Diabetes care for Medicare beneficiaries. Attitudes and behaviors of primary care physicians

OBJECTIVE: To obtain information related to primary care physician (PCP) attitudes, knowledge, and practice patterns, as well as perceptions about barriers to care and the use of materials to assist in the delivery of diabetes care for elderly patients in the office setting. RESEARCH DESIGN AND METHODS: A survey was mailed to a random sample (n = 900) of PCPs (internal medicine, family practice, and general practice physicians and endocrinologists) from the states of Alabama, Iowa, and Maryland who met selection criteria and provided diabetes care to > or = 25 Medicare beneficiaries during calendar year 1993. RESULTS: Respondents provided self-reported information regarding diabetes care for elderly patients. PCP respondents (n = 370) considered blood glucose control to be the most important treatment goal. Most respondents (92%) considered acceptable GHb values to be those < 8%. Blood pressure measurement and foot inspections for the detection of ulcers and infection were the most commonly reported routine procedures performed as part of an office visit. Laboratory tests reported to be frequently ordered included GHb, serum creatinine, and proteinuria tests. Patient nonadherence to the treatment regimen was reported to be the most common barrier to care. The majority of respondents reported using two treatment aids in caring for patients with diabetes. CONCLUSIONS: The results of this study provide some evidence that PCP self-reported attitudes, knowledge, and practice patterns in delivering diabetes care for elderly patients in the office setting more closely reflect current recommended practice than reported in previous physician surveys. Opportunities for improvement still exist.     

On the influence of coarsening on microsegregation

An analytical treatment of the influence of coarsening by ripening on microsegregation is presented. Comparison of results from the model with data on Al-4.5 wt pct Cu and Sn-Bi alloys indicates that an overestimation of the reduction in microsegregation results if it is assumed that ripening proceeds throughout the solidification range. This is attributed to the changing nature of coarsening processes, in which coalescence processes predominate over ripening at higher volume fractions solid.     

Fluorescent brighteners: novel stains for the flow cytometric analysis of microorganisms

Genetic damages are frequently found in both tumor and normal cells at carcinogen exposed areas in the patients with upper aerodigestive tract cancer. These phenomena are explained by the multistage process and/or field cancerization theories. The c-erbB-2 proto-oncogene has been amplified in many human tumors including breast, stomach, kidney and lung cancers. To study the possible evidence of multistage process and/or field cancerization in the development of gastric adenocarcinoma, the amplification statuses of c-erbB-2 proto-oncogene using the Southern hybridization technique were evaluated at the 45 gastric adenocarcinoma specimen sets consisting of tumor tissue, adjacent normal tissue (within 2 cm of the primary tumor), metastatic tissue and normal stomach tissue (at least 5 cm away from primary tumor). As a result, c-erbB-2 proto-oncogene at 2 specimen sets (4.4%) was amplified 2- to 4-fold to normal control status. In these 2 cases, c-erbB-2 proto-oncogene at histologically normal tissue adjacent to tumor tissue was amplified. And, the metastatic tissue of 1 case also exhibited c-erbB-2 proto-oncogene amplification of which the degree was less than that of tumor tissue. From these results, we were able to suspect that c-erbB-2 proto-oncogene amplification in the normal tissue adjacent to tumor tissue could be a biomarker of premalignant changes in a small proportion of gastric adenocarcinoma patients. And, this result might suggest the possible role of multistage process and/or field cancerization in the development of gastric adenocarcinoma.     

LOCA hydroloads calculations with multidimensional nonlinear fluid-structure interaction

A methodology for realistically analyzing three-dimensional fluid-structure interaction effects and the resulting hydrodynamic loads during the subcooled portion of a hypothetical loss of coolant accident (LOCA) in a pressurized water reactor (PWR) is discussed. The methodology uses a hydrodynamic computer program, STEALTH 3D, coupled with a structural response program, WHAMSE 3D, to calculate the dynamic interaction of fluid and structure during a reactor vessel blowdown. This coupled program is user oriented and highly versatile in modeling the various components in complex reactor systems. Assessment of the methodology is provided by STEALTH/WHAMSE 3D calculations of blowdown tests in the German Battelle-Frankfurt RS-16B facility (Test DWR5) and the HDR facility (Test V31.1). The calculations are described and the results compared with experimental data. Agreement between the calculational results and experimental data is extremely good.     

