast at high fields is introduced. High‐resolution three‐dimensional image sets of human brain showing high contrast between white and gray matter areas are presented. The ratio of contrast‐to‐noise was examined as a function of the relevant parameters in the imaging sequence; calculations based on high‐field T1 values as well as the experimental data demonstrated that maximal contrast‐to‐noise ratio is attained under the same magnetization preparation conditions both for cortical and subcortical gray matter relative to white matter, leading to approximately equivalent appearance of all gray matter areas in the same image. In addition, the images displayed clear visualization of subtle anatomical structures such as the subthalamic nuclei (ventral tier nuclei, dorsomedial nucleus, and pulvinar) and mammillothalamic tracts.
Myocardial tagging with B1 insensitive adiabatic DANTE inversion sequences
Authors: Tsekos Nikolaos V. , Garwood Michael , Merkle Hellmut , Xu Ya , Wilke Norbert , Uǧurbil Kǎmil
Published: March 2007

A new technique, based on adiabatic delays alternating with nutations for tailored excitation (DANTE) inversion sequences, is presented for generating uniform contrast tags across the myocardial wall even in the presence of B1 inhomogeneities. The utility of this pulse was demonstrated using a surface coil for both transmission and signal reception in phantom and animal heart tagging studies. The experimental data demonstrated uniform grid contrast over a sixfold variation of B1 magnitude, sharp tagging profiles, and the ability to follow the cardiac wall motion through the deformation of the fine rectangular tagging grid at different phases throughout the cardiac cycle.
The diminishing variance algorithm for real‐time reduction of motion artifacts in MRI
Authors: Sachs Todd S. , Meyer Craig H. , Irarrazabal Pablo , Hu Bob S. , Nishimura Dwight G. , Macovski Albert
Published: March 2007

A technique has been developed whereby motion can be detected in real time during the acquisition of data. This enables the implementation of several algorithms to reduce or eliminate motion effects from an image as it is being acquired. One such algorithm previously described is the acceptance/rejection method. This paper deals with another real‐time algorithm called the diminishing variance algorithm (DVA). With this method, a complete set of preliminary data is acquired along with information about the relative motion position of each frame of data. After all the preliminary data are acquired, the position information is used to determine which data frames are most corrupted by motion. Frames of data are then reacquired, starting with the most corrupted one. The position information is continually updated in an iterative process; therefore, each subsequent reacquisition is always done on the worst frame of data. The algorithm has been implemented on several different types of sequences. Preliminary in vivo studies indicate that motion artifacts are dramatically reduced.
Quite transverse gradiant coils: Lorentz force balanced designs using geometrical similitude
Authors: Bowtell Richard W. , Mansfield Peter
Published: March 2007

The principle of active acoustic screening, recently introduced by Mansfield et al. (1) to reduce acoustic noise ingradient coils for MRI, is applied to the design of transverse distributed gradient coils of the fingerprint design. The results indicate that for complete Lorentz force balancing and for exact satisfaction of Kirchoff's law, it is necessary to have a coil system wound on four cylinders if full active magnetic screening of the assembly is required.
MR imaging of regional cardiac function: Low‐pass filtering of wall thickness curves
Authors: Lamb Hildo J. , Singleton Ross R. , Van Geest Rob J. Der , Pohost Gerald M. , Roos Albert De
Published: March 2007

Wall thickness curves (WTCs) derived from MR images are subject to considerable measurement error. This study determines the effects of low‐pass Fourier filtering of WTCs on functional parameters derived from the curve: peak rate of wall thinning (PRWT) and time to PRWT (TPRWT). The inter‐subject standard deviation (SD) of PRWT changed from 0.35 to 0.18, and the SD of TPRWT from 34.3 to 29.5. Differences between neighboring segments decreased from 0.31 to 0.15% mean thickness/ms for PRWT (P = 0.012), and from 35.0 to 19.0 ms for TPRWT (P = 0.005). It is concluded that filtering of MR imaging‐derived WTCs contributes to a better representation of myocardial wall motion.
Blood oxygenation dependence of t1 and t2 in the isolated, perfused rabbit heart at 4.7t
Authors: Atalay Michael K. , Reeder Scott B. , Zerhouni Elias A. , Forder John R.
Published: March 2007

