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BACKGROUND: Finger prick blood glucose (BG) monitoring remains a mainstay of management in people with type 2 diabetes (T2DM) who take sulphonylurea (SU) drugs or insulin. We recently examined patient experience of BG monitoring in people with type 1 diabetes (T1DM). There has not been any recent comprehensive assessment of the performance of BG monitoring strips or the patient experience of BG strips in people with T2DM in the UK.METHODS: An online self-reported questionnaire containing 44 questions, prepared following consultation with clinicians and patients, was circulated to people with T2DM. 186 responders provided completed responses (25.5% return rate). Fixed responses were coded numerically (eg not confident = 0 fairly confident = 1).RESULTS: Of responders, 84% were treated with insulin in addition to other agents. 75% reported having had an HbA1c check in the previous 6 months. For those with reported HbA1c ≥ 65 mmol/mol, a majority of people (70%) were concerned or really concerned about the shorter term consequences of running a high HbA1c This contrasted with those who did not know their recent HbA1c, of whom only 33% were concerned/really concerned and those with HbA1c CONCLUSION: The group surveyed comprised engaged people with T2DM but even within this group there was significant variation in (a) awareness of shorter term risks, (b) confidence in their ability to implement appropriate insulin dosage (c) awareness of the limitations of BG monitoring technology. There is clearly an area where changes in education/support would benefit many.

In this study we investigated genome-wide sperm DNA methylation patterns in trauma-exposed Vietnam veterans. At the genome-wide level, we identified 3 CpG sites associated with PTSD in sperm including two intergenic and one CpG within the CCDC88C gene. Of those associated with PTSD in sperm at a nominal level, 1868 CpGs were also associated with PTSD in peripheral blood (5.6% overlap) including the RORA, CRHR1 and DOCK2 genes that have been previously implicated in PTSD. A total of 10 CpG sites were significantly associated with a reported history of a diagnosed mental health condition in children and reached genome-wide significance. CpGs associated with a history of a reported mental health condition in children were also enriched (90% of tested genes) for genes previously reported to be resistant to demethylation, making them strong candidates for transgenerational inheritance. In conclusion, our findings identify a unique sperm-specific DNA methylation pattern that is associated with PTSD.

Subjects with obesity have metabolic risk factors for nerve fibre damage. Because bariatric surgery improves these risk factors we have assessed whether this can ameliorate nerve fibre damage.Twenty-six obese subjects without diabetes (age: 46.23 ± 8.6, BMI: 48.7 ± 1.5, HbA1c: 38.0 ± 4.5) and 20 controls (age: 48.3 ± 6.2, BMI: 26.8 ± 4.2, HbA1c: 39.1 ± 2.6) underwent detailed assessment of neuropathy at baseline and 12 months after bariatric surgery.Obese subjects had normal peroneal (45.9 ± 5.5 vs. 48.1 ± 4.5, P = 0.1) and sural (46.9 ± 7.6 vs. 47.9 ± 10.6, P = 0.1) nerve conduction velocity, but a significantly higher neuropathy symptom profile (NSP) (4.3 ± 5.7 vs. 0.3 ± 0.6, P = 0.001), vibration perception threshold (VPT) (V) (10.2 ± 6.8 vs. 4.8 ± 2.7, P 0.0001), warm threshold (C°) (40.4 ± 3.5 vs. 37.2 ± 1.8, P = 0.003) and lower peroneal (3.8 ± 2.2 vs. 4.9 ± 2.2, P = 0.02) and sural (8.9 ± 5.8 vs. 15.2 ± 8.5, P 0.0001) nerve amplitude, deep breathing-heart rate variability (DB-HRV) (beats/min) (21.7 ± 4.1 vs. 30.1 ± 14, P = 0.001), corneal nerve fibre density (CNFD) (n/mmObese subjects have evidence of neuropathy, and bariatric surgery leads to an improvement in weight, HbA1c, lipids, neuropathic symptoms and deficits and small nerve fibre regeneration without a change in quantitative sensory testing, autonomic function or neurophysiology.

