bluuebunny/crossref_metadata_2025_split huggingface dataset:
Costs and Benefits of More Learner Freedom
Authors: Carolan Thomas F. , Hutchins Shaun D. , Wickens Christopher D. , Cumming John M. 
Published: January 2014

Objective: Individual meta-analyses were conducted for six training methods as part of a U.S. Army basic research project. The objective was to identify evidence-based guidelines for the effectiveness of each training method, under different moderating conditions, for cognitive skill transfer in adult learning. Results and implications for two of these training methods, learner control (LC) and exploratory learning (EL), are discussed. LC provides learners with active control over training variables. EL requires learners to discover relationships and interactions between variables. Background: There is mixed evidence on the effectiveness of both LC and EL learning methods on transfer relative to more guided training methods. Cognitive load theory (CLT) provides a basis for predicting that training strategies that manage intrinsic load of a task during training and minimize extraneous load will avail more resources that can be devoted to learning. Method: Meta-analyses were conducted using a Hedges’s g analysis of effect sizes. Control conditions with little to no learner freedom were contrasted with treatment conditions manipulating more learner freedom. Results: Overall more LC was no different from training with limited or no learner control, and more EL was less effective than limited or no exploration; however, each can be effective under certain conditions. Both strategies have been more effective for cognitive skill learning than for knowledge recall tasks. LC exhibited more benefit to very near transfer, whereas EL’s benefit was to far transfer. Conclusion: Task type, transfer test, and transfer distance moderate the overall transfer cost of more learner freedom. Application: The findings are applicable to the development of instructional design guidelines for the use of LC and EL in adult skill training.
The “Cuban Model” and Its Microeconomy
Authors: Anderson Tim 
Published: January 2014

No productivist model of socialism has ever existed in Cuba. Rather, the Cuban approach has drawn on a hybrid of ethical principles with some consistent strategic themes. Cuba’s socialist strategy has been reformulated quite flexibly, in relation to these principles and historical circumstances, and this flexibility seems to have been important in allowing Cuban socialism to adapt and survive. More recently, Cuba has looked for a selective engagement with the global economy, advancing its strong service sectors while protecting key domestic services and domestic food production. The major in-principle change in recent years has been the licensing of the hiring of private labor. Changes to Cuba’s microeconomy are also best understood through the lens of ethical socialism and adaptation. Special attention to Cuba’s microeconomy is warranted because of the complex relation between wages, subsidized prices, and shared services. Nunca ha existido ningún modelo productivista del socialismo en Cuba. Por el contrario, el enfoque cubano se ha basado en un híbrido de principios éticos con algunos temas estratégicos consistentes. La estrategia socialista cubana ha sido reformulada de manera bastante flexible en relación a estos principios y circunstancias históricas, y esta flexibilidad parece haber ayudado en la adaptación y supervivencia del socialismo cubano. Más recientemente, Cuba ha buscado un compromiso selectivo con la economía mundial, avanzando sus sectores de servicio fuertes hacia adelante a la vez que protegiendo servicios domésticos clave y la producción nacional de alimentos. El principal cambio en los últimos años ha sido la licencia de contratación de mano de obra privada. Los cambios a la microeconomía cubana también se entienden mejor a través de un lente de socialismo ético y adaptación. El énfasis en la microeconomía de Cuba tiene sentido dada la compleja relación entre los salarios, los precios subsidiados y los servicios compartidos.
Bumps and bridges on the road to responsible sharing of clinical trial data
Authors: Berlin Jesse A , Morris Sandra , Rockhold Frank , Askie Lisa , Ghersi Davina , Waldstreicher Joanne 
Published: January 2014

