Pilot Study of clinician attitudes to insulin pump therapy: international differences and the need for a greater understanding of the patient perspective

OBJECTIVES: To identify and survey health care professionals (HCPs) attitudes to insulin pump therapy (CSII).

METHODS: Eight specialists were interviewed to explore the attitudes and beliefs about CSII. Responses were analysed thematically and used to inform the design of a new 22-item questionnaire: the Attitudes to Pump Therapy (APT) Survey. The APT was pilottested among 95 HCPs (54% male; 75.5% diabetologists/DSNs, 13.8% general practitioners) at the International Diabetes Federation (IDF) conference, 2006. Results were analysed using non-parametric statistics with bonferroni correction.

RESULTS: Analyses of interview data identified 9 themes: biomedical, perceived control of care/diabetes, technology, quality of life, financial resources, training, education & support, suitability, and evidence-base. Items were designed to reflect these themes with responses scored on a 5-point Likert scale (strongly agree—strongly disagree). No statistically significant differences
were found by gender, HCP speciality, country (and continent) of origin or proportion of patients using CSII. Most notable differences were found in relation to gross domestic product (GDP) and the potential for pump therapy to achieve tight blood glucose control (lower GDP = more agreement: p = 0.001), and result in diabetic ketoacidosis (DKA) (lower GDP = less agreement: p < 0.005). Ranked mean scores showed a split between biomedical/clinical items (N = 11) and items concerned with patient experience (N = 11). Attitudes about biomedical/clinical issues were generally clear (i.e. for 7/11 items, the mean score was “agree”) but less decisive about patient experience (i.e. for 8/11 items, the mean score was “neither agree nor disagree”).

CONCLUSION: Few subgroup differences existed, but those that did may be explained by lack of access to treatment (directly corresponding to GDP). Clinicians’ were generally clear in their attitudes regarding biomedical aspects but less so regarding patient experience. Research focusing on patient-reported outcomes is likely to offer clinicians a greater understanding of the patients’ perspective of insulin pump therapy.

On 4 June 2008 Siberian Red Knots at Elbe Mouth kissed the canonical evening migration departure rule goodbye

Observations of departing Siberian-breeding Red Knots Calidris canutus canutus from their central staging site during northward migration, the Schleswig-Holstein Wadden Sea, Germany, in early June 2008, challenge the established notion that departing long-distance migrating waders only leave around sunset. During four days we scanned several thousand Red Knots for colour-ringed individuals and found a total of 20 different individuals that were previously ringed at either their main wintering site, the Banc d'Arguin in Mauritania, or at stopover sites on the Atlantic coast of France. Body masses of captured Red Knots in Schleswig-Holstein were higher than 200 g and hematocrite values showed an average of 58%, clearly indicating that they were ready for take-off. On all except one evening, we noted impressive departure movements during the incoming tide. On that exceptional evening a cold front thunderstorm passed over the area. Late the next morning, thousands of Red Knots departed during the incoming tide. We assume that the birds avoided taking off in adverse weather conditions and elaborate why Red Knots presumably traded off advantages from departing during twilight. We suggest that during spring migration, schedules are so tight that further delays decrease fitness, either because it would cause another full day of exposure to high predation risk by falcons, or because of conditions upon arrival on the tundra.

Coupling between snoRNP assembly and 3' processing controls box C/D snoRNA biosynthesis in yeast

RNA polymerase II transcribes genes encoding proteins and a large number of small stable RNAs. While pre-mRNA 3'-end formation requires a machinery ensuring tight coupling between cleavage and polyadenylation, small RNAs utilize polyadenylation-independent pathways. In yeast, specific factors required for snRNA and snoRNA 3'-end formation were characterized as components of the APT complex that is associated with the core complex of the cleavage/polyadenylation machinery (core-CPF). Other essential factors were identified as independent components: Nrd1p, Nab3p and Sen1p. Here we report that mutations in the conserved box D of snoRNAs and in the snoRNP-specific factor Nop1p interfere with transcription and 3'-end formation of box C/D snoRNAs. We demonstrate that Nop1p is associated with box C/D snoRNA genes and that it interacts with APT components. These data suggest a mechanism of quality control in which efficient transcription and 3'-end formation occur only when nascent snoRNAs are successfully assembled into functional particles.