Free to read on journal website (may need to create free account first) Objective To determine whether the prevalence of physical comorbidities in Australian Vietnam War veterans with post-traumatic stress disorder (PTSD) is higher than in trauma-exposed veterans without PTSD. Design, setting and participants: Cross-sectional analysis of the health status (based on self-reported and objective clinical assessments) of 298 Australian Vietnam War veterans enrolled by the Gallipoli Medical Research Institute (Brisbane) during February 2014 e July 2015, of whom 108 were confirmed as having had PTSD and 106 served as trauma-exposed control participants. Main outcomes and measures Diagnostic psychiatric interview and psychological assessments determined PTSD status, trauma exposure, and comorbid psychological symptoms. Demographic data, and medical and sleep history were collected; comprehensive clinical examination, electrocardiography, spirometry, liver transient elastography, and selected pathology assessments and diagnostic imaging were performed. Outcomes associated with PTSD were identified; regression analysis excluded the effects of potentially confounding demographic and risk factors and comorbid symptoms of depression and anxiety. Results The mean total number of comorbidities was higher among those with PTSD (17.7; SD, 6.1) than in trauma-exposed controls (14.1; SD, 5.2; P < 0.001). For 24 of 171 assessed clinical outcomes, morbidity was greater in the PTSD group, including for conditions of the gastrointestinal, hepatic, cardiovascular, and respiratory systems, sleep disorders, and laboratory pathology measures. In regression analyses including demographic factors, PTSD remained positively associated with 17 adverse outcomes; after adjusting for the severity of depressive symptoms, it remained significantly associated with ten. Conclusion PTSD in Australian Vietnam veterans is associated with comorbidities in several organ systems, independent of trauma exposure. A comprehensive approach to the health care of veterans with PTSD is needed.

OBJECTIVE—To determine the effectiveness of specialist nurse-led clinics for hypertension and hyperlipidemia provided for diabetic patients receiving hospital-based care. RESEARCH DESIGN AND METHODS—This study was a randomized controlled implementation trial at Hope Hospital, Salford, U.K. The subjects consisted of 1,407 subjects presenting for annual review with raised blood pressure (≥140/80 mmHg), raised total cholesterol (≥5.0 mmol/l), or both. Individuals with diabetes were randomized to usual care or usual care with subsequent invitation to attend specialist nurse-led clinics. Nurses provided clinics for participants, with attendance every 4–6 weeks, until targets were achieved. Lifestyle advice and titration of drug therapies were provided according to the locally agreed upon guidelines. Patients with both conditions were eligible for enrollment in either or both clinics. At subsequent annual review, blood pressure and total cholesterol values were obtained from the Salford electronic diabetes register. Data relating to deaths were obtained from the national strategic tracing service. The primary outcome was the odds ratio of achieving targets in hypertension and hyperlipidemia, attributable to the specialist nurse-led intervention. RESULTS—Overall, specialist nurse-led clinics were associated with a significant improvement in patients achieving the target after 1 year (odds ratio [OR] 1.37 [95% CI 1.11–1.69], P = 0.003). This primary analysis revealed a borderline difference in effect between the two types of clinics (test for interaction between groups: P = 0.06). Secondary analysis, consistent with the prior beliefs of the health care professionals involved, suggested that targets were achieved more frequently in patients enrolled in the specialist nurse-led clinic for hyperlipidemia (OR 1.69 [1.25–2.29], P = 0.0007) than for hypertension (OR 1.14 [0.86–1.51], P = 0.37). Intervention (enrolled to either or both clinics) was associated with a reduction in all-cause mortality (OR 0.55 [0.32–0.92], P = 0.02). CONCLUSIONS—This study provides good evidence to support the use of specialist nurse-led clinics as an effective adjunct to hospital-based care of patients with diabetes. If the standards of care recommended in the National Service Framework for Diabetes are to be achieved, then such proven methods for delivering care must be adopted.

The objective of this study was to document the performance of commercially available forage harvesting equipment on high-tonnage sorghum under a dual-harvest ratoon cropping system and a single-harvest under an extended season. Four mower-conditioner configurations were used in 2009 to document differences in field drying and impact of cropping conditions on machine performance. A windrow inversion was included in the 2010 study to increase moisture loss, prior to harvesting with a large square baler and self-propelled forage harvester (SPFH). The results indicate significant differences in conditioner operating speeds as field conditions degrade with the extended harvest season. The 2010 results confirm some windrower configurations to underperform others in certain field conditions. The raking field efficiency was significantly impacted by the harvest inefficiencies of the windrower and the cross-sectional geometry of the windrow. The SPFH exhibited a greater material capacity than the baler, but was significantly affected by theoretical chop length and crop moisture. Windrow inefficiencies also negatively impacted baler performance and reduced field efficiency due to unnecessary plugging.