An MR line scan protocol has been used to measure relaxation parameters (T1 and T2) in isolated, blood perfused rabbit hearts at various blood oxygenations. Hearts were retro‐gradely perfused at 37°C with a cardioplegic solution (modified St. Thomas' solution) containing sheep red blood cells and adenosine (1 mM) to maximally vasodilate the coronary vascular bed. Arresting the hearts eliminated motion complications and minimized arteriovenous oxygenation differences. The authors have found that under conditions of stable flow, there is a strong correlation between T2 in myocardial septa and hemoglobin (Hb) saturation, while tissue T1 is virtually independent of blood oxygenation. These effects are believed to be due to the paramagnetic agent deoxyhemoglobin.
Functional mri of human brain activation combining high spatial and temporal resolution by a cine flash technique
Authors: Merboldt Klaus‐Dietmar , Krüger Gunnar , Hänicke Wolfgang , Kleinschmidt Andreas , Frahm Jens
Published: March 2007

Functional mapping of human brain activation has been accomplished at high spatial and temporal resolution (voxel size 4.9 μl, temporal increment 100 ms). The approach was based on oxygenation‐sensitive long‐echo time FLASH MRI sequences synchronized to multiply repeated cycles of visual stimulation in a CINE acquisition mode. This high temporal resolution revealed that stimulus‐related signal intensity changes in human visual cortex display an initial latency followed by increases extending over several seconds. Furthermore, the temporal characteristics of the complete CINE MRI signal time course depended on the absolute and relative durations of activation and control periods and, for example, caused an apparent absence of a poststimulation “undershoot” phenomenon. Complementing hyperoxygenation due to rapid hemodynamic adjustments, these results suggest signal intensity modulation by enhanced oxygen consumption and concomitant deoxygenation during prolonged and/or repetitive stimulation.
Sequential dynamic susceptibility contrast MR experiments in human brain: Residual contrast agent effect, steady state, and hemodynamic perturbation
Authors: Levin Jonathan M. , Kaufman Marc J. , Ross Marjorie H. , Mendelson Jack H. , Maas Luis C. , Cohen Bruce M. , Renshaw Perry F.
Published: March 2007

The stability and reproducibility of the dynamic susceptibility contrast (DSC) MRI method for sequential relative cerebral blood volume (relCBV) measurements was evaluated to validate the method for use in quantitative studies of cerebral hemodynamics in humans. A spin echo echo planar imaging protocol was used in conjunction with multiple bolus injections of the susceptibility contrast agent gadoteridol (GD). The effects of variation in interbolus interval (10 min to 4 h), the number of injections (two to four), and the effect of the cerebral vasodilating agent acetazolamide (ACZ) were evaluated in 44 experiments performed with 22 normal subjects. Two fundamental observations were made. First, with multiple injections of GD, the change in MR signal over time was not consistent from first to subsequent boluses. A second bolus administered 10 min to 2 h after an initial bolus resulted in signal change of greater amplitude and duration, resulting in artifactually elevated estimates of relCBV, consistent with a residual effect of GD. Second, a relative steady state could be reached with serial injections of GD, such that the profile of subsequent boluses closely paralleled those of previous ones. This facilitates the reliable measurement of relCBV during activation, as demonstrated by use of ACZ.
Orbital navigator echoes for motion measurements in magnetic resonance imaging
Authors: Fu Zhuo Wu , Wang Yi , Grimm Roger C. , Rossman Phillip J. , Felmlee Joel P. , Riederer Stephen J. , Ehman Richard L.
Published: March 2007