The possible antiketogenic and gluconeogenic effect of the omega-oxidation of fatty acids in rats

The urinary excretion of C4--C10-dicarboxylic acids and 3-hydroxybutyric acid was examined in rats on ketogenic stimulation due to fat-feeding. The urinary excretion of succinic acid decreased while the urinary excretion of adipic and suberic acids increased prior to the appearance of ketosis, and this pattern of excretion was almost independent of the degree of the subsequent ketosis. After administering adipic acid to the ketotic rats, urinary excretion of succinic acid increased at the same time as ketosis decreased and blood glucose increased. The possibility of a physiological antiketogenic and gluconeogenic effect of the omega-oxidation of fatty acids to dicarboxylic acids is discussed.     

Urethral pressure profile in prostatic surgery

Urethral pressure profile measurements were performed in 45 men suffering from micturation disturbances with the aim of evaluating the diagnostic aid of the procedure as compared to conventional urodynamic evaluation. The urethral pressure profile seems to be of value in visualizing the diseases of the prostate and the bladder neck, but it is of no definite aid except for postprostatectomy incontinence.     

Decellularised Human Umbilical Artery as a Vascular Graft Elicits Minimal Pro-Inflammatory Host Response Ex Vivo and In Vivo

Small diameter (<6 mm) vessel grafts still pose a challenge for scientists worldwide. Decellularised umbilical artery (dUA) remains promising as small diameter tissue engineered vascular graft (TEVG), yet their immunogenicity remains unknown. Herein, we evaluated the host immune responses, with a focus on the innate part, towards human dUA implantation in mice, and confirmed our findings in an ex vivo allogeneic human setup. Overall, we did not observe any differences in the number of circulating white blood cells nor the number of monocytes among three groups of mice (1) dUA patch; (2) Sham; and (3) Mock throughout the study (day −7 to 28). Likewise, we found no difference in systemic inflammatory and anti-inflammatory cytokine levels between groups. However, a massive local remodelling response with M2 macrophages were observed in the dUA at day 28, whereas M1 macrophages were less frequent. Moreover, human monocytes from allogeneic individuals were differentiated into macrophages and exposed to lyophilised dUA to maximize an eventual M1 response. Yet, dUA did not elicit any immediate M1 response as determined by the absence of CCR7 and CXCL10. Together this suggests that human dUA elicits a minimal pro-inflammatory response further supporting its use as a TEVG in an allogeneic setup.     

Considerations on Probe Design for Affinity-Guided Protein Conjugation

The plethora of methods developed for the creation of protein conjugates often differs significantly with regard to the heterogeneity of the resulting products, in the degree of genetic manipulation of the protein required, and in the technical skills required to perform the conjugation procedure. Affinity-guided protein conjugation is a protein labeling methodology based on noncovalent binding interactions between a labeling probe and the protein of interest. These interactions increase the local concentration of a reactive group in the probe on the protein surface thus facilitating the conjugation in proximity of the complexation site. The ability to produce high-quality conjugates from nongenetically modified proteins both in vitro, but also in cells, demonstrates the power of affinity-guided protein conjugation. Here, we present the progress of affinity-guided protein conjugation in relation to selective protein labeling in living systems and the formation of high-quality protein conjugates. Furthermore, the probe design will be discussed in relation to the utility of the probe for labeling in vitro or in living systems.     

Studies on the one-dimensional platinum atom chain compound Rb3(H3O)0.2[Pt(CN)4](O3SO·H·OSO3)0.5·0.8H2O

The variation of conductivity and thermopower with temperature for Rb₃(H₃O)_0.2[Pt(CN)₄](O₃SO·H·OSO₃)_0.5·0.8H₂O is reported. The abrupt falls in conductivity at low temperature previously reported have been carefully studied and from the non-reproducible nature of the phenomena, it is deduced that these result from cracks in the sample rather than a phase change in the material.     

A fully automated, ‘thimble-size’ scanning tunnelling microscope

A novel, fully automated high-stability, high-eigenfrequency scanning tunnelling microscope (STM) has been developed. Its key design feature is the application of two piezoelectric ceramic tubes, one for the x-y-z motion of the tip and one for a linear motor (‘nano-worm’) used for the coarse positioning of the tip relative to the specimen. By means of the nano-worm, the tip can be advanced in steps between 16 and 0·2 nm. The walking distance is >2 mm, with a maximum speed of 2000 steps/s. The nano-worm positioning implies that this STM is fully controlled by electronic means, and that no mechanical coupling is needed, which makes operation of the STM extremely convenient. The axial-symmetry construction is rigid, small and temperature-compensated, yielding reduced sensitivity to mechanical and acoustic vibrations and temperature variations. The sample is simply placed on a piece of invar which surrounds the scanner tube and the nano-worm and is held by gravity alone. This allows for easy sample mounting. The performance of the microscope has been tested in air by imaging a variety of surfaces, including graphite and biological samples.