Cost-effectiveness Study of Antidiabetic Drugs in Type 2 Diabetes Mellitus Patients From Mumbai, India

Diabetes is fast gaining the status of a potential epidemic in India, with >62 million individuals currently diagnosed with the disease.1 India currently faces an uncertain future in relation to the potential burden that diabetes may impose on the country. An estimated US$ 2.2 billion would be needed to sufficiently treat all cases of type 2 diabetes mellitus (T2DM) in India.2 Many interventions can reduce the burden of this disease. However, health care resources are limited; thus, interventions for diabetes treatment should be prioritized.

Theory development in humanitarian logistics : A framework and three cases

Purpose: There is a need for theory development within the field of humanitarian logistics to understand logistics needs in different stages of a crisis and how to meet these. This paper aims to discuss three dimensions identified in logistics and organization theories and how they relate to three different cases of humanitarian logistics operations - the regional concept of the International Federation of Red Cross Red Crescent Societies, the development and working of the United Nations Joint Logistics Centre and coordination challenges of military logistics in UN mandated peacekeeping operations. The purpose is to build a framework to be used in further studies. Design/methodology/approach: A framework for the study of humanitarian logistics along three dimensions is developed, followed by a discussion of the chosen cases in relation to these dimensions. The framework will be used as basis for the case studies to be undertaken for the purpose of understanding and identification of new questions and needs for other or revised concepts from theory. Findings: The paper shows the relevance of a wide literature to the issues pertinent to humanitarian logistics. There is considerable promise in extant literature on logistics, SCM and coordination, but this needs to be confronted with the particular issues seen in the humanitarian logistics setting to achieve further theory development. Originality/value: The major contribution of the paper lies in its breadth of theoretical perspectives presented and combined in a preliminary theoretical framework. This is applied more specifically in the three case studies described in the paper.

Europeanization in VET policy as a process of reshaping the educational space

The EU represents a transforming educational space, where national and supranational boundaries in educational governance are becoming blurred. The EU has become an important actor in educational governance and an important arena for policy learning and transfer. This paper explores how the process of reshaping the educational space manifests itself in the process of the Europeanization of VET policy in the case of Estonia. In Estonia, this process was followed by the growth of executive VET institutions and has developed from rather uncritical initial policy transfer to more active learning from the EU, although conformism can still be seen in cases of the introduction of standardizing policy tools. (DIPF/Orig.)

Swath bathymetry using phase difference: Theoretical analysis of acoustical measurement precision

The phase difference principle is widely applied nowadays to sonar systems used for sea floor bathymetry, The apparent angle of a target point is obtained from the phase difference measured between two close receiving arrays. Here we study the influence of the phase difference estimation errors caused by the physical structure of the backscattered signals. It is shown that, under certain current conditions, beyond the commonly considered effects of additive external noise and baseline decorrelation, the processing may be affected by the shifting footprint effect: this is due to the fact that the two interferometer receivers get simultaneous echo contributions coming from slightly shifted seabed parts, which results in a degradation of the signal coherence and, hence, of the phase difference measurement. This geometrical effect is described analytically and checked with numerical simulations, both for square- and sine-shaped signal envelopes. Its relative influence depends on the geometrical configuration and receiver spacing; it may be prevalent in practical cases associated with bathymetric sonars. The cases of square and smooth signal envelopes are both considered. The measurements close to nadir, which are known to be especially difficult with interferometry systems, are addressed in particular.

Variations in chemoprophylaxis for meningococcal disease: a retrospective case note review, analysis of routine prescribing data and questionnaire of general practitioners

