Reflectance Meter Research Articles

Evolution of blood glucose self-monitoring technology

In 1838 G. Rees, a doctor from London (Guy's Hospital), for the first time isolated excess sugar from the blood serum of a patient with diabetes mellitus. Diagnosis of diabetes mellitus gradually developed. The next step was the understanding that regular monitoring of glucose levels by the patient himself is an integral part of diabetes mellitus therapy. The starting point of the technology for self-monitoring of diabetes mellitus was the determination of the sugar content in urine using chemical reactions. The method had no great clinical significance, it only indicated a progressive disease. The first Dextrostix blood glucose test strip (Ames-Mile's laboratories) was introduced in 1964. In 1970, the first automated blood glucose analysis system, the Ames Reflectance Meter (ARM), was created. Over time, the technology has been improved, accuracy, visibility, comfort, and an individual approach to glucometry have been formed. A new chapter was the development of remote technologies and the possibility of remote monitoring. More advanced data processing is now available in tabular and graphical form, with the calculation of 7-, 14-, 30-, and 90-day average glycemic values. A promising direction is the introduction of artificial intelligence in the management of diabetes mellitus.

Instrumental Variable Analysis of Racial Discrimination and Blood Pressure in a Sample of Young Adults.

Racial inequities in blood pressure levels have been extensively documented. Experiences of racial discrimination could explain some of this disparity, although findings from previous studies have been inconsistent. To address limitations of prior literature, including measurement error, we implemented instrumental variable analysis to assess the relationship between racial discrimination in institutional settings and blood pressure. Using data from 3,876 Black and White adults with an average age of 32 years from examination 4 (1992-1993) of the Coronary Artery Risk Development in Young Adults Study, our primary analysis examined the relationship between self-reported experiences of racial discrimination in institutional settings and blood pressure using reflectance meter measurement of skin color as an instrument. Findings suggested that an increase in experiences of racial discrimination was associated with higher systolic and diastolic blood pressure (β=2.23 mm Hg (95% confidence interval: 1.85, 2.61) and β=1.31 (95% confidence interval: 1.00, 1.62), respectively). Our instrumental variable estimates suggest that experiences of racial discrimination within institutional settings contribute to racial inequities in elevated blood pressure and cardiovascular disease outcomes in a relatively young cohort of adults and may yield clinically relevant differences in cardiovascular health over the life course.

Characterization of a Novel Approach for Neonatal Hematocrit Screening Based on Penetration Velocity in Lateral Flow Test Strip.

Hematocrit (HCT) is a crucial parameter for both adult and pediatric patients, indicating potentially severe pathological conditions. Most common methods for HCT assessment are microhematocrit and automated analyzers; however, developing countries present specific needs often not addressed by these technologies. Paper-based devices can be suitable for those environments being inexpensive, rapid, easy to use, and portable. The aim of this study is to describe and validate against a reference method, a novel HCT estimation method based on penetration velocity in lateral flow test strips complying with the requirements in low- or middle-income country (LMIC) scenarios. To calibrate and test the proposed method, 145 blood samples of 105 healthy neonates with gestational age greater than 37 weeks were collected (29 calibration set, 116 test set) in the range of HCT values (31.6-72.5%). The time difference (Δt) from the whole blood sample loading into the test strip instant till the nitrocellulose membrane saturation instant was measured by a reflectance meter. A nonlinear relation was observed between HCT and Δt and was estimated by a third-degree polynomial equation (R2 = 0.91) valid in 30% to 70% HCT interval. The proposed model was subsequently used to estimate HCT values on the test set showing a good agreement between the estimated HCT and the HCT measured by the reference method (r = 0.87, p < 0.001), with a low mean difference of 0.53 ± 5.04% and a slight trend of overestimation for higher hematocrit values. The mean absolute error was 4.29%, while the maximum absolute error was 10.69%. Although the proposed method did not present a sufficient accuracy to be used for diagnostic purposes, it could be suitable as a fast, low-cost, easy-to-use screening tool especially in LMIC scenarios.

