Consumer issues in navigating health care services for type I diabetes

• Despite increasing interest in consumer awareness and participation in health care service delivery, there has been little exploration of consumer views in relation to services for people with type I diabetes. • The purpose of this qualitative exploratory study was to identify strategies people with type I diabetes used to access health services and the barriers they perceived in accessing the services they needed. • Data gathered in semi-structured interviews revealed that consumers experience significant barriers when navigating the health care system. • Three dominant themes were identified. They relate to access to specialist medical skill, to the transition from teenager to young adult and to pre-pregnancy and obstetric care. • Directions for change in service delivery and policy development are discussed.

Renal C-type natriuretic peptide and natriuretic peptide receptor B mRNA expression are affected by water deprivation in the Spinifex Hopping mouse

This study investigated the effect of water deprivation on the expression of C-type natriuretic peptide (CNP) and natriuretic peptide receptor B (NPR-B) mRNA, and the ability of NPR-B to generate cGMP in the Spinifex Hopping mouse, Notomys alexis. This rodent is a native of central and western Australia that is well adapted to survive in arid environments. Initially, CNP and NPR-B cDNAs (partial for NPR-B) were cloned and sequenced, and were shown to have high homology with those of rat and mouse. RT-PCR analysis showed CNP mRNA expression in the kidney, proximal and distal colon and small intestine, whilst NPR-B mRNA expression was found in the kidney, proximal and distal colon and the atria. Using a semi-quantitative multiplex PCR technique, the expression of renal CNP and NPR-B mRNA was determined in 7- and 14-day water-deprived hopping mice, in parallel with control hopping mice (access to water). Water deprivation significantly decreased the relative levels of CNP and NPR-B mRNA expression in both the 7- and 14-day water-deprived hopping mice, when compared to control hopping mice. In contrast, the ability of CNP to stimulate cGMP production was significantly increased after 14 days of water deprivation. This study shows that alterations in the renal CNP/NPR-B system may be an important physiological adjustment when water is scarce.

The response of the natriuretic peptide system to water deprivation in the desert rodent, Notomys alexis

Natriuretic peptides (NPs) are regulatory molecules that cause cGMP-mediated diuresis and natriuresis in mammals. Accordingly, it is interesting to consider their role in desert-adapted animals in which water is often limited. This study investigated the response of the natriuretic peptide (NP) system to varying periods of water deprivation (WD) in the Australian desert rodent species, Notomys alexis. It was hypothesised that the expression of the NP system will be down-regulated in water-deprived N. alexis compared to water-replete animals. The plasma levels of ANP were significantly reduced after 3 days of WD, but were unaffected by 7, 14 and 28 days of WD. Water deprivation for 3, 7, 14 days had a variable effect on the mRNA expression of ANP, CNP, NPR-A, NPR-B, and NPR-C, and a uniform down-regulation was not observed. However, after 28 days of WD, mRNA expression was similar to water-replete animals, except for NPR-A. Surprisingly, 7 and 14 days of WD caused an up-regulation in the ability of ANP to stimulate cGMP; this also occurred at 14 days for CNP. Taken together, the mRNA expression and peptide mediated guanylyl cyclase activity data after WD were in the opposite direction to what was predicted. Interestingly, after 28 days of WD, most parameters were similar to those of water-replete animals, which indicates that a down-regulation of the NP system is not part of the physiological response to an absence of free water in N. alexis.

Identification and expression of natriuretic peptide receptor Type-A and-B mRNA in freshwater and seawater rainbow trout

Natriuretic peptide receptors mediate the physiological response of  natriuretic peptide hormones. One of the natriuretic peptide receptor types is the particulate guanylyl cyclase receptors, of which there are two identified: NPR-A and NPR-B. In fishes, these have been sequenced and characterized in eels, medaka, and dogfish shark (NPR-B only). The euryhaline rainbow trout provides an opportunity to further pursue examination of the system in teleosts. In this study, partial rainbow trout NPR-A-like and NPR-B-like mRNA sequences were identified via PCR and cloning. The sequence information was used in real-time PCR to examine mRNA expression in a variety of tissues of freshwater rainbow trout and rainbow trout acclimated to 35 parts per thousand seawater for a period of 10 days. In the excretory kidney and posterior intestine, real-time PCR analysis showed greater expression of NPR-B in freshwater fish than in those adapted to seawater; otherwise, there was no difference in the expression of the individual receptors in fresh water or seawater. In general, the expression of the NPR-A and NPR-B type receptors was quite low. These findings indicate that NPR-A and NPR-B mRNA expression is minimally altered under the experimental regime used in this study.