The presence and correlates of Interpersonal Family Stress (IFS) were examined among 56 outpatients (mean age 74) meeting DSM-III-R (APA, 1987) criteria for primary degenerative dementia of the Alzheimer's type (Alzheimer's disease, AD), and their caregivers. Patient and caregiver perceptions of IFS were assessed with six representative questions. Information about functional status (ADL's and IADL's), behavior problems, cognitive status, and the social worker's assessment of the degree of interpersonal stress in the family was also obtained. Both patients and caregivers report the presence of IFS in several areas including: disrupted relationships attributed to anger and frustration; interference with normal activities; feelings of uneasiness in the presence of family member; and the use of caution in communication. Caregivers reported IFS more frequently than patients. Among the variables most strongly associated with patients' perception of IFS were behavioral and emotional changes experienced by the p...

To determine the effectiveness of specialist nurse-led clinics for hypertension and hyperlipidemia provided for diabetic patients receiving hospital-based care.This study was a randomized controlled implementation trial at Hope Hospital, Salford, U.K. The subjects consisted of 1,407 subjects presenting for annual review with raised blood pressure(or=140/80 mmHg), raised total cholesterol (or=5.0 mmol/l), or both. Individuals with diabetes were randomized to usual care or usual care with subsequent invitation to attend specialist nurse-led clinics. Nurses provided clinics for participants, with attendance every 4-6 weeks, until targets were achieved. Lifestyle advice and titration of drug therapies were provided according to the locally agreed upon guidelines. Patients with both conditions were eligible for enrollment in either or both clinics. At subsequent annual review, blood pressure and total cholesterol values were obtained from the Salford electronic diabetes register. Data relating to deaths were obtained from the national strategic tracing service. The primary outcome was the odds ratio of achieving targets in hypertension and hyperlipidemia, attributable to the specialist nurse-led intervention.Overall, specialist nurse-led clinics were associated with a significant improvement in patients achieving the target after 1 year (odds ratio [OR] 1.37 [95% CI 1.11-1.69], P = 0.003). This primary analysis revealed a borderline difference in effect between the two types of clinics (test for interaction between groups: P = 0.06). Secondary analysis, consistent with the prior beliefs of the health care professionals involved, suggested that targets were achieved more frequently in patients enrolled in the specialist nurse-led clinic for hyperlipidemia (OR 1.69 [1.25-2.29], P = 0.0007) than for hypertension (OR 1.14 [0.86-1.51], P = 0.37). Intervention (enrolled to either or both clinics) was associated with a reduction in all-cause mortality (OR 0.55 [0.32-0.92], P = 0.02).This study provides good evidence to support the use of specialist nurse-led clinics as an effective adjunct to hospital-based care of patients with diabetes. If the standards of care recommended in the National Service Framework for Diabetes are to be achieved, then such proven methods for delivering care must be adopted.

To reach the goals laid out by the U.S. Government for displacing fossil fuels with biofuels, high-biomass sorghum is well-suited to achieving this goal because it requires less water per unit dry biomass and can produce very high biomass yields. In order to make biofuels economically competitive with fossil fuels it is essential to maximize production efficiency throughout the system. The goal of this study was to use remote sensing technologies to optimize the yield and harvest logistics of high-biomass sorghum with respect to production costs based on spatial variability within and among fields. Specific objectives were to compare yield to aerial multispectral imagery and develop predictive relationships. A 19.2-ha high- biomasssorghumfieldwasselectedasastudysiteandaerialmultispectralimageswereacquired with a four-camera imaging system on July 17, 2009. Sorghum plant samples were collected at predeterminedgeographiccoordinatestodeterminebiomassyield.Aerialimageswereprocessed to find relationships between image reflectance and yield of the biomass sorghum. Results showed that sorghum biomass yield in early August was closely related (R 2 = 0.76) to spectral reflectance. However, in the late season the correlations between the biomass yield and spectral reflectance were not as positive as in the early season. The eventual outcome of this work could lead to predicted-yield maps based on remotely sensed images, which could be used in developing field management practices to optimize yield and harvest logistics. C 2011 Society of