A single “orbital” navigator echo, that has a circular k‐space trajectory, is used to simultaneously measure in‐plane rotational and multi‐axis translational global motion. Rotation is determined from the shift in the magnitude profile of the echo with respect to a reference echo. Displacements are calculated from the phase difference between the current echo and a reference echo. Phantom studies show that this technique can accurately measure rotation and translations. Preliminary results from adaptive motion correction studies on phantom and human subjects indicate that the orbital navigator echo is an effective method for motion measurement in MRI.
High resolution quantitative relaxation and diffusion mri of three different experimental brain tumors in rat
Authors: Eis Manfred , Els Thomas , Hoehn‐Berlage Mathias
Published: March 2007

The potential of quantitative parameter images of the relaxation times T1 and T2, the proton density p and the apparent diffusion coefficient (ADC) to characterize three different experimental rat brain tumors (F98 glioma, RN6 Schwannoma, and E376 neuroblastoma) was studied. All parameter values, as determined in histologically confirmed regions of interest (ROI), were higher in edema than in tumor, which in turn were elevated with respect to normal brain. ROI values of ADC and T2 delivered statistically significant (P < 0.01) differentiation between tumor and edema. Multidimensional parameter combinations improved differentiation between different tissues. However, the three tumor types could not be differentiated. All parameter maps allowed the identification of the whole tumoredema area. On T2 images, edema could be identified best, whereas the tumor itself was hardly visualized. In many cases, tumor presentation using T1 maps corresponded best with histology, nevertheless suffering from a poor tumoredema differentiation.
Quantification of liver blood volume: comparison of ultra short ti inversion recovery echo planar imaging (ulstir‐epi), with dynamic 3d‐gradient recalled echo imaging
Authors: Schwickert Heidi C. , Roberts Timothy P. L. , Shames David M. , Dijke Cornelis F. Van , Disston Alexander , Mühler Andreas , Mann Jeffry S. , Brasch Robert C.
Published: March 2007

An ultra‐short TI inversion recovery echo‐planar imaging (ULSTIR‐EPI) sequence was designed to reduce the influence of water exchange on fractional tissue blood volume (BV) estimation by measurement of T1‐changes induced by a gadolinium‐based macromolecular contrast medium (MMCM). Fractional liver BV in rats, estimated by ULSTIR‐EPI was compared for accuracy to a fast T1‐weighted three‐dimensional gradient‐echo (3D‐SPGR, 3D‐spoiled gradient recalled acquisition in a steady state) sequence using an in vitro inductively coupled plasma atomic emission spectroscopy (ICP‐AES) assay for BV as a standard. Liver images for fractional BV estimation were acquired in eight rats using both ULSTIR‐EPI and 3D‐SPGR before and after (within 3 to 12 min) intravenous bolus administration of albumin‐Gd‐DTPA30 (0.05 mmol Gd/kg). Whereas both MR techniques may be useful for fractional tissue BV estimation, ULSTIR‐EPI offers certain advantages including greater accuracy, direct T1 maps, and minimization of transendothelial proton exchange effects. 3D‐SPGR imaging offers better spatial resolution, current availability on standard clinical MR systems, and acceptable accuracy.
Detection of bromobenzene‐induced hepatocellular necrosis using magnetic resonance microscopy
Authors: Zhou Xiaohong , Maronpot Robert R. , Hedlund Laurence W. , Cofer Gary P. , Johnson G. Allan
Published: March 2007

The authors used magnetic resonance (MR) microscopy to assess hepatic tissue damage induced by bromobenzene both in living rats and in fixed rat liver tissues. Experiments were conducted at 7 Tesla on three groups of Fisher rats treated with bromobenzene at a single dose of 68, 135, and 269 mg/kg, respectively. Optical microscopy of hematoxylin and eosin stained sections showed liver damage only at the highest dose, whereas with MR microscopy, tissue alterations were detected at all three doses both in vivo and ex vivo. The contrast mechanism of the superior sensitivity of MR microscopy is believed to be related to the changes in local diffusion coefficients that accompany cellular degeneration and death, although other contrast mechanisms may also be involved. The superior sensitivity of MR microscopy, as demonstrated in this study, has many implications for potential use of MR techniques to perform in vivo histology.
Use of epr oximetry with india ink to measure the po2 in the liver in vivo in mice
Authors: Nakashima Toshiaki , Goda Fuminori , Jiang Jinge , Shima Toshihide , Swartz Harold M.
Published: March 2007