Inexplicable inefficiency of avian molt? Insights from an opportunistically breeding arid-zone species, Lichenostomus penicillatus

The majority of bird species studied to date have molt schedules that are not concurrent with other energy demanding life history stages, an outcome assumed to arise from energetic trade-offs. Empirical studies reveal that molt is one of the most energetically demanding and perplexingly inefficient growth processes measured. Furthermore, small birds, which have the highest mass-specific basal metabolic rates (BMR_m), have the highest costs of molt per gram of feathers produced. However, many small passerines, including white-plumed honeyeaters (WPHE; Lichenostomus penicillatus), breed in response to resource availability at any time of year, and do so without interrupting their annual molt. We examined the energetic cost of molt in WPHE by quantifying weekly changes in minimum resting metabolic rate (RMR_min) during a natural-molt period in 7 wild-caught birds. We also measured the energetic cost of feather replacement in a second group of WPHEs that we forced to replace an additional 25% of their plumage at the start of their natural molt period. Energy expenditure during natural molt revealed an energy conversion efficiency of just 6.9% (±0.57) close to values reported for similar-sized birds from more predictable north-temperate environments. Maximum increases in RMR_min during the molt of WPHE, at 82% (±5.59) above individual pre-molt levels, were some of the highest yet reported. Yet RMR_min maxima during molt were not coincident with the peak period of feather replacement in naturally molting or plucked birds. Given the tight relationship between molt efficiency and mass-specific metabolic rate in all species studied to date, regardless of life-history pattern (Efficiency (%) = 35.720•10^-0.494BMRm; r² = 0.944; p =<0.0001), there appears to be concomitant physiological costs entrained in the molt period that is not directly due to feather replacement. Despite these high total expenditures, the protracted molt period of WPHE significantly reduces these added costs on a daily basis.

Unification of the copper(I) binding affinities of the metallo-chaperones Atx1, Atox1, and related proteins : Detection probes and affinity standards

Literature estimates of metal-protein affinities are widely scattered for many systems, as highlighted by the class of metallo-chaperone proteins, which includes human Atox1. The discrepancies may be attributed to unreliable detection probes and/or inconsistent affinity standards. In this study, application of the four CuI ligand probes bicinchoninate, bathocuproine disulfonate, dithiothreitol (Dtt), and glutathione (GSH) is reviewed, and their CuI affinities are re-estimated and unified. Excess bicinchoninate or bathocuproine disulfonate reacts with CuI to yield distinct 1:2 chromatophoric complexes [CuIL2] 3- with formation constants β2 = 1017.2 and 1019.8 M-2, respectively. These constants do not depend on proton concentration for pH ≥7.0. Consequently, they are a pair of complementary and stable probes capable of detecting free Cu+ concentrations from 10-12 to 10-19 M. Dtt binds CuI with KD∼10-15 M at pH 7, but it is air-sensitive, and its CuI affinity varies with pH. The CuI binding properties of Atox1 and related proteins (including the fifth and sixth domains at the N terminus of the Wilson protein ATP7B) were assessed with these probes. The results demonstrate the following: (i) their use permits the stoichiometry of high affinity CuI binding and the individual quantitative affinities (KD values) to be determined reliably via noncompetitive and competitive reactions, respectively; (ii) the scattered literature values are unified by using reliable probes on a unified scale; and (iii) Atox1-type proteins bind CuI with sub-femtomolar affinities, consistent with tight control of labile Cu+ concentrations in living cells.

Linking water-resource models to ecosystem-response models to guide water-resource planning -- an example from the Murray--Darling Basin, Australia

Objectively assessing ecological benefits of competing watering strategies is difficult. We present a framework of coupled models to compare scenarios, using the Coorong, the estuary for the MurrayDarling River system in South Australia, as a case study. The framework links outputs from recent modelling of the effects of climate change on water availability across the MurrayDarling Basin to a hydrodynamic model for the Coorong, and then an ecosystem-response model. The approach has significant advantages, including the following: (1) evaluating management actions is straightforward because of relatively tight coupling between impacts on hydrology and ecology; (2) scenarios of 111 years reveal the impacts of realistic climatic and flow variability on Coorong ecology; and (3) ecological impact is represented in the model by a series of ecosystem states, integrating across many organisms, not just iconic species. We applied the approach to four flow scenarios, comparing conditions without development, current water-use levels, and two predicted future climate scenarios. Simulation produced a range of hydrodynamic conditions and consequent distributions of ecosystem states, allowing managers to compare scenarios. This approach could be used with many climates and/or management actions for optimisation of flow delivery to environmental assets.