We examined stimulus-response relationships of vibrissa-activated mechanosensory neurons of the rat's fifth (trigeminal) ganglion. Single-unit activity was recorded with tungsten microelectrodes. The vibrissae were deflected with a variety of parametrically controlled stimulus waveforms. We found that the receptive field of each vibrissa-activated neuron consisted of a single vibrissa. Few, if any, unambiguous examples of spontaneous activity were observed in these neurons. Even if true spontaneous activity was present, its observed incidence was low, as were the measured discharge rates. Thresholds of individual neurons were usually quite discrete; often a 1-2% increase in pulse magnitude (angular displacement) above a level to which the neuron did not respond caused it to discharge on every trial. The distribution of thresholds for the sample was continuous with a median of about 1 degree and a range of over three orders of magnitude. The most sensitive neurons responded to deflections of less than 0.1 degrees. Many neurons responded to a single suprathreshold pulse with more than one spike. We found no consistent relationships among the thresholds of the additional evoked discharges of an individual neuron other than that the total number of evoked spikes either increased or stayed the same, but never decreased, as stimulus magnitude increased. About one-third of the neurons examined had velocity thresholds below 3 degrees/sec. Above that value, thresholds were distributed continuously throughout a range of over three orders of magnitude. The median velocity threshold was about 100 degrees/sec. The broad and continuous distributions of both magnitude and velocity thresholds suggest that a population of vibrissa-activated neurons can code stimulus strength smoothly and continuously over a wide range, even though individual neurons may be poorly suited to do so.

Mechanosensory neurons are often classified as either rapidly adapting or slowly adapting. We examined response decay (adaptation) during constant deflection of the vibrissae with quantitative, repeatable, ad hoc measures. We found that first-order vibrissa-activated neurons of the fifth ganglion exhibit a variety of adaptation rates that appear to be distributed continuously between the rapidly and slowly adapting extremes. Also, adaptation rate is influenced markedly by stimulus magnitude. We found no evidence for a dichotomy within the more slowly adapting neurons on the basis of discharge regularity. Threshold tuning curves were used to evaluate vibration sensitivity. Both the best frequencies and 1:1 discharge thresholds for sinusoidal stimulation ranged over two orders of magnitude and were continuously distributed. First-order vibrissa-activated afferents exhibit a broad variety of response patterns to constant-velocity stimulation. The pattern of discharge varied both as a function of time during constant-velocity (ramp) deflection and as a function of stimulus velocity. Although information about the parameters of a stimulus may be conveyed by any of several features of the response pattern, it appears that few if any neurons function as "pure" encoders of any particular stimulus parameter. We examined quantitatively the relationship between discharge rate and both velocity and amplitude of vibrissa deflection with the aid of a computer-based curve-fitting procedure. We found that about half the observed rate-level functions were best described by a power function; the remainder were best fit by a logarithmic function. The parameters of the best-fitting functions varied widely and continuously, emphasizing further the diversity of coding properties of the rat's vibrissa afferents. Rate-level curves for stimulus magnitude generally exhibited saturation; some were nonmonotonic. None were described adequately by either a logarithmic function or a power function.