An intelligent forex monitoring system

The need for intelligent monitoring systems has become a necessity to keep track of the complex forex market. The vast currency market is a foreign concept to the average individual. However, once it is broken down into simple terms, the average individual can begin to understand the foreign exchange market and use it as a financial instrument for future investing. We attempt to compare the performance of a Takagi-Sugeno, type neuro-fuzzy system and a feedforward neural network trained using the scaled conjugate gradient algorithm to predict the average monthly forex rates. We considered the exchange values of Australian dollar with respect to US dollar, Singapore dollar, New Zealand dollar, Japanese yen and United Kingdom pounds. The connectionist models were trained using 70% of the data and remaining was used for testing and validation purposes. It is observed that the proposed connectionist models were able to predict the average forex rates one month ahead accurately. Experiment results also reveal that the neuro-fuzzy technique performed better than the neural network

Integrated optimization system for high pressure die casting processes

High pressure die casting (HPDC) is a versatile process for producing engineered metal parts by forcing molten metal under high pressure into reusable steel dies. However there are a large number of attributes involved which contribute to the complexity of the process. A novel integrated approach is developed to optimize the high pressure die casting processes. The die temperature profiles will be studied with infrared thermograph technology and the internal cooling system will be optimized to provide even cooling to the components and the die. The heat stored in the die and the components is studied with image processing. Based on the geometrical profile of the components, cooling channels can be redesigned to improve the cooling efficiency while the cooling time is reduced. This will not only significantly improve the quality of the castings but also improve the productivity of the process.
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Environmental management system and electronic communication : Is it the need of the hour?

Implementation and certification of Environmental Management Systems (EMS) is a reality for many businesses. Communication with an organisation’s stakeholders is a required element of any EMS. In the last five years companies have steadily moved towards integrating their different management systems, such as quality, environmental, and occupational health and safety, in an attempt to reduce their costs and increase efficiency. Legislation requires extensive reporting in each of these areas, so compliance is another important driver. During this period, communication by digital technology, or electronic communication, has gained prominence and acceptance amongst all groups of people including businesses primarily as a means to disseminate crucial EMS information to geographically diverse employees in a cost effective and instantaneous manner. Some perspectives have emerged to suggest that change processes in organisations may be hindered or helped in various ways through the application of digital technology in EMS. There are, however, gaps in the literature that document the impact and effectiveness of electronic communication amongst EMS stakeholders. In this paper we will discuss employees as one of the major stakeholders and whether the move to electronic communication has been assisting or hindering transformations in awareness and understanding of issues amongst employees. We highlight opportunities and challenges presented by an increased use of electronic communication in light of the environmental and climate change debates, which underpin EMS.
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An improved method for the purification of rat liver-type fatty acid binding protein from Escherichia coli

We have developed expedient and reliable methods to isolate cyclosporin synthetase for in vitro biosynthesis of cyclosporins. We have examined enzyme purification strategies suited to large-scale processing and present a chromatographic sequence that serves as a pilot model for industrial scale preparation of cyclosporin synthetase from cyclosporin producing fungi. A chromatographic sequence consisting of ammonium sulfate precipitation → gel filtration → hydrophobic interaction chromatography → anion exchange chromatography, yielded an electrophoretically homogeneous cyclosporin synthetase preparation (Coomassie G-250 brilliant blue staining). Furthermore, a native polyacrylamide gel electrophoresis system was developed for the isolation of active cyclosporin synthetase enzyme from crude extracts of cyclosporin producing fungi. The environmental factors affecting enzyme stability and the continuity of the in vitro cyclosporin biosynthetic reaction-temperature, pH, and substrate depletion were assessed and manageable conditions have been defined for sustainable cyclosporin biosynthesis with enzyme isolates. Cyclosporin synthetase exhibited an optimal temperature range of 24–29 °C and a pH optimum of 7.6. The native enzyme displayed a pI of 5.7, as determined by isoelectric focusing. The industrial implementation of an in vitro biosynthetic approach could potentially prove useful for the production of important therapeutic cyclosporins which occur as only minor fermentation by-products.