The partial pressure of oxygen (pO2) of the liver in vivo in unanesthetized mice was determined using electron paramagnetic resonance (EPR) oximetry with India ink. The EPR spectra were obtained using a low‐frequency (1.2 GHz) EPR spectrometer with a loop gap cavity resonator. The line width of the India ink used in this experiment was reversibly broadened by oxygen and was particularly sensitive to pO2 below 30 torr. After the administration of India ink into the tail vein, the India ink particles were taken up mainly by Kupffer cells in the liver and in part by phagocytes in the spleen. The pO2 measured in the normal liver was about 14 torr and was constant for the 2‐week experimental period. The pO2 decreased when measured at 1, 2, and 6 days after treatment with a hepatotoxin (carbon tetrachloride (CCI4)); within 2 weeks, it returned almost to the initial level. Measurements by EPR at sacrifice of controls and CCI4‐treated mice indicated that more than 90% of the India ink went to the liver; the spleen contained 4.7% of total amount in control mice and 8.8% in CCI4‐treated mice when measured 2 weeks after the treatment. These data indicate the usefulness of India ink for measuring the pO2 of the liver in vivo and that the pO2 in the Kupffer cells is decreased when the liver is damaged by CCI4.
Multiple breath‐hold averaging (mba) method for increased snr in abdominal mri
Authors: Feinberg David A. , Rofsky Neil M. , Johnson Glyn
Published: March 2007

Breath‐holding during MR imaging eliminates respiratory motion artifacts but places a major time constraint on data acquisition. This constraint limits image signal‐to‐noise ratio and hence spatial resolution. A new method, multiple breathhold averaging, is presented that overcomes these time limitations. Several images are acquired in sequential breath‐hold periods, separated by periods of normal breathing, and averaged. This averaged image shows the expected increase in SNR with surprisingly little blurring due to misregistration. SNR improvements can be traded for increased spatial resolution. The MBA methodology can also be applied to 3D data acquisitions, dynamic contrast acquisitions, and image subtractions.
Managing components for assemble‐to‐order products with lead‐time‐dependent pricing: The full‐shipment model
Authors: Hsu Vernon Ning , Lee Chung Yee , So Kut C.
Published: March 2007

We study a component inventory planning problem in an assemble‐to‐order environment faced by many contract manufacturers in which both quick delivery and efficient management of component inventory are crucial for the manufacturers to achieve profitability in a highly competitive market. Extending a recent study in a similar problem setting by the same authors, we analyze an optimization model for determining the optimal component stocking decision for a contract manufacturer facing an uncertain future demand, where product price depends on the delivery times. In contrast to our earlier work, this paper considers the situation where the contract manufacturer needs to deliver the full order quantity in one single shipment. This delivery requirement is appropriate for many industries, such as the garment and toy industries, where the economies of scale in transportation is essential. We develop efficient solution procedures for solving this optimization problem. We use our model results to illustrate how the different model parameters affect the optimal solution. We also compare the results under this full‐shipment model with those from our earlier work that allows for multiple partial shipments. © 2007 Wiley Periodicals, Inc. Naval Research Logistics, 2007
Cardiovascular risk factors in confirmed prediabetic individuals. Haffner S M, Stern M P, Hazuda H P, et al. JAMA, 1990; 263: 2893–8
Authors: Shaw K M
Published: March 2007

This paper analyses the atherogenic pattern of risk factors in a large number of individuals who when first studied had normal glucose tolerance but who several years later went on to develop diabetes of the non‐insulin‐dependent type. Base line cardiovascular risk factors were studied in 614 non‐diabetic Mexican Amcricans who went on to participate in the San Antonio heart study, an eight year follow‐up. Forty‐three of these went on to develop Type 2 diabetes. These people were therefore considered to have confirmed prediabetes at the initial examination. They were found to have significant elevation of total and low density lipoprotein cholesterol, triglyceride. fasting glucose. and insulin levels, body weight and blood pressure. with low levels of high density lipoprotein cholesterol. People with initial impaired glucosc tolerance at base line were not considered.
Who uses a diabetes “drop‐in” centre
Authors: Dunning P L , Ward G M , Alford F P
Published: March 2007

