Effect of obesity and insulin resistance on diabetic control

Diabetes Mellitus in obese and non-obese Indian individuals.AIMS: Effect of Obesity and insulin resistance on diabetic control.SETTINGS AND DESIGN: 50 each groups Diabetic individuals obese and non-obese.METHODS AND MATERIAL: On selected 50 each group diabetic patient and normal, following blood investigations has been performed—Plasma Glucose, Glycohemoglobin and Serum Insulin.STATISTICAL ANALYSIS USED: Individuals patient’s results were analyzed and compared with the normal controls.RESULTS AND CONCLUSION: The changes in glycosylated haemoglobin are mainly proportional to the post lunch glucose level (r=0.773) (p<0.01) and not correlated to circulating insulin or the body mass index. However the levels were higher in obese diabetes (Type I and II both) than in non-obese. Mechanism of resistance in insulin receptor interactions due to obesity is well known. However, obesity does not seem to affect directly glycosylated haemoglobin. Under such circumstances, the reduction of weight for a diabetic person can improve sugar control by minimizing insulin resistance and thereby can improve glycosylated haemoglobin levels.     

Troponin T and Heart Type Fatty Acid Binding Protein (h-Fabp) as Biomarkers in Patients Presenting with Chest Pain

Acute coronary syndrome (ACS) is a term for a range of clinical signs and symptoms suggestive of myocardial ischemia. It results in functional and structural changes and ultimately releasing protein from injured cardiomyocytes. These cardiac markers play a major role in diagnosis and prognosis of ACS. This study aims to assess the efficacy of heart type fatty acid binding protein (h-FABP) as a marker for ACS along with the routinely used hs-TropT. In our observational study, plasma h-FABP (cut-off 6.32 ng/ml) and routinely done hs-Trop T (cutoff 0.1 and 0.014 ng/ml) were estimated by immunometric laboratory assays in 88 patients with acute chest pain. Based on the clinical and laboratory test findings the patients were grouped into ACS (n = 41) and non-ACS (n = 47). The diagnostic sensitivity, specificity, NPV, PPV and ROC curve at 95 % CI were determined. Sensitivity of hs-TropT (0.1 ng/ml), hs-TropT (0.014 ng/ml) and h-FABP were 53, 86 and 78 % respectively and specificity for the same were 98, 73 and 70 % respectively. Sensitivity, specificity and NPV calculated for a cut-off combination of hs-TropT 0.014 ng/ml and h-FABP was 100, 51 and 100 % respectively. These results were substantiated by ROC analysis. Measurement of plasma h-FABP and hs-TropT together on admission appears to be more precise predictor of ACS rather than either hs-Trop T or h-FABP.     

The effect of extremely high glucose concentrations on 21 routine chemistry and thyroid Abbott assays: interference study

Introduction

Extremely high glucose concentrations have been shown to interfere with creatinine assays especially with Jaffe method in peritoneal dialysate. Because diabetes is the fastest growing chronic disease in the world, laboratories study with varying glucose concentrations. We investigated whether different levels of glucose spiked in serum interfere with 21 routine chemistry and thyroid assays at glucose concentrations between 17-51 mmol/L.

Materials and methods

Baseline (group I) serum pool with glucose concentration of 5.55 (5.44-5.61) mmol/L was prepared from patient sera. Spiking with 20% dextrose solution, sample groups were obtained with glucose concentrations: 17.09, 34.52, and 50.95 mmol/L (group II, III, IV, respectively). Total of 21 biochemistry analytes and thyroid tests were studied on Abbott c8000 and i2000sr with commercial reagents. Bias from baseline value was checked statistically and clinically.

Results

Creatinine increased significantly by 8.74%, 31.66%, 55.31% at groups II, III, IV, respectively with P values of < 0.001. At the median glucose concentration of 50.95 mmol/L, calcium, albumin, chloride and FT4 biased significantly clinically (-0.85%, 1.63%, 0.65%, 7.4% with P values 0.138, 0.214, 0.004, < 0.001, respectively). Remaining assays were free of interference.

Conclusion

Among the numerous biochemical parameters studied, only a few parameters are affected by dramatically increased glucose concentration. The creatinine measurements obtained in human sera with the Jaffe alkaline method at high glucose concentrations should be interpreted with caution. Other tests that were affected with extremely high glucose concentrations were calcium, albumin, chloride and FT4, hence results should be taken into consideration in patients with poor diabetic control.Key words: assay interference, glucose interference, preanalytical phase, creatinine, Jaffe kinetic assay, thyroid function tests     

供应链上下游企业合作研发模式选择--宝钢-大众激光拼焊项目案例分析

企业供应链的发展促使企业合作研发寻求新的模式。分析了上下游大型企业进行合作研发的诱因及其模式选择问题,结合宝钢一上海大众激光拼焊案例,重点讨论了建立股权制合作研发对上下游企业的影响和供应链创新的意义。     

Using the web to encourage student-generated questions in large-format introductory biology classes

Students rarely ask questions related to course content in large-format introductory classes. The use of a Web-based forum devoted to student-generated questions was explored in a second-semester introductory biology course. Approximately 80% of the enrolled students asked at least one question about course content during each of three semesters during which this approach was implemented. About 95% of the students who posted questions reported reading the instructor's response to their questions. Although doing so did not contribute to their grade in the course, approximately 75% of the students reported reading questions posted by other students in the class. Approximately 60% of the students reported that the Web-based question-asking activity contributed to their learning of biology.     

