New Insulin Delivery Recommendations

Many primary care professionals manage injection or infusion therapies in patients with diabetes. Few published guidelines have been available to help such professionals and their patients manage these therapies. Herein, we present new, practical, and comprehensive recommendations for diabetes injections and infusions. These recommendations were informed by a large international survey of current practice and were written and vetted by 183 diabetes experts from 54 countries at the Forum for Injection Technique and Therapy: Expert Recommendations (FITTER) workshop held in Rome, Italy, in 2015. Recommendations are organized around the themes of anatomy, physiology, pathology, psychology, and technology. Key among the recommendations are that the shortest needles (currently the 4-mm pen and 6-mm syringe needles) are safe, effective, and less painful and should be the first-line choice in all patient categories; intramuscular injections should be avoided, especially with long-acting insulins, because severe hypoglycemia may result; lipohypertrophy is a frequent complication of therapy that distorts insulin absorption, and, therefore, injections and infusions should not be given into these lesions and correct site rotation will help prevent them; effective long-term therapy with insulin is critically dependent on addressing psychological hurdles upstream, even before insulin has been started; inappropriate disposal of used sharps poses a risk of infection with blood-borne pathogens; and mitigation is possible with proper training, effective disposal strategies, and the use of safety devices. Adherence to these new recommendations should lead to more effective therapies, improved outcomes, and lower costs for patients with diabetes. (C) 2016 Mayo Foundation for Medical Education and Research.BD, a manufacturer of injecting devicesSCI(E)[email protected]

Heterogeneous Host Susceptibility Enhances Prevalence of Mixed-Genotype Micro-Parasite Infections

Dose response in micro-parasite infections is usually shallower than predicted by the independent action model, which assumes that each infectious unit has a probability of infection that is independent of the presence of other infectious units. Moreover, the prevalence of mixed-genotype infections was greater than predicted by this model. No probabilistic infection model has been proposed to account for the higher prevalence of mixed-genotype infections. We use model selection within a set of four alternative models to explain high prevalence of mixed-genotype infections in combination with a shallow dose response. These models contrast dependent versus independent action of micro-parasite infectious units, and homogeneous versus heterogeneous host susceptibility. We specifically consider a situation in which genome differences between genotypes are minimal, and highly unlikely to result in genotype-genotype interactions. Data on dose response and mixed-genotype infection prevalence were collected by challenging fifth instar Spodoptera exigua larvae with two genotypes of Autographa californica multicapsid nucleopolyhedrovirus (AcMNPV), differing only in a 100 bp PCR marker sequence. We show that an independent action model that includes heterogeneity in host susceptibility can explain both the shallow dose response and the high prevalence of mixed-genotype infections. Theoretical results indicate that variation in host susceptibility is inextricably linked to increased prevalence of mixed-genotype infections. We have shown, to our knowledge for the first time, how heterogeneity in host susceptibility affects mixed-genotype infection prevalence. No evidence was found that virions operate dependently. While it has been recognized that heterogeneity in host susceptibility must be included in models of micro-parasite transmission and epidemiology to account for dose response, here we show that heterogeneity in susceptibility is also a fundamental principle explaining patterns of pathogen genetic diversity among hosts in a population. This principle has potentially wide implications for the monitoring, modeling and management of infectious diseases

Capacity Building Needs of Rural Areas in Virginia

To assess the capacity building needs of rural areas brought on both by internal demands of local citizens for improvements in community assistance and services and demands placed on local communities by higher levels of government, information and data were obtained from personal interviews with 93 local officials and 344 community leaders in 8 rural areas of Virginia in 1977. Major community needs were found to exist in engineering and public works, industrial development, recreation, education, health and welfare, housing, and planning. The five major capacity building needs were fiscal, staffing, planning, citizen participation, and inter-governmental coordination. Lack of adequate finances was a major capacity gap uncovered in all communities. Rural local governments were being called upon to handle assignments that required an increasingly higher degree of staff professionalism. Although comprehensive plans had been developed in rural communities, such plans were not widely followed in making decisions. Because financial and personnel resources were limited, rural local governments relied heavily on citizen volunteers. To retain rural government viability in program activities requiring large capital investments, specialized expertise, and area-wide planning, increased attention was being given to pooling of available resources. Recommendations are included for each of the identified gaps

Capacity Building Needs of Rural Areas in Virginia

To assess the capacity building needs of rural areas brought on both by internal demands of local citizens for improvements in community assistance and services and demands placed on local communities by higher levels of government, information and data were obtained from personal interviews with 93 local officials and 344 community leaders in 8 rural areas of Virginia in 1977. Major community needs were found to exist in engineering and public works, industrial development, recreation, education, health and welfare, housing, and planning. The five major capacity building needs were fiscal, staffing, planning, citizen participation, and inter-governmental coordination. Lack of adequate finances was a major capacity gap uncovered in all communities. Rural local governments were being called upon to handle assignments that required an increasingly higher degree of staff professionalism. Although comprehensive plans had been developed in rural communities, such plans were not widely followed in making decisions. Because financial and personnel resources were limited, rural local governments relied heavily on citizen volunteers. To retain rural government viability in program activities requiring large capital investments, specialized expertise, and area-wide planning, increased attention was being given to pooling of available resources. Recommendations are included for each of the identified gaps