bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of the Utility of a Glycemic Pattern Identification System
Authors: Otto Erik A. , Tannan Vinay 
Published: May 2014

Background: With the increasing prevalence of systems allowing automated, real-time transmission of blood glucose data there is a need for pattern recognition techniques that can inform of deleterious patterns in glycemic control when people test. We evaluated the utility of pattern identification with a novel pattern identification system named Vigilant™ and compared it to standard pattern identification methods in diabetes. Method: To characterize the importance of an identified pattern we evaluated the relative risk of future hypoglycemic and hyperglycemic events in diurnal periods following identification of a pattern in a data set of 536 patients with diabetes. We evaluated events 2 days, 7 days, 30 days, and 61-90 days from pattern identification, across diabetes types and cohorts of glycemic control, and also compared the system to 6 pattern identification methods consisting of deleterious event counts and percentages over 5-, 14-, and 30-day windows. Results: Episodes of hypoglycemia, hyperglycemia, severe hypoglycemia, and severe hyperglycemia were 120%, 46%, 123%, and 76% more likely after pattern identification, respectively, compared to periods when no pattern was identified. The system was also significantly more predictive of deleterious events than other pattern identification methods evaluated, and was persistently predictive up to 3 months after pattern identification. Conclusions: The system identified patterns that are significantly predictive of deleterious glycemic events, and more so relative to many pattern identification methods used in diabetes management today. Further study will inform how improved pattern identification can lead to improved glycemic control.
Application of PK/PD Modeling and Simulation to Dosing Regimen Optimization of High-Dose Human Regular U-500 Insulin
Authors: de la Peña Amparo , Ma Xiaosu , Reddy Shobha , Ovalle Fernando , Bergenstal Richard M. , Jackson Jeffrey A. 
Published: May 2014

Background: Pharmacokinetic/pharmacodynamic (PK/PD) studies of human regular U-500 insulin (U-500R) at high doses commonly used in clinical practice (>100 units) have not been performed. The current analysis applied PK/PD modeling/simulation to fit the data and simulate single-dose and steady-state PK/PD of U-500R high-dose regimens. Method: Data from 3 single-dose euglycemic clamp studies in healthy obese and normal-weight patients, and normal-weight patients with type 1 diabetes were used to build the model. The model was sequential (PK inputs fed into PD component). PK was described using a 1-compartment model with first-order absorption and elimination. The model estimated separate absorption rate constants for U-500R and human regular U-100 insulin. The PD component used an effect compartment model, parameterized in terms of maximum pharmacologic effect (Emax) and concentration to achieve 50% of Emax. Results: The model described the data well. Steady-state PK for once-daily (QD), twice-daily (BID), or thrice-daily (TID) administration appeared to be reached 24 hours after the first dose. At steady-state, QD dosing showed the greatest fluctuations in PK/PD. BID dosing showed a gradual increase in insulin action with each dose and a fairly stable basal insulin effect. For TID dosing, activity was maintained throughout the dosing interval. Conclusions: PK/PD modeling/simulation of high U-500R doses supports BID or TID administration with an extended duration of activity relative to QD. TID dosing may provide slightly better full-day insulin effect. Additional PK/PD studies and randomized controlled trials of U-500R are needed to validate model predictions in patients with insulin-resistant diabetes requiring high-dose insulin.
A Study of Patient Experience Using a Blood Glucose Meter With an In-Built Insulin Dose Calculator
Authors: Ramtoola Shenaz , Jude Edward , Robinson Anthony , Malik Iqbal , Rayman Gerrard , Dang Cuong , Martin Graham David Ross , Ali Amar 
Published: May 2014