Prevalenceof diabetes mellitus among Bahrainis attending primary health care centres

A sample of 573 subjects from a Bahraini population aged 20 years and above was randomly selected from persons attending four health centres. The capillary blood glucose level was measured with reflectance meter 2 hours after administering 75 g oral glucose in people with negative history for diabetes. An alarmingly high prevalence of total glucose intolerance was found. The observed prevalence rate of diabetes mellitus was 25.5%, with a further 14.7% prevalence for glucose intolerance. Hypertension and positive family history of diabetes among diabetic subjects were 27.6% and 41.7%, respectively, and mean body mass index was 27.9 +/- 5.2. Effective primary prevention strategies are needed, to be intensified among high risk groups. Awareness of the disease needs to be promoted

Comparison of Trimble GreenSeeker and Crop Circle (Model ACS-210) Reflectance Meters for Assessment of Severity of Late Leaf Spot

ABSTRACT Four field experiments conducted in 2015 were used to examine the relationships among normalized difference vegetation index (NDVI) measurements from two canopy crop sensors and visual estimates of defoliation by late leaf spot (Nothopassalora personata) of peanut (Arachis hypogaea) the predominant foliar disease in this study. For each evaluation, reflectance was measured with each the two meters, and leaf spot severity was measured visually within as short a time as possible. Linear and quadratic regression models were used to characterize the relationships between percent defoliation from late leaf spot and NDVI measured with the GreenSeeker (NDVIGS) and Crop Circle (NDVICC) instruments and the relationships between NDVIGS and NDVICC. NDVIGS decreased with increasing percent defoliation according to linear or quadratic functions in three of the four trials, NDVICC decreased with increasing percent defoliation according to linear functions in three of four trials. In two of the four trials, NDVICC increased with increasing NDVIGS according to quadratic functions, but there was no significant regression for those variables in two trials. In three of the four trials, NDVICC linear regression had a better fit for predicting percent defoliation according to the coefficient of determination (R2). There was no indication for either instrument that the same NDVI reading corresponded with the same level of defoliation across trials. Results indicated that NDVI measurements from the two instruments are not interchangeable.

A flow-through cell counting assay for point-of-care enumeration of CD4 T-cells

CD4 T-cell count is a priority for staging HIV disease and guiding clinical management as part of HIV care. Conventional CD4 T-cell enumeration methods based on flow cytometry are expensive, require well-trained personnel, and are challenging to use in rural, resource-scarce areas. A simple CD4 T-cell count test that can be used at point-of care, the Flow-Through cell Counting Assay (FTCA), is described in this article. The FTCA is based on the use of: 1) a special membrane that selectively retains white blood cells (WBCs); 2) a sample delivery system; and 3) optical signal detection. To show the feasibility of the FTCA, a proof-of-concept prototype of the FTCA cassette and digital camera or handheld reflectance meter were used for obtaining quantitative assay results within 30 min. The results show that the FTCA allows for quantitative enumeration of CD4 T-cells in the clinically relevant range of CD4 T-cell concentrations. The advantages of the FTCA technology, including simplicity, short analysis time, and portability, suggest that FTCA has great potential for use in clinical practice and wide applicability for other cell-based diagnostic tests.