This study aimed to document patients' reasons for attendance at a “drop‐in” centre serving a general diabetic clinic (n = 756). Over six months the following data were documented: reasons for attendance (self‐initiated or referred and source or referrals); length of consultation; age and sex of clients; whether NIDDM or IDDM; and treatment modes. All 133 minor consultations (<30 min) (95 NIDDM and 38 IDDM) were self‐initiated. Of the 71 major consultations (>30 min) comprising 59 NIDDM (of whom 47 were insulin‐treated) and 12 IDDM, 48 were self‐initiated. The main reasons for major consultations were: 20 presented with persisting hyperglycaemia > 17 mmol/l (17 required insulin adjustment); eight had unfavourable social circumstances affecting diabetes management and required counselling; 10 requested ongoing diabetes education; six presented with foot lesions (two with neuropathic ulcers); and 10 diabetics came with non‐diabetes‐related health problems. Unexpectedly, there were no requests for dietary advice, and few for hypoglycaemia. There were six contacts by relatives, five parents of people with IDDM expressing concern about their child's lifestyle which compromised metabolic control and one husband of a person with NIDDM. We conclude that our clients demonstrate a definite need for diabetes‐related education or advice between clinic visits. In our study the major reasons for seeking advice were for hyperglycaemia needing treatment modification, counselling and to increase diabetes knowledge.
The costs and benefits of introducing a nurse‐run diabetic review service into general practice
Authors: Sullivan F M , Menzies A
Published: March 2007

A prospective six‐year study of all diabetic patients in a single practice was conducted to investigate the benefits to patients which resulted from the introduction of a nurse‐run diabetic review service. The opportunity of the audit was also used to determine the capital and running costs of such a service. After initial expenditure of around £200–;300, GPs can expect to devote a total of 10‐15 minutes of their own time and 20‐30 minutes of their nurse's time to providing an annual check to each of their diabetic patients. Using our assumptions, this amounts to a cost to the practice of £4 per nurse review. Further costs beyond this minimum level are calculable for individual practices based on the data presented. Benefits to patients were evident for individual patients whose retinopathy or foot lesions were detected early and in the increasing numbers of examinations performed. It is possible for general practice teams to coordinate a comprehensive review service for their diabetic patients.
Self‐adjustment of insulin: An educational failure?
Authors: Gill G V , Redmond S
Published: March 2007

Self‐adjustment of insulin doses by diabetic patients is widely encouraged but efficacy of technique has not been evaluated or audited.

We recently published a series of guidelines for insulin adjustment in the BDA lay journal, “Balance” and a quiz for readers to complete and submit.

Six questions gave home blood glucose (BG) profiles on various insulin regimens. Patients were asked what adjustments to dose, if any, were required.

Sixty insulin‐treated diabetics responded, 97% were actively adjusting their doses. Only five (8%) answered all six questions correctly; 73% reacted wrongly to a single‐day BG profile; 22% made potentially hazardous changes in response to obviously erratic profiles; 63% changed doses of a once‐daily insulin system despite clear advice to the contrary. When specific insulin changes were indicated, 25% responded with the wrong insulin for a twice‐daily short/intermediate insulin system and 37% for a “Novopen” system.

We conclude that even amongst interested and motivated patients knowledge of self‐adjustment principles is poor. These skills need to be specifically taught to selected patients and their response requires auditing. If such a programme cannot be provided, then self‐adjustment should not be encouraged.
A geriatric diabetic clinic reviewed
Authors: Turnbull C J
Published: March 2007

One hundred and seventy‐three patients attending geriatric diabetic clinics were reviewed. The mean age was 79.2 years and 25% of patients were on insulin treatment, though most had Type 2 diabetes.