Background: Accurate calculation and adjustment of insulin doses is integral to maintaining glycemic control in insulin treated patients. Difficulties with insulin dose calculations may lead to poor adherence to blood glucose monitoring and insulin treatment regimes, resulting in poor metabolic control. The main objective of this study was to evaluate ease of use and user preference of a high specification touch screen blood glucose meter, which has an in-built insulin calculator, compared to patients’ usual method of testing blood glucose and deciding insulin doses. Methods: Patients with diabetes on a multiple daily injection insulin regime used the Test Meter without the insulin calculator and 1 of 3 comparator meters, each for a 7-day period. They then used the Test Meter with the in-built calculator for 10 days. Patients completed an ease of use questionnaire after each 7-day period, a preference questionnaire after the second 7-day period, and a questionnaire comparing the Test Meter with their usual method after the final 10-day period. Results: Of 164 patients who completed the study, 76% stated a preference for the Test Meter as a diabetes management tool compared to their usual method. A small number of patients preferred familiar methods and/or calculating insulin doses themselves. The log book function of meters was important to most patients. Conclusions: The Test Meter system with in-built insulin calculator supports people to better manage their diabetes and increases their confidence. Patients have different needs and preferences which should be acknowledged and supported in a patient centered health service.
Use of the DISST Model to Estimate the HOMA and Matsuda Indexes Using Only a Basal Insulin Assay
Authors: Davidson Shaun M. , Docherty Paul D. , Chase J. Geoffrey 
Published: May 2014

Background: It is hypothesized that early detection of reduced insulin sensitivity ( SI) could prompt intervention that may reduce the considerable financial strain type 2 diabetes mellitus (T2DM) places on global health care. Reduction of the cost of already inexpensive SI metrics such as the Matsuda and HOMA indexes would enable more widespread, economically feasible use of these metrics for screening. The goal of this research was to determine a means of reducing the number of insulin samples and therefore the cost required to provide an accurate Matsuda Index value. Method: The Dynamic Insulin Sensitivity and Secretion Test (DISST) model was used with the glucose and basal insulin measurements from an Oral Glucose Tolerance Test (OGTT) to predict patient insulin responses. The insulin response to the OGTT was determined via population based regression analysis that incorporated the 60-minute glucose and basal insulin values. Results: The proposed method derived accurate and precise Matsuda Indices as compared to the fully sampled Matsuda ( R = .95) using only the basal assay insulin-level data and 4 glucose measurements. Using a model employing the basal insulin also allows for determination of the 1-day HOMA value. Conclusion: The DISST model was successfully modified to allow for the accurate prediction an individual’s insulin response to the OGTT. In turn, this enabled highly accurate and precise estimation of a Matsuda Index using only the glucose and basal insulin assays. As insulin assays account for the majority of the cost of the Matsuda Index, this model offers a significant reduction in assay cost.
Clinical Evaluation of a Novel On-Strip Calibration Method for Blood Glucose Measurement
Authors: Noble Michael , Rippeth John , Edington David , Rayman Gerry , Brandon-Jones Sarah , Hollowood Zoe , Kew Simon 
Published: May 2014

Background: This study evaluated a novel technology for improving accuracy of self-monitoring of blood glucose (SMBG). The technology calibrates each and every test by measuring the response from a predetermined amount of glucose present in the sample chamber of each test strip. Method: SMBG test strips were modified to include a lid coated with a fast dissolving formulation containing glucose. These test strips were characterized for hematocrit (Hct) and temperature induced error response to develop a calibration algorithm. The modified test strips were used in a clinical evaluation involving fingerstick blood samples from 160 subjects. Results: Experiments involving Hct and temperature induced errors show that the technology generates a signal characteristic of the error conditions in any particular test, but independent of glucose concentration, allowing a correction algorithm to be derived. The approach substantially reduced Hct and temperature derived errors. Clinical evaluation using fingerstick blood directly applied to prototype strips showed the error (measured as MARD) was reduced from 11.1 to 5.9% by the on-strip correction approach and the number of outliers reduced by approximately 90%. Conclusion: This technology could improve the accuracy and precision of glucose monitoring systems and so reduce decision errors particularly in clinical situations where hematocrit and temperature may be significant confounders.
Platelets are required for enhanced activation of the endothelium and fibrinogen in a mouse thrombosis model of APS
Authors: Proulle Valerie , Furie Richard A. , Merrill-Skoloff Glenn , Furie Barbara C. , Furie Bruce 
Published: May 2014