Cost-effectiveness of surgically induced weight loss for the management of type 2 diabetes : modeled lifetime analysis

OBJECTIVE--To estimate the cost-effectiveness of surgically induced weight loss relative to conventional therapy for the management of recently diagnosed type 2 diabetes in class VII obese patients.

RESEARCH DESIGN AND METHODS--This study builds on a within-trial cost-efficacy analysis. The analysis compares the lifetime costs and quality-adjusted life-years (QALYs) between the two intervention groups. Intervention costs were extrapolated based on observed resource utilization during the trial. The proportion of patients in each intervention group with remission of diabetes at 2 years was the same as that observed in the trial. Health care costs for patients with type 2 diabetes and outcome variables required to derive estimates of QALYs were sourced from published literature. A health care system perspective was adopted. Costs and outcomes were discounted annually at 3%. Costs are presented in 2006 Australian dollars (AUD) (currency exchange: 1 AUD = 0.74 USD).

RESULTS--The mean number of years in diabetes remission over a lifetime was 11.4 for surgical therapy patients and 2.1 for conventional therapy patients. Over the remainder of their lifetime, surgical and conventional therapy patients lived 15.7 and 14.5 discounted QALYs, respectively. The mean discounted lifetime costs were 98,900 AUD per surgical therapy patient and 101,400 AUD per conventional therapy patient. Relative to conventional therapy, surgically induced weight loss was associated with a mean health care saving of 2,400 AUD and 1.2 additional QALYs per patient.

CONCLUSIONS--Surgically induced weight loss is a dominant intervention (it both saves health care costs and generates health benefits) for managing recently diagnosed type 2 diabetes in class IBI obese patients in Australia.

Study of the natriuretic peptide hormone system in plants

In this study, both physiological and cellular effects are elicited by natriuretic peptides (NPs), a novel type of plant hormone. It was found that rat ANP (rANP) influenced stomatal opening movement in Tradescantia sp., where a significant increase in stomatal opening was observed in the presence of 1 µM rANP. Furthermore, this effect is mediated by cGMP, a (putative) second messenger of NPs. Two inhibitors of guanylyl cyclase, LY 83583 and methylene blue, inhibited rANP-induced stomatal opening. In contrast, stomatal opening is induced in a concentration dependent manner by the cell permeant cGMP analogue 8-Br-cGMP. In addition it was found, that like in animals, the secondary structure of rANP is essential for rANP responses. Linearised rANP is biologically inactive. Since ANP elicit plant responses, an attempt was made to isolate NP analogues from plants. A protocol for partially purifying NP from plants was developed. It was found that two fractions eluted from an immunoaffinity chromatography column (0.5 M KCI eluted fraction and 0.75 M KCI eluted fraction) were biologically active. The level of cGMP in response to NPs was also tested. It is suggested that the receptor of NP is specific since only 0.75 M KCI eluted fractions increased cGMP levels in Zea mays root stele tissue. rANP did not elicit an effect on cGMP levels in this tissue and LY 83583 did not affect this response. It is therefore argued that a plant specific biologically active NP system is present in the stele and it is predicted that NPs modulate solute movement in this tissue. NPs also influence K⁺, Na⁺ and H⁺ fluxes in Zea mays root stele. Increase in both K⁺ and Na+ uptake were observed after 30 min., while H⁺ flux shifted immediately toward influx in the presence of both 0.5 and 0.75 KCI eluted fractions. Finally, a model is proposed for the effect of NPs on solute movement and its signalling system in plants.

Reliability and validity of the system for observing children's activity and relationships during play (SOCARP)

Background: Children frequently engage in diverse activities that are broadly defined as play, but little research has documented children’s activity levels during play and how they are influenced by social contexts. Assessing potentially modifiable conditions that influence play behavior is needed to design optimal physical activity interventions.

Methods: System for Observing Children’s Activity and Relationships during Play (SOCARP) was developed to simultaneously assess children’s physical activity, social group sizes, activity type, and social behavior during play. One hundred and fourteen children (48 boys, 66 girls; 42% overweight) from 8 elementary schools were observed during recess over 24 days, with 12 days videotaped for reliability purposes. Ninety-nine children wore a uni-axial accelerometer during their observation period.