A high prevalence of large vessel complications such as stroke and ischaemic heart disease was found. Control of diabetes was poor and the reasons for this are discussed. There was minimal evidence of an association of poor control, history of smoking or hypertension with complications.
An audit of diabetic inpatient care
Authors: Lewis Fiona , Jones Julie , Jones Heather , Child D F
Published: March 2007

An audit of diabetic inpatients in a district general hospital over a period of one month revealed that 6% of all admissions were diabetic; half of these were due to diabetes or diabetic‐related complications. Average length of stay was 11.1 days as compared to 6.95 days for all patients.

Increased length of stay was mainly attributable to diabetic foot disease, with an average length of stay of 17.8 days.

Management of non‐medical diabetic admissions was an important part of the diabetic team's workload.
The “piqure” effect
Authors: Quin J D , Maccuish A C , O'Donnell J
Published: March 2007

Treatment for hypoglycaemia with glucagon and IV glucose improved consciousness in a 28‐year‐old male diabetic. He remained confused, however, which was thought to be the result of prolonged hypoglycaemia and he was treated with mannitol and IV insulin. Twenty‐four hours after admission he was lucid and a CT scan performed 24 hours later was normal.
An audit of patient satisfaction
Authors: Harrison C J , Roaf E J , Boulton A J M , Tomlinson S
Published: March 2007

The Manchester Diabetes Centre was opened in March 1988 to replace the traditional diabetic clinic at the Manchester Royal Infirmary. In order to audit the effect of this move on the satisfaction of patients, surveys were undertaken both before and after the move. Patients questioned in the Diabetes Centre were significantly more satisfied with the organisation, waiting times, environment, clinical care, education and relationships with staff than those questioned in the traditional clinic.
Comparison of human isophane insulin (Human InsulatardTM) with crystalline insulin zinc suspension (Human UltratardTM) as night‐time longer‐acting insulins in a multiple injection regimen
Authors: Mansell P I , Havard F , O'Hare J P
Published: March 2007

In a randomised cross‐over study we compared human isophane insulin (Human InsulatardTM) with human crystalline insulin zinc suspension (Human UltratardTM) as longer‐acting, night‐time insulins given thrice daily soluble insulin in the management of diabetes. We studied 20 insulin‐dependent patients aged 20–47 years. At the end of each 12‐week study period, total daily insulin dose was 56.9 ± 3.9U with Human InsulatardTM and 59.4 ± 4.4U with Human UltratardTM (no significant difference). The amount of longer‐acting insulin used was lower with Human InsulatardTM than with Human UltratardTM (23.3 ± 2.5 vs 29.0 ± 3.2U per day, p<0.001), despite which the early morning (fasting) blood glucose concentration was lower using Human InsulatardTM (7.4 ± 0.6 vs 10.0 ± 1.0mmol per litre, p<0.02). Serum fructosamine, glycosylated haemoglobin and mean daily blood glucose concentrations were similar with either insulin. Patients reported a total of 85 (range 0.25, median 2) hypoglycaemic episodes using Human InsulatardTM compared with 161 (0.33, 3) when using Human UltratardTM (0.05 <p<0.10). Following the study, 15 patients elected to use Human InsulatardTM compared with five choosing Human UltratardTM (p<0.05). In many patients, human isophane insulin appears to be more satisfactory than human crystalline insulin zine suspension as a longer acting insulin in a multiple injection regimen.
Quality control of blood pressure readings performed by practice nurses
Authors: Burden M L , Burden A C
Published: March 2007

Practice nurse measurement of blood pressure is an accepted technique for blood pressure screening and monitoring of anti‐blood pressure therapy in the diabetic clinic. Consequently it is important to design a quality control programme to ensure accuracy of measurement. We describe such a technique employing the Society of Hypertension video on Blood Pressure. Responses were obtained from 36 practice nurses attending a study day on diabetes. Major potential errors of equipment and maintenance were discovered (64% not calibrated or overhauled; 22.5% unable to be adjusted for height). Errors of measurement were also found: 50% of diastolic values were incorrect, and 30% of systolic values. Since anti‐hypertensive treatment is so important in people with diabetes, the responses described demonstrate the need for more care about the teaching on blood pressure measurement and a continuing quality control programme.
Diabetes mellitus, papilloedema, benign intracranial hypertension
Authors: Singh B M , Kilvert J A , Fitzgerald M G
Published: March 2007