BACKGROUND: Invasive meningococcal disease is a significant cause of mortality and morbidity in the UK. Administration of chemoprophylaxis to close contacts reduces the risk of a secondary case. However, unnecessary chemoprophylaxis may be associated with adverse reactions, increased antibiotic resistance and removal of organisms, such as Neisseria lactamica, which help to protect against meningococcal disease. Limited evidence exists to suggest that overuse of chemoprophylaxis may occur. This study aimed to evaluate prescribing of chemoprophylaxis for contacts of meningococcal disease by general practitioners and hospital staff. METHODS: Retrospective case note review of cases of meningococcal disease was conducted in one health district from 1st September 1997 to 31st August 1999. Routine hospital and general practitioner prescribing data was searched for chemoprophylactic prescriptions of rifampicin and ciprofloxacin. A questionnaire of general practitioners was undertaken to obtain more detailed information. RESULTS: Prescribing by hospital doctors was in line with recommendations by the Consultant for Communicable Disease Control. General practitioners prescribed 118% more chemoprophylaxis than was recommended. Size of practice and training status did not affect the level of additional prescribing, but there were significant differences by geographical area. The highest levels of prescribing occurred in areas with high disease rates and associated publicity. However, some true close contacts did not appear to receive prophylaxis. CONCLUSIONS: Receipt of chemoprophylaxis is affected by a series of patient, doctor and community interactions. High publicity appears to increase demand for prophylaxis. Some true contacts do not receive appropriate chemoprophylaxis and are left at an unnecessarily increased risk

Development of computer application for determination of chemical diffusion properties in biological tissues

The main objective of this work was to develop an application capable of determining the diffusion times and diffusion coefficients of optical clearing agents and water inside a known type of muscle. Different types of chemical agents can also be used with the method implemented, such as medications or metabolic products. Since the diffusion times can be calculated, it is possible to describe the dehydration mechanism that occurs in the muscle. The calculation of the diffusion time of an optical clearing agent allows to characterize the refractive index matching mechanism of optical clearing. By using both the diffusion times and diffusion of water and clearing agents not only the optical clearing mechanisms are characterized, but also information about optical clearing effect duration and magnitude is obtained. Such information is crucial to plan a clinical intervention in cooperation with optical clearing. The experimental method and equations implemented in the developed application are described in throughout this document, demonstrating its effectiveness. The application was developed in MATLAB code, but the method was personalized so it better fits the application needs. This process significantly improved the processing efficiency, reduced the time to obtain he results, multiple validations prevents common errors and some extra functionalities were added such as saving application progress or export information in different formats. Tests were made using glucose measurements in muscle. Some of the data, for testing purposes, was also intentionally changed in order to obtain different simulations and results from the application. The entire project was validated by comparing the calculated results with the ones found in literature, which are also described in this document.

Exploring the Role of Parental Hearsay when Children Witness a Crime

In cases of potential child abuse, parents may provide hearsay testimony on behalf of a child, retelling events from the child’s perspective. However, according to the limited research that exists, parents may have a negative impact on their child’s memory of an event (Principe, DiPuppo, & Gammel, 2013). In order to gain a better understanding of parental hearsay, parents’ descriptions of information children provided in recorded parent-child discussions were compared to the actual information the children provided in the initial discussion and in a 1-week follow-up interview. Children interviewed by parents were also compared to children interviewed by a trained interviewer. To date, 11 children between the ages of 6-9 years have been assessed. While the current sample size was too small to yield many significant results, graphs and effect sizes suggest there are differences in memory accuracy and completeness between parents and children and across children’s interview condition. Whether hearsay testimony or children’s testimony is preferable may depend on how suggestive the initial parent-child discussion is.

The Blame Game: Perceptions of Blame, Responsibility and Seriousness in Cyberbullying

Cyberbullying is gaining increasing media attention. Victims may be reluctant to report such bullying due to the perception by others that these victims somehow play a role in their own victimization. This perception, often referred to as victim blame, has been commonly researched in child sexual abuse, rape and hate crime cases, but it has not really been examined in cases of cyberbullying. To assess victim blame, 241 participants were recruited and asked to read a scenario of cyberbullying that involved either a 14-year-old or a 20-year old victim. Perpetrator gender and victim gender were also manipulated. It was found that perceptions regarding the scenario were influenced by the gender of the perpetrator and the age of the victim. This was particularly the case when perceptions of the seriousness of the crime and the necessity for legal action were assessed.

Promoting Investment and Increasing Employment among the Economically Inactive - A Review of Best Practice.