Key PointsThe anti-β2GP1 autoantibody/β2GP1 complex binds to the platelet thrombus, amplifying platelet activation. Platelets are required for enhanced activation of the endothelium and fibrin generation by the anti-β2GP1 autoantibody/β2GP1 complex.
The patient perspective on overactive bladder: a mixed-methods needs assessment
Authors: Filipetto Frank A , Fulda Kimberly G , Holthusen Amy E , McKeithen Thomas M , McFadden Pam 
Published: May 2014

Abstract

Background
While overactive bladder is often managed in the primary care setting, a number of barriers including embarrassment, poor communication, and low patient adherence contribute to the under-treatment of patients with burdensome urinary symptoms. In order to address these challenges, it is crucial to have a fundamental understanding of patient perspectives toward OAB and urinary symptoms. To meet this aim, researchers designed and conducted a study to identify patients’ knowledge, experiences and attitudes, barriers to treatment adherence, and desires and tendencies regarding patient/clinician communications.

Methods
A mixed-methods qualitative/quantitative needs assessment of patients with overactive bladder and/or urinary symptoms. Researchers conducted in-depth qualitative interviews via telephone with 40 patients. Interview results informed the design and dissemination of a quantitative survey, which was completed by 200 self-selected respondents who had previously identified themselves as having overactive bladder or bladder problems. Statistical and qualitative analysis of results were conducted.

Results
Among survey respondents, an average of 3.5 years elapsed between symptom onset and seeking diagnosis by a physician. In the long term most patients do not experience improvement in symptoms. Medication non-adherence is common and is related to therapy effectiveness and adverse effects. Patients clearly indicate that communication and patient/physician relationships are important to them and they would prefer the clinician initiate the conversation on overactive bladder. Patient experiences, perspectives, and attitudes toward their bladder symptoms differ in many ways from clinicians’ assumptions.

Conclusions
The significant time gap between symptom onset and diagnosis indicates ongoing need for screening and diagnosis of overactive bladder. Contrary to guideline recommendations, urinalysis and physical examination are not widely used in clinical practice. Many patients experience no improvement in symptoms over time. Patients indicate that clinician/patient relationships and communication regarding their condition are important.
Diisocyanate-induced asthma in Switzerland: long-term course and patients’ self-assessment after a 12-year follow-up
Authors: Rüegger Martin , Droste Doreen , Hofmann Markus , Jost Marcel , Miedinger David 
Published: May 2014

AbstractBackgroundIsocyanates are among the most common causes of occupational asthma (OA) in Switzerland. Patients with OA have been shown to have unfavourable medical, socioeconomic and psychological outcomes. We investigated long-term asthma and the socio-economic outcomes of diisocyanate-induced asthma (DIA) in Switzerland.Patients and methodsWe conducted an observational study on 49 patients with DIA and followed 35 of these patients over a mean exposure-free interval of 12 ± 0.5 (range 11.0-13.0) years. At the initial and follow-up examinations, we recorded data on respiratory symptoms and asthma medication; measured the lung function; and tested for bronchial hyperreactivity. We allowed the patients to assess their state of health and overall satisfaction using a visual analogue scale (VAS) at these visits.ResultsThe 35 patients whom we could follow had a median symptomatic exposure time of 12 months, interquartile range (IQR) 26 months and a median overall exposure time of 51 (IQR 104) months. Their subjective symptoms (p < 0.001) and the use of asthma medication (p = 0.002), particularly the use of inhaled corticosteroids (p < 0.001), decreased by nearly 50%. At the same time, the self-assessment of the patients’ state of health and overall satisfaction increased considerably according to both symptomatology and income. In contrast, slight reductions in terms of FVC% predicted from 102% to 96% (p = 0.04), of FEV1% predicted from 91% to 87% (p = 0.06) and of the FEV1/FVC ratio of 3%; (p = 0.01) were observed while NSBHR positivity did not change significantly. In univariate as well as multivariate logistic analyses we showed significant associations between age, duration of exposure and FEV1/FVC ratio with persistent asthma symptoms and NSBHR.ConclusionsWe found that the patients’ symptoms, the extent of their therapy and the decrease in their lung volumes during the follow-up period were similar to the findings in the literature. The same hold true for some prognostic factors, whereas the patients’ self-assessment of their state of health and overall satisfaction improved considerably.
Predicting outcomes after blunt chest wall trauma: development and external validation of a new prognostic model
Authors: Battle Ceri Elisabeth , Hutchings Hayley , Lovett Simon , Bouamra Omar , Jones Sally , Sen Aruni , Gagg James , Robinson David , Hartford-Beynon Jake , Williams Jeremy , Evans Adrian 
Published: May 2014