Background Sharing data from clinical trials could assist with the advancement of science and medicine, potentially providing a better understanding of both the benefits and risks of medicines and other treatments. Sharing data also allows for questions to be addressed at the meta-analysis level that cannot be addressed within individual studies. Purpose In this article, we offer some practical recommendations that will allow researchers to readily combine datasets from different studies and sources, thereby enabling meta-analyses that could have significant impact on advancing medicine. Methods The authors relied on their collective experience in the conduct and reporting of clinical trials to define the areas of potential concern related to responsible sharing of clinical trial data. We conducted a review of the literature and engaged in an iterative consensus-building process. Results To further the goal of responsible sharing of clinical trial data, collaboration on a consistent set of data standards and methods across both industry and academia is sorely needed. Protection of participant privacy is a paramount principle. The additional questions of who maintains, funds, and oversees databases of participant-level data will be important to resolve. Requiring researchers to register their requests for participant-level data and to provide details of their intended research would allow others to evaluate the proposed research plan, consistent with the principles of science and transparency. Limitations The recommendations represent the views of the individual authors. We recognize that other approaches to data sharing that have been advocated are also based on sound ethical and scientific principles.
Amniotic fluid embolism: Then and now
Authors: Rafael A , Benson MD 
Published: January 2014

Background The first case report to describe amniotic fluid embolism that appeared in 1926 in Basil-Medico is translated from Portuguese to English. Case A patient with a dead fetus for several weeks, presented in labor and died suddenly with fetal squames evident in the maternal pulmonary vasculature at autopsy. Conclusion As can be seen from the translation, this case report is remarkably similar in many of its features to some of the eight patients described 15 years later in the first English language discussion of the disease by Steiner and Luschbaugh in JAMA. An enigma presented by this first case remains today: fetal material in the maternal pulmonary vasculature appears specific for amniotic fluid embolism at autopsy but not in living patients.
Addressing the inverse care law: the role of community paediatric services
Authors: Rahman Fawzia R , Maharaj Veena , Yates Rowena , Beeley Chris , Moore Ian , Rose Alex , Counsell Andy 
Published: January 2014

Background: Children’s health suffers disproportionately from the effects of poverty. The inverse care law states that those who need care the most are the least likely to receive it. Community paediatricians are well placed to address health inequalities in children. Aims: To explore, using routinely collected data, whether we address health inequalities and the inverse care law, particularly for certain conditions targeted by our specialty. Methods: Five years of data were analysed, during which health equity audits have led to service changes in order to tackle inequities. The data include postcodes, allowing each child to be assigned to a deprivation quintile, and a range of diagnoses, including five sentinel conditions: attention deficit hyperactivity disorder (ADHD) on medication, autistic spectrum disorder (ASD), epilepsy, cerebral palsy and Down’s syndrome. This allowed analysis of the caseload by deprivation index for these conditions, comparison with the background population and exploration of time trends. Results: The number of children on the caseload and their distribution across the quintiles remained stable. The proportion of deprived children (i.e. in the lowest two quintiles) on the caseload over the last five years taken together is 56%, compared to 44% in the background population. The numbers of children with ADHD on medication has almost quadrupled in deprived quintiles and doubled in the least deprived quintile, while the numbers of children with this diagnosis in the most deprived is four times that in the least deprived. Numbers of children with ASD have also increased in each quintile. In contrast, the number of children with epilepsy and cerebral palsy did not show much variation, but those from deprived quintiles made up a greater proportion of the caseload. Conclusions: Routine data collection demonstrates that inequalities are addressed using all four quality domains of service provision and sentinel conditions more likely to affect deprived children are targeted. We believe it is possible for all services to collect and analyse data thus with minimal effort, thereby providing a foundation from which to address the inverse care law.
A Prospective Evaluation of Insulin Dosing Recommendations in Patients with Type 1 Diabetes at near Normal Glucose Control: Bolus Dosing
Authors: King Allen B. , Armstrong Dana U. 
Published: January 2014