Use of Beef Collagen in Beef Hot Dogs

ObjectivesThe use of protein ingredients in meat products is becoming increasingly popular to increase protein levels, as a meat substitute due to its lower cost compared to meat, improve product texture, increase cook yields or to enhance final product flavor. Beef collagen comes from the corium layer of beef hides is an allergen-free, functional protein ingredient which can replace some or all of the traditional binders and other Group 2 protein ingredients like mustard (a declared allergen in Europe and Canada) in meat products. Beef collagen can also be used to replace meat to provide cost savings. Beef collagen is USDA/FSIS approved and listed on Directive 7120.1 for various comminuted meat products where binders are permitted not to exceed 3.5% of product formulation. The objective of this study was to evaluate quality characteristics of beef hot dogs by utilizing beef collagen with or without mustard flour as a Group 2 protein to maximize the added water.Materials and MethodsThree treatments of beef hot dogs were formulated: Control with 0.6% mustard flour (added water = 8.78), TRT 2: 0.6% mustard flour + 0.4% Beef collagen + 1.37% additional water (added water = 8.78), TRT 3: 1.01% Beef collagen + 2.83% additional water (added water = 10). Lean beef with 10% fat, salt, sodium phosphate, sodium nitrite, sodium erythorbate and half the water/ice were chopped in a bowl chopper to a temperature of 12°C. Beef with 50% fat, rest of the dry ingredients and the remaining water were added to the bowl chopper and chopped until the temperature reached 21°C. The emulsion was stuffed into a 22 mm diameter cellulose casings and cooked in a smokehouse to an internal temperature of 71.6°C. Hot dogs were stabilized using USDA Appendix B guidelines, peeled, vacuum packaged and stored in a cooler at 4°C for 120 d.Hot dogs were evaluated for cook yield by difference in weight before and after cooking, texture profile analysis (TPA) using a Texture Analyzer equipped with a 1-cm diameter stainless steel probe, with compression setting to 30% of hot dog of 2.54-cm height. TPA was measured on hot dogs that were warmed on a Model 12 Star Roller Grill set on medium heat for 15 min. Interior color (L, a, and b values) was measured using a handheld Hunterlab color reflectance meter equipped with a D65 Optical Sensor. Purge was measured by difference in weight of product and weight of liquid expelled in the package over 12 wk of refrigerated storage of vacuum packaged hot dogs. The study was replicated three times and statistical analysis was performed using ANOVA (P < 0.05) with StatView for Windows.ResultsCook yields were significantly (P < 0.05) higher for TRT 2 and TRT 3, compared to control. The hardness, gumminess and chewiness values were significantly (P < 0.05) higher for TRT 2, but not significantly (P > 0.05) different for TRT 3 compared to control. Hunterlab interior L values were significantly (P < 0.05) higher for the test treatments compared to the control. Hunterlab a and b values were not significantly (P > 0.05) different for any of the treatments. Purge was significantly (P < 0.05) lower for all test treatments compared to control over 12 wk of refrigerated storage of vacuum packaged hot dogs.ConclusionBeef collagen is an allergen-free functional Group 2 protein ingredient that can be used to replace other protein ingredients or meat to increase cook yields, reduced purge and improve texture in comminuted meat products.

Current State of Bedside Glucose Meter Testing.

As arguably the most measured analyte in clinical chemistry, glucose remains a topic of great discussion. The measurement of glucose is relatively straightforward and robust in the central laboratories, whereby glucose in plasma or serum and other body fluids is quantified using enzymatic-spectrophotemetric–based methods. At the bedside, glucose is most routinely assessed with handheld meters using test strips that measure whole blood glucose in an enzymatic-electrochemical manner. Test strip methods have come a long way since the early days; current generation glucose meters provide rapid measurement (<10 seconds) of glucose, in small volumes of whole blood (<10 μL), using a variety of specimen types (arterial, venous, capillary, and neonatal heel-stick whole blood). The operation of the device is purposefully designed to be intuitive and simple. Meter features such as operator management, wireless connectivity to the laboratory/hospital information system, and QC testing features are all important quality assurance parameters characteristic of today's hospital glucose meters. Historically, glucose meter testing did not start in the hospital; it started in physicians' offices around 1970 with the Ames Reflectance Meter. Over time, the glucose meter evolved in both design and technology, finding its way into the hands of patients, quickly becoming a very useful tool for the self-management of diabetes. Eventually, these glucose meters migrated into …