Abstract
Introduction
Blunt chest wall trauma accounts for over 15% of all trauma admissions to Emergency Departments worldwide. Reported mortality rates vary between 4 and 60%. Management of this patient group is challenging as a result of the delayed on-set of complications. The aim of this study was to develop and validate a prognostic model that can be used to assist in the management of blunt chest wall trauma.

Methods
There were two distinct phases to the overall study; the development and the validation phases. In the first study phase, the prognostic model was developed through the retrospective analysis of all blunt chest wall trauma patients (n = 274) presenting to the Emergency Department of a regional trauma centre in Wales (2009 to 2011). Multivariable logistic regression was used to develop the model and identify the significant predictors for the development of complications. The model’s accuracy and predictive capabilities were assessed. In the second study phase, external validation of the model was completed in a multi-centre prospective study (n = 237) in 2012. The model’s accuracy and predictive capabilities were re-assessed for the validation sample. A risk score was developed for use in the clinical setting.

Results
Significant predictors of the development of complications were age, number of rib fractures, chronic lung disease, use of pre-injury anticoagulants and oxygen saturation levels. The final model demonstrated an excellent c-index of 0.96 (95% confidence intervals: 0.93 to 0.98).

Conclusions
In our two phase study, we have developed and validated a prognostic model that can be used to assist in the management of blunt chest wall trauma patients. The final risk score provides the clinician with the probability of the development of complications for each individual patient.
Root resorption after leveling with super-elastic and conventional steel arch wires: a prospective study
Authors: Alzahawi Kawa , Færøvig Espen , Brudvik Pongsri , Bøe Olav Egil , Mavragani Maria 
Published: May 2014

Abstract

Background
The aim of this prospective study was to compare root resorption after the leveling phase of treatment, performed by either super-elastic or conventional multi-stranded stainless steel arch wires.

Methods
From a total of 156 future orthodontic patients in a private clinic, 82 were included in the study after excluding those who earlier had orthodontic or endodontic treatment or signs of resorption. Patients were equally arbitrary allocated into two groups, where leveling was performed either with super-elastic heat-activated or conventional multi-stranded stainless steel arch wires. Root length loss was calculated using pre-treatment and post-leveling periapical radiographs.

Results
The use of super-elastic arch wires did not significantly increase the severity of root resorption, except for tooth 31, while it reduced leveling time compared to conventional stainless steel wires. Crossbite of maxillary lateral incisors seemed to be a risk factor for resorption.

Conclusion
Incisor root resorption after leveling did not differ significantly between patients treated with super-elastic and conventional stainless steel arch wires, except for a mandibular incisor.
At the Bedside:Helicobacter pylori, dysregulated host responses, DNA damage, and gastric cancer
Authors: Dalal Rahul S , Moss Steven F 
Published: May 2014