Background: Current bolus insulin dosing recommendations are based on retrospective studies of patients with Type 1 diabetes in whom the glucose control was not intensely established. Using continuous glucose monitoring (CGM), we prospectively studied these recommendations in patients treated with continuous subcutaneous insulin infusion. Methods: Thirty subjects were studied over a mean of two weeks of continuous glucose monitoring with near daily insulin adjustments. First a basal glucose goal was achieved of <5% of values <70 mg/dL and <20%>, 170mg/dL. Then bolus dosing factors; Insulin to Carbohydrate Ratio (g of meal carbohydrates/unit of insulin, ICR) and Correction Factor (mg/dL fall in blood glucose/unit of insulin, CF); were established for each meal time to a goal of ± 20% of premeal glucose (ICR) or 80–120 mg/dL (CF) by the fourth post bolus hour. Results: All treatment goals were achieved in each subject. Modification of formulas from ICR = 450/Total Daily Dose (TDD) to ICR = (217/TDD) + 3 and from CF = 1700/TDD to CF = (1076/TDD) + 12 more closely matched observed results than published formulas. There was no significant difference in each factor with time of day. There was a highly significant relationship between ICR and CF, ICR*4.44 = CF (r = 0.9, p < 0.0005), total basal dose (TBD) and TDD. Conclusions: Current formulas need to be modified to provide higher insulin bolus doses. The interrelationships between ICR, CF, TBD and TDD suggest that any change in one may require a change in the others.
Optimizing Display, Analysis, Interpretation and Utility of Self-Monitoring of Blood Glucose (SMBG) Data for Management of Patients with Diabetes
Authors: Rodbard David 
Published: January 2014

Background: Self-monitoring of blood glucose (SMBG) data have not been used to fullest advantage. Few physicians routinely download data from memory-equipped glucose meters and perform systematic analyses and interpretation of the data. There is need for improved methods for display and analysis of SMBG data, for a systematic approach for identification and prioritization of clinical problems revealed by SMBG, for characterization of blood glucose variability, and for clinical decision support. Methods: We have developed a systematic approach to the analysis and interpretation of SMBG data to assist in the management of patients with diabetes. This approach utilizes the following criteria: 1) Overall quality of glycemic control; 2) Hypoglycemia (frequency, severity, timing); 3) Hyperglycemia; 4) Variability; 5) Pattern analysis; and 6) Adequacy of monitoring. The “Pattern analysis” includes assessment of: Trends by date and by time of day; relationship of blood glucose to meals; post-prandial excursions; the effects of day of the week, and interactions between time of day and day of the week. Results: The asymmetrical distribution of blood glucose values makes it difficult to interpret the mean and standard deviation. Use of the median (50th percentile) and Inter-Quartile Range (IQR) overcomes these difficulties: IQR is the difference between the 75th and 25th percentiles. SMBG data can be used to predict the A1c level and indices of the risks of hyperglycemia and hypoglycemia. Conclusion: Given reliable measures of glucose variability, one can apply a strategy to progressively reduce glucose variability and then increase the intensity of therapy so as to reduce median blood glucose and hence A1c, while minimizing the risk of hypoglycemia.
Teaching Diabetes to Middle-School Students with the www.2aida.net AIDA Online Diabetes Software Simulator
Authors: Palacio Andres , Lehmann Eldon D. , Olson Darin E. 
Published: January 2014

