Are there time and cost savings by using telemanagement for patients on intensified insulin therapy? A randomised,controlled trial

BACKGROUND: Patients with insulin dependent diabetes require frequent advice if their metabolic control is not optimal. This study focuses on the fiscal and administrative aspects of telemanagement, which was used to establish a supervised autonomy of patients on intensified insulin therapy. METHODS: A prospective, randomised trial with 43 patients on intensified insulin therapy was conducted. Travelling distance to the diabetes centre was 50 min one way; all patients had undergone a diabetes education course with lessons in dose adaptation. Patients were randomly assigned to telecare (n=27) or conventional care (n=16). They used BG-meters with a storage capacity of 120 values (Precision QID Abbott/Medisense) and transmitted their data over a combined modem/interface via telephone line to the diabetes centre. Data were displayed and stored by a customised software (Precision Link Plus, Abbott/Medisense). Advice for proper dose adjustment was given by telephone. RESULTS: Average time needed for instruction in the telemedical system was 15 min. Data were transmitted every 1-3 weeks and a teleconsultation was performed by phone every 2-4 weeks, depending on the extent of specific problems. On average, personal visits in the control group were performed once a month. Physician's time expenditure for telemanagement, compared to conventional advice was moderately higher (50 vs. 42 min per month). A substantial amount of time on the patients side could be saved through replacing personal communications by telephone contacts and data transmission reduction (96 vs. 163 min/month including data transmission time). Setting up an optimal telemanagement scenario, a cost analysis was carried out yielding savings of approximately 650 euro per year per patient. HbA(1c) dropped significantly from 8.2 to 7.0% after 8 months of observation, but there was no significant difference between the intervention and control groups. Major technical problems with the telematic system did not occur during the study. CONCLUSIONS: Telemanagement of insulin-requiring diabetic patients is a cost and time saving procedure for the patients and results in metabolic control comparable to conventional outpatient management.     

The Sceno Game in the course of time

This article describes 50 years of working with the Sceno test, the first decades being in close cooperation with Gerhild von Staabs. After many years experience with the Sceno test in Swiss psychiatric hospitals over 1000 Sceno test games were conducted in the psychosomatic ward of the University of Munich Outpatient Department for Children and evaluated with a special record and slides. These were games carried out by children and adolescents with behavioral disorders, psychosomatic illnesses, and handicaps, in some cases by their mothers in an accompanying simultaneous analysis. Using the projective method the initial Sceno test, vulgar and original answers, key situations, repetition and memory compulsions were recorded. With 100 adults diagnosed as being schizophrenic Sceno tests with chaotic apparent order analogous to pictures painted by schizophrenics were observed. With adults and children with cerebro-organic damage we found an "organic play syndrom" in the game structure. Six medical dissertations dealt with the psychosomatics of children. Along with the depth psychology problems, in principle, the formality of the Sceno test set-up depending on age and development phase of the child also has to be taken into consideration. The Sceno test in its original form has proven itself to be up to date even today and requires only minor changes to some game elements, adapting them to the modern surroundings of children which means that a Sceno-R (Fliegner 1995) with 23 new game elements seems unnecessary. Psychodiagnostics and psychotherapy of our Sceno test game are based on the analytical method of Hans Zulliger and Anna Freud.     

Constraining User Response via Multimodal Dialog Interface

This paper presents the results of an experiment comparing two different designs of an automated dialog interface. We compare a multimodal design utilizing text displays coordinated with spoken prompts to a voice-only version of the same application. Our results show that the text-coordinated version is more efficient in terms of word recognition and number of out-of-grammar responses, and is equal to the voice-only version in terms of user satisfaction. We argue that this type of multimodal dialog interface effectively constrains user response to allow for better speech recognition without increasing cognitive load or compromising the naturalness of the interaction.     

Alkylpolyglucoside - Technologie und Eigenschaften

Alkylpolyglucosides - Technology and Properties. Carbohydrate derivatives with surfactant properties are known for a long time. Nevertheless, their large scale commercial production has not been realized in the past, especially due to the lack of suitable economical manufacturing procedures. Among the well-known carbohydrate surfactant structures, the long chain alkyl polyglucosides are expected to succeed within the group of large scale leading surfactants. The development of the chemistry of carbohydrate surfactants is reviewed, particulary describing manufacturing process options for alkyl polyglucosides. Present large scale glucoside surfactant manufacture is based on a number of decisive product and process improvements, leading to products which meet the demands of the surfactant market regarding performance, quality and price. Alkyl polyglucosides are a new category of mild, moderately foaming, highly soluble nonionic surfactants suitable for many applications and industries. Their unique performance and formulating properties are summarized.     

Characterization of Nonmetallic Inclusions in 18CrNiMo7-6

Metallurgical and Materials Transactions B - The detrimental effect of nonmetallic inclusions (NMIs) in steels on, e.g., fatigue lifetime is well known. In order to increase the durability and...     

The effect of tool vibrations on the flank surface created by peripheral milling

Tool vibrations have a significant influence on the surface quality with respect to surface location error and roughness. Even chatter-free milling processes can produce a high surface location error since chatter-free does not necessarily mean vibration-free. This article describes a geometric model for predicting the surface formation resulting from peripheral milling processes when tool vibrations are present. This model enables one to predict and minimize the roughness and location error of the flank surface. Comparisons between simulations and experiments show the effectiveness of this modeling approach. An important result of this research is that it has shown that milling at a stability maximum does not generally yield the best surface quality.     

Computer science for the many

People read in the newspapers about computer chips, supercomputers, artificial intelligence, and myriad new technologies, and they want to understand them. Is there a better way to give them a grasp of computing than by providing the superficial view a typical of ordinary “computer literacy” courses, without making them struggle through the rigorous curriculum required in a computer science education? Yes, there is. This article describes a first course for nonmajors that covers a surprisingly broad set of topics in substantial depth. Advances in teaching methods involving an appropriate selection of topics, proper coverage of those topics, and the use of animated simulations can significantly ease the teaching of computer science to nonspecialists. The course described enables students to develop skill in programming, learn the fundamental mechanisms of computer hardware and software, and gain a substantial understanding of important topics such as computational intractability, noncomputability, parallel architectures, and artificial intelligence     

Eine Methode zur Bestimmung von Wasserstoff,Sauerstoff und Stickstoff in niedrig sublimierenden Substanzen

A method for determining Hydrogen, Oxygen and Nitrogen gas concentration from materials, which sublimate at low temperatures . By application of the method Gas-Extraction with a special crucible-filter-system it is possible, to determine gas contents in the region of ppm from materials, which sublimate at low temperatures. The advantages of the High-Vacuum-Degasification in connection with Mass Spectrometric gas analysis, i. e. the detection of all gas components by using only one measurement, were used in this method.