A randomised, controlled trial of the effects of a mobile telehealth intervention on clinical and patient-reported outcomes in people with poorly controlled diabetes

Objective The objective of this research is to determine the effects of mobile telehealth (MTH) on glycosylated haemoglobin (HbA1c) and other clinical and patient-reported outcomes in insulin-requiring people with diabetes. Methods A nine-month randomised, controlled trial compared standard care to standard care supplemented with MTH (self-monitoring, mobile-phone data transmissions, graphical and nurse-initiated feedback, and educational calls). Clinical (HbA1c, blood pressure, daily insulin dose, diabetes outpatient appointments (DOAs)) and questionnaire data (health-related quality of life, depression, anxiety) were collected. Mean group changes over time were compared using hierarchical linear models and Mann-Whitney tests. Results Eighty-one participants with a baseline HbA1c of 8.98% ± 1.82 were randomised to the intervention ( n = 45) and standard care ( n = 36). The Group by Time effect revealed MTH did not significantly influence HbA1c ( p = 0.228), but p values were borderline significant for blood pressure ( p = 0.054) and mental-health related quality of life ( p = 0.057). Examination of effect sizes and 95% confidence intervals for mean group differences at nine months supported the existence of a protective effect of MTH on mental health-related quality of life as well as depression. None of the other measured outcomes were found to be affected by the MTH intervention. Conclusions Findings from this study must be interpreted with caution given the small sample size, but they do not support the widespread adoption of MTH to achieve clinically significant changes in HbA1c. MTH may, however, have positive effects on blood pressure and protective effects on some aspects of mental health

Challenges in Patient Recruitment, Implementation, and Fidelity in a Mobile Telehealth Study

Introduction: Mobile telehealth (MTH) evaluations in diabetes have been conducted, but few report details and issues related to recruitment, implementation (intervention delivery), fidelity, and context. These have important implications on the interpretation of the findings and effectiveness of the intervention. This article reports these data from an MTH study and describes the challenges experienced in running an intervention such as this in an active clinical environment. Materials and Methods: We conducted a mixed-methods MTH study that included a 9-month randomized controlled trial in people with poorly controlled diabetes. Detailed recruitment data were recorded during the study. Data on contacts between MTH participants and the MTH team were collected and used to report on intervention delivery and fidelity. Meeting and field notes, as well as communications between research team members during the study, were used to report on the contextual factors that affected recruitment, implementation, and fidelity. Results: The recruited sample size represented 6% of the total clinic population (n = 1,360) and 10.7% of the number of potentially eligible people at the clinic (n = 802) identified at the beginning of the study. Contextual factors related to patients, healthcare providers, the institution, or the recruitment protocol contributed to influence access to study participants and the number of participants randomized (n = 81). Technical and device-related aspects of the MTH intervention were delivered successfully, but the expected education and clinical feedback by the MTH nurse were not delivered according to the protocol. Although 92.5% of introductory calls were made by the MTH nurses, only 13.3% of expected educational calls were performed. Changes to the MTH nursing staff affected intervention participants differently and contributed to the low fidelity of intervention delivery. Conclusions: The current article presents data on the influence of contextual factors on the conduct of this MTH study and underlines the need for these processes to be assessed and reported adequately in future MTH research

Quality assessment of ground-based microwave measurements of chlorine monoxide, ozone, and nitrogen dioxide from the NDSC radiometer at the Plateau de Bure

A ground-based microwave radiometer dedicated to chlorine monoxide (ClO) measurements around 278GHz has been in operation from December 1993-June 1996 at the Plateau de Bure, France (45° N, 5.9° E, 2500m altitude). It belongs to the international Network for the Detection of Stratospheric Change. A detailed study of both measurements and retrieval schemes has been undertaken. Although dedicated to the measurements of ClO, simultaneous profiles of O<sub>3</sub>, ClO and NO<sub>2</sub>, together with information about the instrumental baseline, have been retrieved using the optimal estimation method. The vertical profiles have been compared with other ground-based microwave data, satellite-borne data and model results. Data quality shows: 1) the weak sensitivity of the instrument that obliges to make time averages over several hours; 2) the site location where measurements of good opacities are possible for only a few days per year; 3) the baseline undulation affecting all the spectra, an issue common to all the microwave instruments; 4) the slow drift of some components affecting frequencies by 3-4MHz within a couple of months. Nevertheless, when temporally averaging data over a few days, ClO temporal variations (diurnal and over several weeks in winter 1995) from 35-50km are consistent with model results and satellite data, particularly at the peak altitude around 40km, although temporal coincidences are infrequent in winter 1995. In addition to ClO, it is possible to obtain O<sub>3</sub> information from 30-60km whilst the instrument is not optimized at all for this molecule. Retrievals of O<sub>3</sub> are reasonable when compared with model and another ground-based data set, although the lowermost layers are affected by the contamination of baseline remnants. Monthly-averaged diurnal variations of NO<sub>2</sub> are detected at 40km and appear in agreement with photochemical model results and satellite zonally-averaged data, although the amplitude is weaker than the other data sets. This NO<sub>2</sub> result highlights the great potential of the retrieval scheme used