Respiratory pattern in awake rats : effects of motor activity and of alerting stimuli

Our aim was to assess the impact of motor activity and of arousing stimuli on respiratory rate in the awake rats. The study was performed in male adult Sprague–Dawley (SD, n = 5) and Hooded Wistar (HW, n = 5) rats instrumented for ECG telemetry. Respiratory rate was recorded using whole-body plethysmograph, with a piezoelectric sensor attached for the simultaneous assessment of motor activity. All motor activity was found to be associated with an immediate increase in respiratory rate that remained elevated for the whole duration of movement; this was reflected by: i) bimodal distribution of respiratory intervals (modes for slow peak: 336 ± 19 and 532 ± 80 ms for HW and SD, p < 0.05; modes for fast peak 128 ± 6 and 132 ± 7 ms for HW and SD, NS); and ii) a tight correlation between total movement time and total time of tachypnoea, with an R2 ranging 0.96–0.99 (n = 10, p < 0001). The extent of motor-related tachypnoea was significantly correlated with the intensity of associated movement. Mild alerting stimuli produced stereotyped tachypnoeic responses, without affecting heart rate: tapping the chamber raised respiratory rate from 117 ± 7 to 430 ± 15 cpm; sudden side move — from 134 ± 13 to 487 ± 16 cpm, and turning on lights — from 136 ± 12 to 507 ± 14 cpm (n = 10; p < 0.01 for all; no inter-strain differences). We conclude that: i) sniffing is an integral part of the generalized arousal response and does not depend on the modality of sensory stimuli; ii) tachypnoea is a sensitive index of arousal; and iii) respiratory rate is tightly correlated with motor activity.

Generating comprehensible summaries of rushes sequences based on robust feature matching

This paper describes our first attempt at tackling a pilot task in Trecvid: video summarization of rushes data [3]. Our method is based on the tight clustering produced via SIFT matching. In this first attempt, we try to examine how our approach performs without complex implementation in terms of concept detection and excerpt assembly (i.e, no picture-in-picture, split screen and special transitions). Although we do not perform very well in terms of concept inclusion, we rank very well in terms of the summary being easy to understand and relevancy of included segments.

An embedded suggestive interface for making home videos

This paper describes a novel suggestive interface embedded in a smart camera prototype aimed at aiding home movie makers. We focus on the problem of generating shot capture suggestions suitable to the user's filming context, intended audience and style, and formulate a novel aesthetic measure by which to judge proposed suggestions. Tight coupling between media and software allows the aesthetic measure to be sensitive to previous footage captures, including those taken without the system's prompting, in a manner allowing flexible, end-to-end migration of the authoring task from user to machine. An approximate method is used to find timely, near-optimal solutions to the aesthetic measure. Qualitative evaluation in the form of a user study shows it to be a promising approach to the flexible home movie authoring context.

Osteo-cise : Strong bones for life': protocol for a community-based randomised controlled trial of a multi-modal exercise and osteoporosis education program for older adults at risk of falls and fractures

Background : Osteoporosis affects over 220 million people worldwide, and currently there is no 'cure' for the disease. Thus, there is a need to develop evidence-based, safe and acceptable prevention strategies at the population level that target multiple risk factors for fragility fractures to reduce the health and economic burden of the condition.

Methods : The 'Osteo-cise: Strong Bones for Life' study will investigate the effectiveness and feasibility of a multi-component targeted exercise, osteoporosis education/awareness and behavioural change program for improving bone health and muscle function, and reducing falls risk in community-dwelling older adults at an increased risk of fracture. Men and women aged 60 years or above will participate in an 18-month randomised controlled trial comprising a 12-month structured and supervised community-based program and a 6-month 'research to practise' translational phase. Participants will be randomly assigned to either the 'Osteo-cise' intervention or a self-management control group. The intervention will comprise a multi-modal exercise program incorporating high velocity progressive resistance training, moderate impact weight-bearing exercise and high challenging balance exercises performed three times weekly at local community-based fitness centres. A behavioural change program will be used to enhance exercise adoption and adherence to the program. Community-based osteoporosis education seminars will be conducted to improve participant knowledge and understanding of the risk factors and preventative measures for osteoporosis, falls and fractures. The primary outcomes measures, to be collected at baseline, 6, 12, and 18 months, will include DXA-derived hip and spine bone mineral density measurements and functional muscle power (timed stair-climb test). Secondary outcomes measures include: MRI-assessed distal femur and proximal tibia trabecular bone micro-architecture, lower limb and back maximal muscle strength, balance and function (four square step test, functional reach test, timed up-and-go test and 30-second sit-to-stand), falls incidence and health-related quality of life. Cost-effectiveness will also be assessed.