Two cases are outlined of patients with visual deterioration due to papilloedema that may have easily been attributed to an anterior ischaemic optic neuropathy if a lumbar puncture diagnostic of benign intracranial hypertension (cerebrospinal fluid pressure > 200mm) had been omitted, with the consequent missed opportunity for beneficial vision‐saving therapeutic intervention. In one case hypothalamic pituitary dysfunction, a known association of benign intracranial hypertension, was documented during an insulin hypoglycaemia stress test, and this may have contributed to sudden onset of unheralded severe hypoglycaemia. The chance co‐occurrence of benign intracranial hypertension and diabetes mellitus may present clinical problems that require careful consideration of the differential diagnosis.
Structuring diabetes care within general practice
Authors: Goulder J , Balme M , Hooper P
Published: March 2007

In an eighteen month project within the Portsmouth and SE Hants Health District, facilitators helped structure diabetes care in 27 practices. In total 39 practices were visited. The prevalence of diabetes in the practices providing structured care was 1.56% (2,684 diabetics in a population of 177,100). Delivery of structured care within the District increased four‐fold by the end of the project.
Random blood glucose estimations on admission as a screening test for diabetes in an elderly population
Authors: Shotliff K , Prasad A
Published: March 2007

The prevalence of diabetes mellitus increases with advancing age but often remains undiagnosed. We examined the use of a blood glucose assay, performed on admission in 515 consecutive acute admissions, aged 65 years and over as an initial screening test for diabetes mellitus. Of these, 7.6% were previously known to have diabetes and 4.7% were newly diagnosed on the basis of subsequent fasting blood glucose estimations. Using a random blood glucose level ≥8.0mmol/1, 18.5% of those screened needed further investigation. Although this method has been used for many years to screen for diabetes a formal comparison with a glucose tolerance test is needed before it can be used as the sole screening test.
Moving to adult care
Authors: Dunning T
Published: March 2007

The transfer from paediatric to adult diabetes care is often stressful for young people with insulin‐dependent diabetes mellitus (IDDM) and their parents. Since 1984 we have been conducting an after‐hours clinic for IDDM patients aged 18–30 years. Eleven criteria for an appropriate IDDM clinic were identified and evaluated, using a 10cm Likert scale, by clinic attendees and the clinic staff. The results indicate that our clinic is meeting the expectations of our young IDDM patients, but privacy during consultations could be improved.
A multicentre study of the B‐DTM (Becton Dickinson) Pen as a delivery system for human insulin
Authors: Anderson Dm , Barnett Ah , Pizzey M , Rowe Br , Songer N
Published: March 2007

One thousand and sixteen insulin‐treated patients from 84 UK diabetes centres were entered into a 12‐week open study to assess the acceptability and safety of the B‐DTM (Becton Dickinson) Pen with HumulinTM (human insulin [prb], Eli Lilly & Co) cartridges. Patients completed an acceptability questionnair after six and 12 weeks' use of the Pen. Patients were asked to score various Pen characteristics on a five‐point scale of very easy to very difficult which included: changing the needle and storing and carrying the Pen; setting the insulin dose; fitting a new cartridge; injecting insulin; reading the dosage markings and noting when the cartridge was empty. Nine hundred and ten patients (90%) completed the study.

The commonest insulin used was Humulin M3, a fixed mixture of 30% soluble and 70% isophane insulin (33% of patients), and the most popular dosing regimen was twice daily, (65% of patients). The average daily dose of insulin was 39 units.