Use of Dehydrated Pork Stock as a Group 2 Protein in Hot Dogs

ObjectivesProtein ingredients are primarily used in meat products to decrease formulation costs, improve product texture, increase cook yield or enhance product flavor. In 2010, dehydrated pork stock was approved by the USDA in comminuted and whole muscle meat products such as, sausages, meatballs, meatloaf, meat patties and hams. Dehydrated pork stock is an allergen-free, functional ingredient which can replace some or all of the traditional binders and allergens in meat products. Dehydrated pork stock can be used to replace lean meat to provide cost savings. The collagen enriched dehydrated pork stock contains over 90% protein which can be used to contribute 1% Group 2 protein in cooked sausages to maximize the added water. The objective of this study was to evaluate quality characteristics of hot dogs by utilizing dehydrated pork stock to maximize Group 2 protein to maximize the added water.Materials and MethodsThree treatments of pork and beef hot dogs were formulated: Control (fat plus added water = 35), Trt. 2: 1.07% Dehydrated pork stock + 3.5% additional water (fat + added water = 35), Trt. 3: 1.07% Dehydrated pork stock + 8.03% additional water (fat = added water = 40). Pork 72 trim, salt, sodium phosphate, sodium erythorbate and sodium nitrite and half the water/ice was chopped in a bowl chopper to a temperature of 11C. The Pork 42 trim and Beef 50 trim, rest of the dry ingredients and the remaining water was added to the bowl chopper and chopped until the temperature reached 18C. The emulsion was stuffed into a 22 mm diameter cellulose casing and cooked in a smokehouse to an internal temperature of 71.6C. The hot dogs were chilled following USDA Appendix B guidelines, peeled, vacuum packaged and stored in a cooler at 4C.Hot dogs were evaluated for cook yield by difference in weight before cooking/chilling. Texture profile analysis (TPA) was done using a Texture Analyzer equipped with a 1-cm stainless steel cylindrical probe set to 30% compression of 2.54-cm height of the product. The TPA was measured on hot dogs that were heated for 15 min on a Model 12 Star Roller Grill set on medium heat. Interior color was measured using a handheld Hunterlab color reflectance meter set to a D65 light source. Freeze-thaw purge was measured by difference in weight of the hot dogs after one freeze–thaw cycle. The study was replicated three times and statistical analysis was performed using ANOVA (P < 0.05) with StatView for Windows on 3 replications.ResultsCook yields were significantly (P < 0.05) higher for Trt. 2 compared to the control. The hardness, gumminess and chewiness values were significantly (P < 0.05) higher for Trt. 2, but not significantly (P > 0.05) different for Trt. 3 compared to the control. Hunterlab interior color (L, a and b values) were not significantly (P > 0.05) different for any of the treatments. Freeze-thaw purge was significantly (P < 0.05) lower for both test treatments compared to the control.ConclusionDehydrated pork stock is a cost-effective, functional, allergen-free Group 2 protein which can be used in hot dogs to increase cook yields, reduce purge and improve texture while providing significant cost savings. This ingredient is not considered a “binder” by USDA hence meat processors are able to make “no binder no filler” claims.

Polyelectrolyte Complex Formation between Cationic Fixing Agent and Dissolved Substances in Papermaking

Dissolved substances (DS) in papermaking suspension contribute a large portion of negativity to the total dissolved and colloidal substances (DCS). Compared to colloidal substances (CS), dissolved substances are clearly more difficult to be removed by fixing agents (FA). Formation of polyelectrolyte complexes (PECs) between fixing agents and dissolved substances plays a very important role in clarifying the mechanism of a fixing agent acting on DCS. This study, therefore, focused on the characteristics of PECs formed between fixing agents and dissolved substances. Three polyamines (PA) with different molecular weight and slight different charge density were synthesized and used as fixing agents, in four different kinds of water including, two kinds of DCS water separated from a same deinked pulp (DIP) but with different size and distribution of CS particles, and two kinds of DS water modeled by oxidized starch (OS) and hemicelluloses (HC). The formation of PEC in these systems and their corresponding characteristics were characterized using focused beam reflectance meter (FBRM), laser particle size analyzer (LPSA), turbidity meter, and charge detection. From the results, it is concluded that for a given DS component and a certain kind of fixing agent, the formation of DSfixing agent PECs highly depended on the molecular weight of the fixing agent and its dosage. A fixing agent with enough low molecular weight could form big but loose and dispersible DS-FA PECs, increasing its dosage would produce denser and smaller PECs; and a fixing agent with enough high molecular weight could directly form dense PECs, increasing its dosage increased the size of PECs. Depositing DS-FA PECs onto small CS particles also played an important role in forming new CS particles with larger sizes, and in this case, a fixing agent with higher molecular weight tended to produce more large particles.

Foliar N Concentration and Reflectance Meters to Guide N Fertilization for Anthracnose Management of Annual Bluegrass Putting Green Turf

Site‐specific management using objective assays to determine N requirement based on canopy reflectance could improve current recommendations for cultural control of anthracnose (Colletotrichum cereale Manns sensu lato Crouch, Clarke, and Hillman). The objectives of this study were to determine the relationships among foliar sap nitrate–nitrogen (NO3–N) concentrations, canopy reflectance indices (normalized difference vegetation index [NDVI] and chlorophyll index [CI]), foliar total N concentrations, and N rate on anthracnose severity in annual bluegrass (ABG), Poa annua L. f. reptans (Hausskn) T. Koyama. A 2‐yr field study was conducted on ABG putting green turf in Storrs, CT. Nitrogen treatments were applied as urea at 0.0 to 36.8 kg ha−1 every 14 d in spring and summer of 2011 to 2012. Anthracnose severity declined linearly with increasing biweekly N rate from 0 kg ha−1 up to the estimated critical level of 12.8 kg ha−1. A minimum critical foliar N concentration of 33.5 g kg−1 maintained anthracnose at ≤32% plot area. Canopy reflectance indices were correlated with foliar N concentration. Anthracnose severity decreased linearly as relative NDVI and relative CI increased. Maintaining relative NDVI between 0.94 to 0.98 through N fertility alone would provide a ∼76 to 93% probability of maintaining ≤32% turf area infested, or relative CI range of 0.73 to 0.93 had the same result ∼40 to 98% of the time.