Results: Estimated energy expenditure rates from SOCARP observations and mean accelerometer counts were significantly correlated (r = .67; P < .01), and interobserver reliabilities (ie, percentage agreement) for activity level (89%), group size (88%), activity type (90%) and interactions (88%) met acceptable criteria. Both physical activity and social interactions were influenced by group size, activity type, and child gender and body weight status.

Conclusions: SOCARP is a valid and reliable observation system for assessing physical activity and play behavior in a recess context.

Many routes lead to Rome : potential causes for the multi-route migration system of Red Knots, Calidris canutus islandica

Migrants, such as birds or representatives of other taxa, usually make use of several stopover sites to cover the distance between their site of origin and destination. Potentially, multiple routes exist, but often little is known about the causes and consequences of alternative migration routes. Apart from their geographical distribution, the suitability of potential sites might play an important role in the animals’ decisions for a particular itinerary. We used an optimal-migration model to test three nonmutually exclusive hypotheses leading to variations in the spring migration routes of a subspecies of Red Knot, Calidris canutus islandica, which migrates from wintering grounds in Western Europe to breeding grounds in Greenland and the Canadian Arctic: the breeding location hypothesis, the energy budget hypothesis, and the predation risk hypothesis. Varying only breeding location, the model predicted that birds breeding in the Canadian Arctic and on West Greenland stop over on Iceland, whereas birds breeding in East and Northeast Greenland migrate via northern Norway, a prediction that is supported by empirical findings. Energy budgets on stopover sites had a strong influence on the choice of route and staging times. Varying foraging-intensity and mass-dependent predation risk prompted the birds to use less risky sites, if possible. The effect of simultaneous changes in the energy budget and predation risk strongly depended on the site where these occurred. Our findings provide potential explanations for the observations that C. canutus islandica uses a diverse array of migration routes. Scrutinizing the three alternative driving forces for the choice of migratory routes awaits further, specific data collection in rapidly developing fields of research (e.g., predation risk assessment, GPS tracking). Generally, the type of modeling presented here may not only highlight alternative explanations, but also direct follow-up empirical research.

Young adults’ management of Type 1 diabetes during life transitions

Aim. To identify life transitions likely to impact diabetes self-care among young adults with Type 1 diabetes and their coping strategies during transition events.
Background. Relationships among psychosocial stress, adjustment, coping and metabolic control affect clinical outcomes and mental health. Life transitions represent major change and are associated with stress that temporarily affects individuals’ problem-solving, coping abilities and blood glucose levels.
Design. A qualitative interpretive inquiry.
Method. Semi-structured interviews were conducted with 20 young adults with Type 1 diabetes and a constant comparative analysis method. Data and analysis was managed using QSR NVIVO 7 software.
Results. Participants identified two significant transition groups: life development associated with adolescence, going through the education system, entering new relationships, motherhood and the workforce and relocating. Diabetes-related transitions included being diagnosed, developing diabetes complications, commencing insulin pump treatment and going on diabetes camps. Participants managed transitions using ‘strategic thinking and planning’ with strategies of ‘self-negotiation to minimise risks’; ‘managing diabetes using previous experiences’; ‘connecting with others with diabetes’; ‘actively seeing information to ‘patch’ knowledge gaps’; and ‘putting diabetes into perspective’.
Conclusions. Several strategies are used to manage diabetes during transitions. Thinking and planning strategically was integral to glycaemic control and managing transitions. The impact of transitions on diabetes needs to be explored in larger and longitudinal studies to identify concrete strategies that assist diabetes care during life transitions.
Relevance to clinical practice. It is important for health professionals to understand the emotional, social and cognitive factors operating during transitions to assist young adults with Type 1 diabetes to achieve good health outcomes by prioritising goals and plan flexible, timely, individualised and collaborative treatment.

Experiences in porting a virtual reality system to Java

Practical experience in porting a large virtual reality system from C/C++ to Java indicates that porting this type of real-time application is both feasible, and has several merits. The ability to transfer objects in space and time allows useful facilities such as distributed agent support and persistence to be added. Reflection and type comparisons allow flexible manipulations of objects of different types at run-time. Native calls and native code compilation reduce or remove the overhead of interpreting code.Problems encountered include difficulty in achieving cross-platform code portability, limitations of the networking libraries in Java, and clumsy coding practices forced by the language.