Electrical activity of single vibrissa-activated neurons was recorded in pars interpolaris and pars oralis of the nucleus of the trigeminal spinal tract of rats. Stimuli consisted of quantitatively controlled deflections of individual mystacial vibrissae. The evoked spike trains were analyzed as point-process time series with a variety of quantitative procedures. Most second-order trigeminal neurons were directionally sensitive. About one-third of interpolaris neurons and over half of oralis neurons responded to axial push of the hair shaft. About half of the neurons of both oralis and interpolaris had receptive fields that included more than one vibrissa. The upper-quartile receptive field size of neurons of interpolaris was about half that of oralis, although the distributions overlapped. In interpolaris, almost one-fifth of the sample discharged in the absence of an intentionally applied stimulus; in oralis, over one-third of the sample displayed background activity. The ranges of angular displacement thresholds of both samples exceeded three orders of magnitude. The distributions differed quantitatively. They were, nevertheless, similar in shape, and exhibited considerable overlap. The median threshold of oralis neurons was about half that of interpolaris neurons, and about one-fifth that of first-order neurons. About one-fourth of the second-order neurons exhibited a nonmonotonic relationship between pulse displacement and the number of evoked spikes. Neurons of interpolaris tended to be more severely nonmonotonic than those of oralis, and some "turned off" at stimulus magnitudes well above threshold. Nevertheless, the number of spikes evoked in either entire sample was a monotonically increasing function of pulse displacement. The range of angular velocity thresholds observed in both second-order samples exceeded three orders of magnitude. As with the angular displacement thresholds, the distributions of angular velocity thresholds were quantitatively different, although their shapes and extremes were similar, and they overlapped extensively. The observed differences of stimulus-response relationships of the neurons in interpolaris and oralis reflect differences in the ways different trigeminal nuclei receive, process, and distribute information to the circuits in which they participate.

We defined spatial patterns of tactile projections to cerebellar cortex of anesthetized albino rats using microelectrode micromapping methods. Low threshold natural stimulation of cutaneous mechanorec

We studied single units innervating the glabrous forepaw skin of 35 domestic kittens ranging in age from 1 to 52 postnatal days. Three aspects of coding were emphasized: (a) size and force thresholds of receptive fields, (b) time course of recovery between stimulus presentations, and (c) electrical conduction properties of the afferent nerve fibers. Receptive field (RF) size and force thresholds were (a) positively correlated with age for palmar but not digital RFs, and (b) were significantly larger on palm than on digits. Unit responsiveness was highly dependent on intertrial interval, complete recovery requiring at least 30 sec. Conduction velocity increased more rapidly than nerve fiber length, thus conduction time decreased with age. Refractory period decreased with age, but the conduction velocities of sequential spikes were proportional, regardless of age. These changes which we observed can more readily be ascribed to alterations of the mechanical properties of skin and conduction properties of nerve fibers than to changes in the coding mechanisms themselves.

We defined spatial patterns of organization of projections from somatosensory cerebral cortex (SI) to the somatosensory cerebellar cortex of anesthetized albino rats using microelectrode (stimulation

Recent micromapping studies of tactile areas in rat cerebellum have revealed a spatially precise mosaic of granule cell layer areas termed ‘patches’, with multiple patches on several folia resulting in multiple representations of the same body part. The research reported in the present paper tested the hypothesis that trigeminocerebellar mossy fiber branching is patch-related, so that collaterals terminate only within the boundaries of one or more of the tiny (often less than 1 sq. mm) patches having similar receptive fields. This hypothesis was supported by 3 separate series of electrophysiological physiological experiments: (1) electrical stimulation in a patch resulted in short latency, low threshold responses confined within the boundaries of a second patch having a similar receptive field; (2) antidromic collison tests demonstrated that collaterals of axons originating in nucleus interpolaris reach pairs of patches with similar receptive fields; and (3) micromapping of the area from which a particular interpolaris neuron could be antidromically activated revealed that local terminal branching of a given mossy fiber axon appeared to be confined within the boundaries of a single patch. Together these results indicate that trigeminocerebellar mossy fiber branching is related to the fractured somatotopical organization of the granule cell layer. Possible functional implications of such mossy fiber branching are discussed.

We discovered a small tactile area in a single a folium of the uvula of the cauday vermis of the rat's cerebellum. Gentle mechanical stimulation of relatively small cutaneous receptive fields (RFs) activated multiple units in the granule cell (GC) layer in a portion of a single folium in rats anesthetized with sodium pentobarbital. The total size of this area on each side of the midline is about 1.5 mm2, yet micromapping within this tiny region using tungsten ball microelectrodes and a high puncture sampling density (about 75 punctures/mm2) revealed a highly differentiated pattern of cutaneous projections to the GC layer. All peripheral projections are ipsilateral; the two homologous areas from each side adjoining at the midline of folium 9a. The larger projection areas from cutaneous RFs are mostly from mystacial vibrissae and upper lip, but small projection sites from the remainder of the head, neck and forelimb also are present. The pattern of projections were patch-like, forming a fractured somatotopic pattern or mosaic, with some somatotopic and some nonsomatotopic features. Each RF activated units in a vertical column in the GC layer. This area has not been described in any mammal, and its functional role can now be studied.