Final report to the Department of Enterprise, Trade and Investment, Northern Ireland. This report sets out the findings from a study into strategies that link the promotion of investment and the employment of economically inactive groups. The aim is to ascertain current practice in 10 relevant countries (Australia; Belgium; Denmark; Finland; Germany; the Netherlands; New Zealand; Slovenia; Spain; USA plus Great Britain) and their transferability to the Northern Ireland (NI) policy and labour market context. The study was carried out by the Employment Research Institute at Edinburgh Napier University on behalf of the Department of Trade, Enterprise and Investment in NI (DETI). The study describes cases of good practice in securing investment in areas, sectors and occupations that provide accessible entry-level positions for economically inactive groups. It seeks to identify the ‘critical success factors’ common to effective strategies, drawing out lessons for future Northern Ireland policy. In this study ‘Investment’ includes foreign direct investment (FDI) and private investment that expands the ‘export’ capacity of the NI economy (i.e. excluding investment aimed at the NI market). ‘Economically inactive’ people are those excluded or seriously at risk of exclusion from the labour market.

Hyperinsulinaemic hypoglycaemia - a diagnostic challenge. A report of two atypical cases

Objectives: The authors describe 2 atypical cases of patients with hypoglycaemia, suspected for insulinoma. Methods: The 2 reports are accompanied by a concise review of the literature. Results: Patient 1 had a distal pancreatectomy performed for suspected insulinoma, and was diagnosed with a glucagonoma and beta-cell hyperplasia (nesidioblastosis). To the authors’s knowledge, co-existing glucagonoma and nesidioblastosis had not been previously reported. Patient 2 was diagnosed with a benign insulinoma and 5 years later with metastatic disease. Conclusion: The authors conclude that insulinomas are rare entities which often present a diagnostic and therapeutic challenge. In such cases, patient referral to tertiary multidisciplinary centers is recommended.

Assessment of SARAL/AltiKa Wave Height Measurements Relative to Buoy, Jason-2, and Cryosat-2 Data

SARAL/AltiKa GDR-T are analyzed to assess the quality of the significant wave height (SWH) measurements. SARAL along-track SWH plots reveal cases of erroneous data, more or less isolated, not detected by the quality flags. The anomalies are often correlated with strong attenuation of the Ka-band backscatter coefficient, sensitive to clouds and rain. A quality test based on the 1Hz standard deviation is proposed to detect such anomalies. From buoy comparison, it is shown that SARAL SWH is more accurate than Jason-2, particularly at low SWH, and globally does not require any correction. Results are better with open ocean than with coastal buoys. The scatter and the number of outliers are much larger for coastal buoys. SARAL is then compared with Jason-2 and Cryosat-2. The altimeter data are extracted from the global altimeter SWH Ifremer data base, including specific corrections to calibrate the various altimeters. The comparison confirms the high quality of SARAL SWH. The 1Hz standard deviation is much less than for Jason-2 and Cryosat-2, particularly at low SWH. Furthermore, results show that the corrections applied to Jason-2 and to Cryosat-2, in the data base, are efficient, improving the global agreement between the three altimeters.

Yellow Nail Syndrome: Report of Two Cases and a Brief Review of the Current Literature

Yellow Nail Syndrome (YNS) is a rare, and probably misdiagnosed, condition. It must be considered in middle-aged patients with unexplained chronic respiratory manifestations, lymphedema and nail abnormalities. We present two cases of undiagnosed YNS until the current admissions, despite several years of investigation. The authors wish to draw attention to this syndrome, of which diagnosis is clinical and of exclusion.

Unusual presentation of Gilbert disease with high levels of unconjugated bilirubin: report of two cases

Gilbert's syndrome is a benign condition characterized by asymptomatic sporadic episodes of jaundice, due to a mild unconjugated hyperbilirubinemia caused by a deficiency in bilirubin glucoronidation. Under certain physiologic or pathologic events, bilirubin level rises but according to literature it does not reach out more than 3 mg/dl. We report 2 cases of Gilbert's syndrome, genetically tested, which presented with bilirubin levels above 6 mg/dl without any trigger or coexisting condition. In conclusion, bilirubin levels higher than 6 mg/dl in Gilbert syndrome are rare, hemolytic and other metabolism diseases must be ruled out, and genetic testing may be necessary in some cases.