Introduction: The lifetime risk of developing diabetes for students born in the new millennium in the United States is estimated to be 27% to 52%. Many students need to learn about diabetes for their personal care, or desire to learn about diabetes to develop a career in healthcare. Most teenagers are adept at learning through Web-based computer tools. Methods: Twenty-one students entering 8th and 9th grades (aged 12 to 14 years old) enrolled in a Biotechnology Summer Camp focused on diabetes. Lectures on pathophysiology and clinical aspects of diabetes were followed by simulated cases using the AIDA online diabetes software simulator accessed via the internet at www.2aida.net . Two cases demonstrated glycemic effects and pharmacokinetics of insulin administration, diet, and exercise in insulin-dependent (Type 1) diabetes and non-insulin-dependent (Type 2) diabetes. Students filled out standardized evaluations at the end of the session to assess receptiveness to this type of learning; opinions on the utility, information, and ease of use; and perceived risks of using the online simulator to understand diabetes. Results: All students were receptive to this educational tool. The majority found AIDA online useful (17/21 [81%]), educational (21/21 [100%]), worthy of wider distribution (20/21 [95%]), and would recommend the program to others with diabetes or wanting to learn about diabetes (18/21 [86%]). A minority (2/21 [9.5%]) found the program risky regarding the information given to the students. Positive comments included the ability to visualize concepts being taught in earlier lectures, and recognized the rigors required to manage diabetes. Fewer negative comments reflected frustration with the web-based user interface, the course materials, or difficulty in achieving good simulated glycemic control. Discussion: Teaching pathophysiology of diabetes and pharmacology of insulin to middle school students is enhanced with the AIDA online diabetes simulator. Future versions of this program, and development of similar programs, could be useful in teaching adolescents who have diabetes, and might help stimulate interested students to learn more about the care of people with diabetes.
Impact of Treatment with Rosiglitazone or Metformin on Biomarkers for Insulin Resistance and Metabolic Syndrome in Patients with Polycystic Ovary Syndrome
Authors: Steiner Charles A. , Janez Andrej , Jensterle Mojca , Reisinger Katrin , Forst Thomas , Pfützner Andreas 
Published: January 2014

Background: There is increasing evidence that insulin resistance (IR) has an important implication in the pathogenesis of polycystic ovary syndrome (PCOS), a common endocrinopathy in women. This study was performed to investigate the impact of different treatments for IR on five currently discussed markers for insulin resistance: Intact proinsulin, adiponectin, retinol-binding protein 4 (RBP4), resistin, and visfatin in patients with PCOS. Methods: Thirty-five women with clinically confirmed PCOS diagnosis were included in the study [age (mean±SD): 24.7±4.8 years; body mass index: 27.4+6.0 kg/m2]. They were randomized to receive either metformin (850 mg twice a day) or rosiglitazone (4 mg once a day). Blood samples for measurement of the HOMAIR score, visfatin, RBP4, intact proinsulin, resisitin, and adiponectin were taken at baseline and after 6 months of treatment. Results: Both drugs improved ovulation, and an increase in insulin sensitivity was observed, especially in the rosiglitazone arm. Adiponectin levels increased in both treatment arms (metformin: 8.6±3.3 to 16.7±7.2 mg/liter, p < 0.001; rosiglitazone: 8.2±3.5 to 26.2±9.5 mg/liter, p < 0.001), but the increase was more pronounced with rosiglitazone (p < 0.001). While no changes of visfatin concentrations were observed during rosiglitazone therapy (15.4±6.9 ng/ml vs 17.4±4.8 ng/ml, n.s.), there was an increase in the metformin treatment arm (11.9±4.0 to 21.8±8.3 ng/ml, p < 0.001). Significant increases demonstrated for RBP4 in both treatment arms were more pronounced in the metformin group (metformin: +66%, rosiglitazone: +33%). All patients were in stage I or II of ß-cell dysfunction and none of them showed increased intact proinsulin levels or changes in resisitin at baseline or end point. Conclusions: Both drugs slightly improved ovulation in our PCOS patient population during 6 months of therapy, which was accompanied by improved insulin sensitivity and an increase in adiponectin levels. Metformin increased visfatin concentrations. Despite improved insulin resistance, an increase in RBP4 concentration was seen for both drugs. Rosiglitazone seems to be the more favorable drug under these circumstances. However, our results regarding visfatin and RBP4 contradict other reports and further research is required to clarify their value as diagnostic markers for the metabolic syndrome. In this study, adiponectin appeared to be the most promising indicator of both metabolic status and therapeutic success.
GIM, Simulation Software of Meal Glucose—Insulin Model
Authors: Dalla Man Chiara , Raimondo Davide M. , Rizza Robert A. , Cobelli Claudio 
Published: January 2014