Stick it to me

Stick it to me

Light protection of the skin after photodynamic therapy reduces inflammation: an unblinded randomized controlled study

Photodynamic therapy (PDT) is followed by significant inflammation. Protoporphyrin (Pp)IX is still formed in the skin after PDT and patients are sensitive to daylight 24-48 h after treatment. Exposure to daylight after PDT may therefore increase inflammation. To investigate whether protection with inorganic sunscreen, foundation or light-blocking plaster after PDT can reduce inflammation caused by daylight-activated PpIX. On the right arm of 15 subjects with sun-damaged skin, four identical squares (3 × 3 cm) were given conventional PDT treatment. Immediately after red-light illumination the squares were either left unprotected or protected by inorganic sunscreen [sun protection factor (SPF) 50], foundation (SPF50) or light-blocking plaster. The skin was then illuminated with artificial daylight for 2 h and afterwards covered for 24 h. Fluorescence and erythema (inflammation) were measured with a fluorescence camera and a reflectance meter. PpIX was significantly reduced after artificial daylight illumination (P < 0·0004), except on the square protected with light-blocking silver plaster, where it had increased (P = 0·09). The increased erythema 24 h after treatment was reduced by 19% with the sunscreen (P = 0·29), by 27% with the foundation (P = 0·10) and by 44% with the silver plaster (P = 0·002). Artificial daylight exposure after conventional PDT increases skin erythema. Light-blocking plaster gives more effective protection against post-PDT daylight exposure than inorganic sunscreen and foundation. In practice such full protection can be achieved by use of sun-blocking clothes or daylight avoidance for 24 h.

Good agreement between minimal erythema dose test reactions and objective measurements: an in vivo study of human skin

The erythema resulting from the minimal erythema dose (MED) test is subjectively assessed. The evaluator visually grades erythema on an ordinal scale. Both intra- and interobserver variation have been found for this erythema assessment. We wanted to examine if objective measurements could be used to confirm the subjective finding. One hundred two ultraviolet radiation (UVR)-exposed skin sites on the backs of 17 healthy volunteers were assessed. Erythema was visually graded according to a 5-point scale [0, (+), 1+, 2+, 3+] and objectively measured by a skin reflectance meter. Skin water content was objectively measured by tissue dielectric constant measurements. The relationship between subjective assessments and objective measurements of erythema was found to be linear (R(2) = 0.482, P < 0.0001). A positive correlation was found between subjective assessments of erythema and objective measurements of water content (Spearman's Rho = 0.414, P < 0.0001). Water content in categories 2+ and 3+ of the subjective erythema assessments differed significantly from the lesser categories (P < 0.0001). A linear relationship was found between the objective measurements of erythema and water content (R(2) = 0.241, P < 0.0001). Objective measurements of skin erythema and water content after UV exposure were in good agreement with the subjective assessments of erythema, but showed considerable interpersonal variation.

Development of Tea Whitener Using Concentrated Whey and Milk Solids

Whey and toned milk was effectively used for the development of tea whitener. Cheese whey was concentrated to 12% solids in a vacuum evaporator, pasteurized at 72℃±2℃ for 15 s, diluted back to 11.5% solids and was cold blended with toned milk of 11.5% solids in three ratios viz. 25:75, 50:50 and 75:25 and selected blends were homogenized at 1200-1500 psi. Tea was prepared by adding 80 mL whitener to 100 mL decoction and addition of sugar at 8% (w/v). The tea whitener was selected based on the sensory attributes of tea beverages. The colour of the beverages, tea whiteners and decoction were analyzed by reflectance meter and computer vision image analysis technique. The viscosity of the beverage was tested using a Brookfield viscometer. Coffee stability test was done to assess the stability of tea whitener under acidic conditions. Standard plate count, Coliform count and Presumptive Coliform test were done to assess the microbiological quality of the whitener. Homogenization had a positive impact on the viscosity and colour. The reflectance value of tea prepared from 25% homogenised whey milk blend and toned milk were in the range of 43-46 and 45-49, respectively. The viscosity of tea was found to increase with homogenization and whey levels. The sedimentation values of 25% whey blends and toned milk were 1.25 mL and 1 mL respectively. The shelf life of the blends was 2 days under refrigerated conditions. It can be concluded that a satisfactory tea whitener can be prepared by blending whey with toned milk in 25:75 proportion followed by homogenization.