ISM-CMAP-Combine (ICMC) for hierarchical knowledge scenario in quality engineering education

Quality assurance in engineering education is a multifaceted problem further augmented by the stakeholders of engineering education. Students, parents and employers are rightfully questioning the quality of the curriculum, the instructional delivery, the learning environment, accessibility to learning technologies and equipment, employability as well as the possibilities of lifelong learning and the improvement of knowledge (Karapetrovic 2002 Karapetrovic, S. 2002. Why and how to develop a meaningful quality assurance system in engineering schools. Int. J. Engg. Educ, 18(3): 285–294. [Web of Science ®] [Google Scholar]). The purpose of the study is, therefore, to identify the parameters that influence the quality of an engineering education system and develop an integrated model of hierarchical structuring and a concept map for pre-identified concept elements through a process of iterative-interactive consensus-driven methodology, as advocated by second-generation system design paradigm for evolving knowledge scenario of concepts related to quality engineering education.     

Factors underlying students' decisions to use mobile devices in clinical settings

University policies prohibiting use of mobile devices by medical students during clinical placements are contradicted by regular use by physicians. Consequently, many students use their mobile devices, which can be beneficial for learning but may put patient privacy at risk. This study explores the reasons underlying students' decisions about using mobile devices in clinical settings. We used a mixed-methods sequential explanatory design involving a questionnaire and focus groups. Qualitative data from the questionnaire and focus groups was analysed through thematic analysis. We found students were aware of the risks mobile devices posed to professionalism and medical practice. Despite prohibitions, many made individual decisions to use mobile devices because the benefits outweighed the risks. These students were influenced by an organised, strategic approach to learning and a motivation to comply with the beliefs and behaviours of their medical teams and conform to physicians' directives in order to participate in their community of practice. Many students appear to be transferring everyday use of mobile devices to clinical settings. There is a need to understand and promote aspects of learning that are enhanced by mobile devices in clinical settings, while articulating clear guidelines and boundaries compatible with the professional behaviour expected of students.     

Trends and practices in functional behavior assessments completed by school psychologists

Functional Behavior Assessments (FBAs) utilize direct and indirect methods to collect data on student behavior to generate a functional hypothesis and drive intervention development. School psychologists are trained to conduct FBAs and use them regularly in schools. However, no evidence exists describing the specific practices used by school psychologists when they conduct FBAs. In this study, 199 respondents completed a web‐based survey developed using expert review and cognitive pretesting. Most respondents reported their gender as female (87%), were between 30 and 39 years old (50%), and practiced at the Specialist level (57%). Respondents reported receiving training in FBA across multiple sources and utilizing multi‐method data collection methods when conducting FBAs. A large amount of variability was observed in the specific instruments used by school psychologists, with a substantial proportion using forms that were not standardized or pre‐constructed. Implications for current practitioners, trainers, and researchers are described.     

A focus on time-lapse ethnography: learning to teach

This article makes the claim that developing ethnographic work through follow-up interviews can add to our understanding of researched phenomena and explores how using concepts from Bourdieu and theories on the social construction of time strengthen the research design and add a stronger longitudinal diachronic element to data analysis. Extending an ethnographic study of learning to teach by interviewing respondents nine years after the study and after the completion of their teacher education course is shown to develop insights around the initial research findings by focusing on the temporal aspects of data. Adopting this methodological approach can develop small-scale qualitative work and contribute to an accumulation of research findings to avoid simply revisiting familiar research ground.     

The Twelve Cranial Nerves of Christmas: Mnemonics,Rhyme, and Anatomy – Seeing the Lighter Side

Anatomy, has in history, been linked to helpful ways to remember structures, branches of nerves, structures passing through foramina, etc. Scalp is even a mnemonic in itself (S kin, C onnective tissue, A poneurosis, L oose areolar tissue, P ericranium). There has been concern by some educators that using mnemonics or rhymes promotes a surface approach to learning and is unhelpful in establishing long-term and meaningful deep learning. This article argues that mnemonics and rhyme can be used, in the appropriate way, at the right time, by students as an important learning strategy. That strategy can help lay a foundation of knowledge to be developed and later built upon, or simply recall information more easily. Mnemonics, like all information that is to be recalled, is consolidated by rehearsal. In examining the neuroanatomy of learning theories, it is therefore possible to suggest that when students begin to learn an area of anatomy, such as the cranial nerves, using a mnemonic or rhyme, it can help students remember the names and facilitate the engagement of the working memory processes assisting the student to build a construct for subsequent deeper layers of knowledge. Modern approaches to anatomy education involve a myriad of learning opportunities, but educators must assess the value of each one before recommending them to students. It appears that using mnemonics and rhyme is as valid today as it has been for centuries.