Background: A simulation model of the glucose—insulin system in normal life conditions can be very useful in diabetes research, e.g., testing insulin infusion algorithms and decision support systems and assessing glucose sensor performance and patient and student training. A new meal simulation model has been proposed that incorporates state-of-the-art quantitative knowledge on glucose metabolism and its control by insulin at both organ/tissue and whole-body levels. This article presents the interactive simulation software GIM (glucose insulin model), which implements this model. Methods: The model is implemented in MATLAB, version 7.0.1, and is designed with a windows interface that allows the user to easily simulate a 24-hour daily life of a normal, type 2, or type 1 diabetic subject. A Simulink version is also available. Three meals a day are considered. Both open- and closed-loop controls are available for simulating a type 1 diabetic subject. Results: Software options are described in detail. Case studies are presented to illustrate the potential of the software, e.g., compare a normal subject vs an insulin-resistant subject or open-loop vs closed-loop insulin infusion in type 1 diabetes treatment. Conclusions: User-friendly software that implements a state-of-the-art physiological model of the glucose-insulin system during a meal has been presented. The GIM graphical interface makes its use extremely easy for investigators without specific expertise in modeling.
Assessing Quality of Life for New Diabetes Treatments and Technologies: A Simple Patient-Centered Score
Authors: Pickup John C. , Harris Anna 
Published: January 2014

Background: A simple quality of life measure is needed for use in diabetes, particularly for the assessment of new treatments and technologies. We devised and validated a patient-centered quality of life (PCQoL) measure that should be applicable to routine clinical practice or trial of therapies. Methods: People with diabetes completed a two-part, PCQoL questionnaire where they nominated five aspects of generaland diabetes-related life judged most important for their overall quality of life and rated each for current level of satisfaction. Scores derived from the questionnaire were compared with a reference measure—the Diabetes Control and Complications Trial diabetes quality of life (DQoL) score. Both were repeated after 1 month. The participants were 72 diabetic patients (60% with type 1 diabetes); 29 people with type 1 diabetes were treated by continuous subcutaneous insulin infusion (CSII) and 14 were treated by multiple daily insulin injections (MDI). Results: Patients most often cited family and relationships or fear of complications and hypoglycemia as important facets of quality of life for them. The PCQoL measure was highly correlated with the reference DQoL measure (r = 0.73, p < 0.0001), had high repeatability (r = 91, p < 0.0001), and could be completed in less than 5 minutes. The test was sensitive enough to detect a better quality of life in CSII-treated patients vs MDI-treated patients. Conclusion: The PCQoL measure is simple, quick, valid, and suitable for routine use in diabetes or trials of new treatments.
Predictive Monitoring for Improved Management of Glucose Levels
Authors: Reifman Jaques , Rajaraman Srinivasan , Gribok Andrei , Ward W. Kenneth 
Published: January 2014

Background: Recent developments and expected near-future improvements in continuous glucose monitoring (CGM) devices provide opportunities to couple them with mathematical forecasting models to produce predictive monitoring systems for early, proactive glycemia management of diabetes mellitus patients before glucose levels drift to undesirable levels. This article assesses the feasibility of data-driven models to serve as the forecasting engine of predictive monitoring systems. Methods: We investigated the capabilities of data-driven autoregressive (AR) models to (1) capture the correlations in glucose time-series data, (2) make accurate predictions as a function of prediction horizon, and (3) be made portable from individual to individual without any need for model tuning. The investigation is performed by employing CGM data from nine type 1 diabetic subjects collected over a continuous 5-day period. Results: With CGM data serving as the gold standard, AR model-based predictions of glucose levels assessed over nine subjects with Clarke error grid analysis indicated that, for a 30-minute prediction horizon, individually tuned models yield 97.6 to 100.0% of data in the clinically acceptable zones A and B, whereas cross-subject, portable models yield 95.8 to 99.7% of data in zones A and B. Conclusions: This study shows that, for a 30-minute prediction horizon, data-driven AR models provide sufficiently-accurate and clinically-acceptable estimates of glucose levels for timely, proactive therapy and should be considered as the modeling engine for predictive monitoring of patients with type 1 diabetes mellitus. It also suggests that AR models can be made portable from individual to individual with minor performance penalties, while greatly reducing the burden associated with model tuning and data collection for model development.