AbstractClinical trials performed in populations at high GC risk have demonstrated that eradication of Helicobacter pylori from the stomach with a course of combination antimicrobials helps prevent gastric carcinogenesis when they are administered before precancerous lesions have yet developed. In this review, we consider the insights into H. pylori-associated gastric carcinogenesis that have been gained from these and many other clinical studies in the field to highlight priority areas for basic research and clinical investigation. Among these are defining the magnitude of the risk reduction that may be achieved in clinical practice and at a population level by H. pylori eradication and investigating when, during the slow multistep progression to GC, intervention will be of the most benefit. Additional strategies to prevent GC induced by H. pylori, including chemoprevention, dietary modification, and close endoscopic surveillance, may also have value in augmenting the risk reduction. Why only a small subpopulation of those infected by H. pylori go on to develop GC may be partially explained by genetic susceptibility related to SNPs in several genes regulating the intensity of the gastric inflammatory response to H. pylori. Investigation of the basic mechanisms underlying the promotion of GC by H. pylori and the associated inflammatory response will likely continue to improve clinical strategies for the prevention of one of the most common causes of cancer death globally. See related review, At the Bench: H. pylori, dysregulated host responses, DNA damage, and gastric cancer.
Unarticulated Memories of the Battle of Okinawa: The Early Fiction of Second-Generation War Survivor Medoruma Shun
Authors: Ikeda Kyle 
Published: May 2014

This article examines two early pieces of literary war fiction by Okinawa's leading contemporary writer, Medoruma Shun, that deal with two kinds of unarticulated memories of the Battle of Okinawa: memory constrained by social consequence and the inexpressible memory of trauma. Both stories constitute explorations of war memory that are not found in survivor testimony and, as such, simultaneously reveal and critique the limitations of survivor-authored narratives of the war. I first explicate how the war-survivor characters in “Fûon” (“The Crying Wind,” 1985 – 86) lived their lives since the war without telling anyone about their most haunting war experiences, in large part, I argue, because of the possible social consequences of disclosure. Drawing from Bessel A. van der Kolk and Onno van der Hart's, as well as Oka Mari's, scholarship on the nature of traumatic memory, I demonstrate how the traumatic war experiences of an elderly war-survivor character in “Heiwa dôri to nazukerareta machi or aruite” (“Walking the Street Named Peace Boulevard,” 1986) remain beyond her ability to narrate them.
The article argues that Medoruma's war fiction needs to be interpreted within the frame of second-generation survivorship in order to better reveal the ways in which his narratives contribute to understandings of the Battle of Okinawa and its ongoing effects on survivors. It is Medoruma's experience as the child, grandchild, and relative of numerous survivors of the Battle of Okinawa that has provided him with an intimate look at the nature of war trauma and made him aware of the gap between war stories that survivors recount in public and the inarticulate expressions of war trauma that haunt many of them in private. At the same time, because he has not directly experienced the war, Medoruma is removed enough from the traumatic event to be able to address that which survivors have avoided or have been unable to articulate.
Apuntes sobre la percepción subconsciente en el cine. El ejemplo de Alien, el octavo pasajero (1979) y su propuesta orgánica de atracción/repulsión
Authors: Carrasco Molina Enrique 
Published: May 2014

En una revisión profunda en la que se aportan datos hasta ahora inéditos, el presente artículo analiza nuevas claves de por qué la película Alien, el octavo pasajero (Ridley Scott, 1979), ha causado una atracción sobredimensionada del espectador en su estreno y reposición a lo largo de más de tres décadas. Se propone la tesis de que el film emplea un conjunto de símbolos audiovisuales ocultos o semi-ocultos que provocan sensaciones de placer/displacer (eros y tanatos) y son las causantes directas de sus nutridas afinidades. Se explicita además cómo en el diseño/ presentación de un universo alienígena aparentemente nuevo (respecto al cine de ciencia ficción precedente) el espectador asume una mímesis identificativa y orgánica que se introduce en las profundidades del inconsciente, despertando un interés sorprendente entre audiencias de diferentes generaciones y edades. Se analiza el fenómeno subliminal o subconsciente en el cine, desde el punto de vista de la percepción, a partir de los experimentos publicitarios de los años 50 en una sala de exhibición de los Estados Unidos. También se estudia por primera vez el curioso paralelismo del argumento de la película con el impacto mediático previo y simultáneo del primer bebé probeta nacido el 25 de julio de 1978, en pleno inicio del rodaje de este film en los estudios londinenses Shepperton.