Discussion : The findings from the Osteo-cise: Strong Bones for Life study will provide new information on the efficacy of a targeted multi-modal community-based exercise program incorporating high velocity resistance training, together with an osteoporosis education and behavioural change program for improving multiple risk factors for falls and fracture in older adults at risk of fragility fracture. Trial Registration: Australian New Zealand Clinical Trials Registry reference ACTRN12609000100291

Hormonal responses to extreme fasting in subantarctic fur seal (Arctocephalus tropicalis) pups

Surviving prolonged fasting implies closely regulated alterations in fuel provisioning to meet metabolic requirements, while preserving homeostasis. Little is known, however, of the endocrine regulations governing such metabolic adaptations in naturally fasting free-ranging animals. The hormonal responses to natural prolonged fasting and how they correlate to the metabolic adaptations observed, were investigated in subantarctic fur seal (Arctocephalus tropicalis) pups, which, because of the intermittent pattern of maternal attendance, repeatedly endure exceptionally long fasting episodes throughout their development (1–3 mo). Phase I fasting was characterized by a dramatic decrease in plasma insulin, glucagon, leptin, and total L-thyroxine (T4) associated with reductions in mass-specific resting metabolic rate (RMR), plasma triglycerides, glycerol, and urea-to-creatine ratio, while nonesterified fatty acids (NEFA) and β-OHB increased. In contrast, the metabolic steady-state of phase II fasting reached within 6 days was associated with minimal concentrations of insulin, glucagon, and leptin; unchanged cortisol and triiodothyronine (T3); and moderately increased T4. The early fall in insulin and leptin may mediate the shift to the strategy of energy conservation, protein sparing, and primary reliance on body lipids observed in response to the cessation of feeding. In contrast to the typical mammalian starvation response, nonelevated cortisol and minimal glucagon levels may contribute to body protein preservation and downregulation of catabolic pathways, in general. Furthermore, thyroid hormones may be involved in a process of energy conservation, independent of pups' nutritional state. These original hormonal settings might reflect an adaptation to the otariid repeated fasting pattern and emphasize the crucial importance of a tight physiological control over metabolism to survive extreme energetic constraints.

Structure and biodegradation mechanism of milled Bombyx mori silk particles

The aim of this study was to understand the structure and biodegradation relationships of silk particles intended for targeted biomedical applications. Such a study is also useful in understanding structural remodelling of silk debris that may be generated from silk-based implants. Ultrafine silk particles were prepared using a combination of efficient wet-milling and spray-drying processes with no addition of chemicals other than those used in degumming. Milling reduced the intermolecular stacking forces within the β-sheet crystallites without changing the intramolecular binding energy. Because of the rough morphology and the ultrafine size of the particles, degradation of silk particles by protease XIV was increased by about 3-fold compared to silk fibers. Upon biodegradation, the thermal degradation temperature of silk increased, which was attributed to the formation of tight aggregates by the hydrolyzed residual macromolecules. A model of the biodegradation mechanism of silk particles was developed based on the experimental data. The model explains the process of disintegration of β-sheets, supported by quantitative secondary structural analysis and microscopic images. © 2012 American Chemical Society.

Stressors, Recovery Processes, and Manifestations of Training Distress in Dance

Abstract
Dancers are expected to maintain consistently high levels of performance capability and to perform on demand. To meet these expectations, they subject their bodies to long hours of intensive physical training. Such training regimens are often combined with tight rehearsal and performance schedules, which over time, can lead to persistent fatigue, psychological distress, performance decrements, and injury. A similar process has been observed as a consequence of high-intensity training in many different sports, and considerable sport-related research has been devoted to identifying the antecedents, the symptoms that are experienced, and the most cost-effective ways of monitoring symptom development. This paper presents a general heuristic framework for understanding this “training distress process” and discusses the framework with specific reference to dance.

Lying idiots: reality television & lie to me

This article addresses perhaps the key question for Television Studies: Who does television think you are? It argues that Reality Television answers this question by producing its viewers as, in the Classical Greek sense, idiots (meaning private and ignorant persons). Idiots are the perfect target for the advertising dollar that supports commercial television production. As Reg Grundy observes, Reality Television is anything but reality. With its tight framings of reality, it paradoxically operates to sever the viewing self from reality—from the “truth” of life. Lie to Me is the type of television we are left with after the demise of Reality Television. Lie to Me makes us self-conscious, in the strongest sense, and thus sustains the mission of Reality Television. By dragging the notion of reality into its self-serving fictions, it puts the viewer into the dangerous position of being unable to lie to television. If Reality Television constrained reality to falsity, Lie to Me implicates the viewer in the zone where falsity transforms into reality. Lastly, this article enquires into the possibilities, in today’s television ecology, for a mode of TV citizenship that would counter the abject viewing position of the consumerist idiot.