Three per cent of patients reported some Pen malfunction during the study, and 9% of patients at week 6 and 16% at week 12 reported Pen breakage. All aspects of Pen usage were assessed as 'very easy/fairly easy' by over 84% of patients at both week 6 and week 12; the Pen compared favourably to previous injection methods. Ninety percent of patients who previously used a needle and syringe and 62% who previously used another pen device opted to continue using the B‐D Pen at the end of the study.
The supply of insulin to patients in the community: Problems and solutions
Authors: Cantrill JA , Baker L
Published: March 2007

With the large number of insulin preparations available, there is potential for confusion not only for patients but for health care professionals. The aim of this study was to identify any problems relating to the supply of insulin from community pharmacles to diabetic patients. Sixty‐five patients and 30 pharmacists were interviewed. Twenty‐four pharmacists reported a total of 34 problems relating to prescriptions for insulin, the most common being ambiguity over the species of the insulin. Six patients were aware that they had received prescriptions for the wrong insulin (five dispensed) and two had been given a prescription for viais when cartridges were required (two dispensed).

This study reinforces the importance of educating patients about their insulin therapy and the need for health care professionals to keep up‐to‐date with developments in insulin therapy.
Management through pregnancy of a patient with an implantable programmable insulin infusion pump
Authors: Gallacher SJ , Maccuish AC , Lunan C B , Paterson KR
Published: March 2007

A 31 year old woman with a 26 year history of Type 1 diabetes mellitus and reslstance to subcutaneous insulin who used a programmable implantable insulin infusion pump for intravenous insulin delivery became pregnant. This report describes our experience of management of this patient through her pregnancy. The pregnancy was complicated by, first, failure of the power supply of the insulin Infusion pump in the second trimester and, second, the later development of pregnancy‐induced hypertension and proteinurla. Throughout this pregnancy, glycaemic control was good with glycated haemoglobin ranging from 7.0−9.0% (non‐diabetic reference range 4.9−7.6%). A normal female infant was subsequently delivered by Caesarean section at 34 weeks' gestation.

This report illustrates the fact that, with a well‐motivated patient, glycaemic control through pregnancy may be optimised using an implantable programmable insulin infusion pump.
Diabetes audit from 1987 to 1993 carried out in a general practice clinic
Authors: Smithson J
Published: March 2007

A seven year audit of a GP practice nurse‐run diabetic review service was done with the aim of identifying any improvement in control by analysing the HbA1c results. The study also monitored the diagnostic rate of diabetes within the practice over this period. The audit showed some improvement in levels of control by 1993, with 75% of diabetic patients achieving ‘acceptable’ control. Over the seven year period the proportion of those diagnosed with diabetes within the practice increased from 1.1% to 1.6%.
Capillary blood sampling: How much pain is necessary?. Part 1: Comparison of existing finger stick devices
Authors: Fruhstorfer H , Müller T
Published: March 2007

Six commercially available automatic lancing devices were examined with regard to puncture pain and capillary blood volume. They differed significantly in puncture pain: devices with greater penetration depth, thicker lancets and inexact lancet guidance got higher pain scores. Blood volumes obtained were generally too large.
Improvement in psychological well‐being in new NIDDMs. DSN versus medical initial assessment
Authors: Harrower ADB , Tallon L , McCue P , Sullivan P , Coates S , Jack H
Published: March 2007

Because of an increasing waiting list of new NIDDMs, we designed a new system to make better use of our existing facilities which include a small diabetes centre staffed by diabetes specialist nurses and a dietitian, and a conventional hospital clinic. Patients were usually seen at the clinic for medical assessment, where their treatment and education programme was also initiated. This programme was continued at the diabetes centre and an early clinic review was made to assess progress. After review of treatment protocols and establishment of clear guidelines for medical advice, a new system was introduced where initial assessment was made in the diabetes centre by a diabetes specialist nurse and dietitian, and medical examination was deferred until later. In order to assess this system, psychological well‐being was measured using Hospital Anxiety and Depression (HAD) scales in 150 consecutive new NIDDMs under the old system, and in 100 consecutive NIDDMs under the new system. A check on the presence of medical and diabetic complications was also made. There was a significant reduction (p<0.005) in anxiety alone and both anxiety and depression together, and no significant undiagnosed medical or diabetic complications were missed. With appropriate safeguards, initial assessment of new NIDDMs can be made by diabetes specialist nurses and, by providing an earlier appointment in a less stressful environment, patient well‐being is improved.