We recorded effects of electrical stimulation of sensorimotor cortex on the responses of 45 neurons in the interpolar trigeminal nucleus to mechanical stimulation of vibrissae. Responses elicited by peripheral mechanical stimulation were enhanced when a neuron's receptive field (RF) included the RF of the cortical stimulating locus, and suppressed when the RFs of the cortical site and the interpolar neuron did not overlap. Several interpolaris neurons influenced by cortical stimulation were shown to project to the cerebellum.

Summary We examined stimulus-response (S-R) profiles of 35 single mechanoreceptive afferent units having small receptive fields in glabrous forepaw skin of 24 anesthetized domestic kittens. Single unit activity was recorded with tungsten microelectrodes from cervical dorsal root ganglia. The study was designed to be as quantitatively descriptive as possible. We indented each unit's receptive field with a broad battery of simple, carefully controlled stimuli whose major parameters, including amplitude, velocity, acceleration, duration, and interstimulus interval were systematically varied. Stimuli were delivered by a small probe driven by a feedback-controlled axial displacement generator. Single unit discharge data were analyzed by a variety of direct and derived measures including dot patterns, peristimulus histograms, instantaneous and mean instantaneous firing rates, tuning curves, thresholds for amplitude and velocity, adaptation rates, dynamic and static sensitivities, and others. We found that with respect to any of the S-R transactions examined, the properties of our sample of units were continously and broadly distributed. Any one unit might exhibit either a slow or rapid rate of adaptation, or might superficially appear to preferentially code a single stimulus parameter such as amplitude or velocity. But when the entire range of responsiveness of units to the entire stimulus battery was surveyed by a variety of analytic techniques, we were unable to find any justifiable basis for designation of discrete categories of S-R profiles. Intermediate response types were always found, and in general, all units were both broadly tuned and capable of responding to integrals of several stimulus parameters. Our data argue against the usefulness of evaluating a unit's S-R coding capabilities by means of a limited set of stimulation or response analysis procedures.

Two mathematical models are presented which describe perception of the loudness of a tone masked by noise. The designation “psychoneural” indicates that the models are consistent with accepted findings in the fields of neuroanatomy, neurophysiology, and psychophysics. Each of the models consists of two channels, one which responds only to noise and another which responds to a weighted sum of tone and noise. Each channel is functionally equivalent to the model proposed by MacKay to explain intensity perception. In the first of the two masking models, it is assumed that the noise decreases the perceived loudness of the tone by lateral inhibition at a central location. In the second model, it is assumed that the noise decreases the loudness of the tone by efferent inhibition which acts at the periphery. The quantitative predictions of both models are identical and, with the appropriate adjustment of certain parameters, can be brought into close agreement with psychophysical masking data. The relative merits and handicaps of the models are discussed in the context of a more complex representation of the masking process in which a separate channel is assigned to each critical frequency band.

A typical set of visual contrast data can be described by a function which relates brightness responses to the luminance stimulus provided by a target that is viewed against an illuminated surround. This brightness-luminance function is represented by a psychoneural visual-contrast model having two channels, one corresponding to the brightness of the target and the other to the brightness of the surround. The principal ascending and descending pathways in each channel are represented by a submodel which is equivalent to the intensity-perception model described by MacKay. The interaction between the channels, which accounts for the perception of contrast, takes the form of nonlinear lateral inhibition. Brightness responses calculated with the use of the pshychoneural contrast model correspond very closely to the data upon which the brightness-luminance function is based.

A highly simplified evolving system was investigated by computer simulation. The genetic complement of each simulated organism in the population was represented by a single chromosome that consisted of a string of symbols. Individual fitness was measured as the number of symbols that corresponded to a specified rule. Reproduction was simulated with a non-breeding algorithm and two variants of a breeding algorithm, and was subject to random point mutations. In each generation, selection was effected by replacing the less fit members of the population with offspring of the more fit. The size of the population and the fraction replaced, though under experimental control, were constant for each simulation run. It was found that even such a simplified system is able to mimic a variety of properties observed in natural systems. In addition, the effect of the simulation parameters on the course of fitness increase provides a basis for using a genetic algorithm as an optimization technique.