Study of nephrocalcinosis in rainbow trout (Oncorhynchus mykiss), from fry to brood stock

For survey incidence of nephrocalcinosis in rainbow trout fish, during winter 1385, samplings were performed in three fish farm with different water source: river, spring and recirculation system by using well water. In this survey 5 specimens from each 8 groups and in general 120 specimens of this fish were caught by random sampling, and also amounts of O2, CO2, pH and temperature of water were measured. Then blooding and renal tissue sampling performed that renal samples were fixed in 10% buffered formalin and blood samples after separating serum stored in -200C. Renal specimens transferred to pathology laboratory, pathological slides were prepared and stained by hematoxylin & Eosin method. From 120 specimens, 6 cases of fish represent nephrocalcinosis. Pathologic signs include: renal epithelial necrosis, dilated ureters, dense basophilic materials inside the dilated tubules and cast formation in some renal tubules. From 6 cases of nephrocalcinosis, 3 cases (7/5%) were related to recirculation system and 2 (5%) case were related to river water and 1 (2/5%) case was related to spring water. In survey amount of urea, creatinine and Uric acid between different weight groups, distinguished that difference between creatinine middling in different weight groups were significant and also in between healthy and afflicted fish, significant statistical difference were only in creatinine amount between healthy and afflicted fish in each farm. Amounts of O2, pH and temperature of water in three farms were in normal range and only rate of water CO2 in ponds of recirculatory system were very higher (25 mg/lit) than other farms. May be, this reason led to high number of nephrocalcinosis in recirculatory system, than other farms, nemley 7/5% of fish that caught from this farm .This subject is related to the role of CO2 in creating nephrocalcinosis which is descript in references.

Regimes of spray vaporization and combustion in counterflow configurations

This article addresses the problem of spray vaporization and combustion in axisymmetric opposed-jet configurations involving a stream of hot air counterflowing against a stream of nitrogen carrying a spray of fuel droplets. The Reynolds numbers of the jets are assumed to be large, so that mixing of the two streams is restricted to a thin mixing layer that separates the counterflowing streams. The evolution of the droplets in their feed stream from the injection location is seen to depend fundamentally on the value of the droplet Stokes number, St, defined as the ratio of the droplet acceleration time to the mixing layer strain time close to the stagnation point. Two different regimes of spray vaporization and combustion can be identified depending on the value of St. For values of St below a critical value, equal to 1/4 for dilute sprays with small values of the spray liquid mass loading ratio, the droplets decelerate to approach the gas stagnation plane with a vanishing axial velocity. In this case, the droplets located initially near the axis reach the mixing layer, where they can vaporize due to the heat received from the hot air, producing fuel vapor that can burn with the oxygen in a diffusion flame located on the air side of the mixing layer. The character of the spray combustion is different for values of St of order unity, because the droplets cross the stagnation plane and move into the opposing air stream, reaching distances that are much larger than the mixing layer thickness before they turn around. The vaporization of these crossing droplets, and also the combustion of the fuel vapor generated by them, occur in the hot air stream, without significant effects of molecular diffusion, generating a vaporization-assisted nonpremixed flame that stands on the air side outside the mixing layer. Separate formulations will be given below for these two regimes of combustion, with attention restricted to the near-stagnation-point region, where the solution is self-similar and all variables are only dependent on the distance to the stagnation plane. The resulting formulations display a reduced number of controlling parameters that effectively embody dependences of the structure of the spray flame on spray dilution, droplet inertia, and fuel preferential diffusion. Sample solutions are given for the limiting cases of pure vaporization and of infinitely fast chemistry, with the latter limit formulated in terms of chemistry-free coupling functions that allow for general nonunity Lewis numbers of the fuel vapor.