A new hard-particle model for anisotropic fluids

We report a new hard-particle model system consisting of hard cylinders, we have determined the geometrical conditions that let us know whether or not two given cylinders overlap. In addition we have carried out Monte Carlo simulations sampling the canonical ensemble on this system, the numerical results indicate that this system exhibits mesomorphic behaviour

High frequency dynamics in a monatomic glass

The high frequency dynamics of glassy Selenium has been studied by Inelastic X-ray Scattering at beamline BL35XU (SPring-8). The high quality of the data allows one to pinpoint the existence of a dispersing acoustic mode for wavevectors ($Q$) of $1.5<Q<12.5$ nm$^{-1}$, helping to clarify a previous contradiction between experimental and numerical results. The sound velocity shows a positive dispersion, exceeding the hydrodynamic value by $\approx$ 10% at $Q<3.5$ nm$^{-1}$. The $Q^2$ dependence of the sound attenuation $\Gamma(Q)$, reported for other glasses, is found to be the low-$Q$ limit of a more general $\Gamma(Q) \propto \Omega(Q)^2$ law which applies also to the higher $Q$ region, where $\Omega(Q)\propto Q$ no longer holds.Comment: Phys. Rev. Lett. (Accepted

The impact of mobile monitoring technologies on glycosylated hemoglobin in diabetes: a systematic review

Background: A new development in the field of telehealth is the use of mobile health technologies (mhealth) to help patients record and track medical information. Mhealth appears particularly advantageous for conditions that require intense and ongoing monitoring, such as diabetes, and where people are of working age and not disabled. This review aims to evaluate the evidence for the effectiveness of mhealth interventions in diabetes management on glycosylated hemoglobin. Method: A comprehensive search strategy was developed and applied to eight electronic databases to identify studies that investigated the clinical effectiveness of mobile-based applications that allowed patients to record and send their blood glucose readings to a central server. The eligibility of 8543 papers was assessed against the selection criteria, and 24 papers were reviewed. All studies reviewed were assessed for quality using a standardized quality assessment tool. Results: Results for patients with type 1 and type 2 diabetes were examined separately. Study variability and poor reporting made comparison difficult, and most studies had important methodological weaknesses. Evidence on the effectiveness of mhealth interventions for diabetes was inconsistent for both types of diabetes and remains weak

Materials on dies for pressure die casting

In the contribution the stress of die materials of thermal fatigue is defi ned and material life is derived theoretically and compared with the measured values. The important properties of the die materials as thermal conductivity, coeffi cient of thermal expansivity, modulus of elasticity and mechanical properties are described. Binding to it single die materials as carbon steels and chrome-tungsten steels are analyzed. As the perspective die material for pressure die casting of ferrous metals appears molybdenum with regard to advantageous properties

Analytic Inversion of Emission Lines of Arbitrary Optical Depth for the Structure of Supernova Ejecta

We derive a method for inverting emission line profiles formed in supernova ejecta. The derivation assumes spherical symmetry and homologous expansion (i.e., $v(r) \propto r$), is analytic, and even takes account of occultation by a pseudo-photosphere. Previous inversion methods have been developed which are restricted to optically thin lines, but the particular case of homologous expansion permits an analytic result for lines of {\it arbitrary} optical depth. In fact, we show that the quantity that is generically retrieved is the run of line intensity $I_\lambda$ with radius in the ejecta. This result is quite general, and so could be applied to resonance lines, recombination lines, etc. As a specific example, we show how to derive the run of (Sobolev) optical depth $\tau_\lambda$ with radius in the case of a pure resonance scattering emission line.Comment: 6 pages, no figures, to appear in Astrophysical Journal Letters, requires aaspp4.sty to late

Dynamic of taking out molding parts at injection molding

Most plastic parts used in automobile production are manufactured by injection molding. Their quality depends also on taking out molding and on the manipulators for it. Task of this contribution is to theoretically describe a transport of molding at taking out after injection molding in relation on its regulation. The following quantities are derived at it: the transition characteristic of the taking out system, the blocking diagram of taking out molding regulation, the amplitude and phase characteristic and the transition characteristic of action quantity at taking out molding regulation