The Measurements of Spectral Reflectance Spatial Distribution on Mc-Si Solar Cell Surface

Measurement results of spectral reflectance spatial distribution on multi-crystalline silicon solar cells surface are presented. The optical measurement apparatus employs a specific designed micro-spectral reflectance meter. It is suitable for working in visible wavelength range; measurable sample size can be as small as 0.06mm. Results of reflectance distribution on mc-Si solar cell are presented as a spatial sampling interval of 0.1 mm. The peak values of spectral reflectance appear about 400nm wavelength and vary from 10% to 30% with the spatial position on solar cell.

Satellite-based herbicide rate recommendation for potato haulm killing

When using variable-rate application (VRA), tractor-mounted sensors are typically used to measure crop status. Crop status can also be measured with a satellite-based sensor. In both cases a vegetation index derived from the sensor measurements is used as an indicator of the amount of crop biomass. The first objective of this study was to establish a relationship between the Weighted Difference Vegetation Index (WDVI) in potato as measured with a nearby, ground-based crop reflectance meter on the one hand and WDVI as measured with remote, satellite-based sensors on the other hand. It was found that ground-based WDVI and satellite-based WDVI are strongly and linearly related, thus making it feasible to calculate herbicide rates for potato haulm killing on the basis of satellite-based measurements. The scale at which VRA is applied is an important determinant of the reduction in input use. The second objective was to estimate the potential to reduce herbicide use for potato haulm killing as a function of the size of decision units, using the above-mentioned relationship, satellite imagery of 13 potato fields and a previously developed decision rule for herbicide rate. It was found that when the size of the decision unit was 15m×15m (the size of an ASTER pixel), a reduction in herbicide use of at least 50% would be achieved in one out of every two of the fields, and a reduction of at least 33% would be achieved in all fields. When the size of the decision unit was 30m×30m, a reduction of at least 33% would be achieved in one out of every two of the fields. In conclusion, satellite-based crop reflectance measurements can be used instead of ground-based measurements for determining herbicide rate for potato haulm killing. When the size of the decision unit is not larger than 30m×30m, a 50% reduction in herbicide use for potato haulm killing can be achieved with VRA.

Self-monitoring of blood glucose in patients with type 2 diabetes mellitus who are not using insulin

Self-monitoring of blood glucose (SMBG) has been found to be effective for patients with type 1 diabetes and for patients with type 2 diabetes using insulin. There is much debate on the effectiveness of SMBG as a tool in the self-management for patients with type 2 diabetes who are not using insulin. To assess the effects of SMBG in patients with type 2 diabetes mellitus who are not using insulin. Multiple electronic bibliographic and ongoing trial databases were searched supplemented with handsearches of references of retrieved articles (date of last search: 07 July 2011). Randomised controlled trials investigating the effects of SMBG compared with usual care, self-monitoring of urine glucose (SMUG) or both in patients with type 2 diabetes who where not using insulin. Studies that used glycosylated haemoglobin A(1c) (HbA(1c)) as primary outcome were eligible for inclusion. Two authors independently extracted data from included studies and evaluated the studies' risk of bias. Data from the studies were compared to decide whether they were sufficiently homogeneous to pool in a meta-analysis. Primary outcomes were HbA(1c), health-related quality of life, well-being and patient satisfaction. Secondary outcomes were fasting plasma glucose level, hypoglycaemic episodes, morbidity, adverse effects and costs. Twelve randomised controlled trials were included and evaluated outcomes in 3259 randomised patients. Intervention duration ranged from 6 months (26 weeks) to 12 months (52 weeks). Nine trials compared SMBG with usual care without monitoring, one study compared SMBG with SMUG, one study was a three-armed trial comparing SMBG and SMUG with usual care and one study was a three-armed trial comparing less intensive SMBG and more intensive SMBG with a control group. Seven out of 11 studies had a low risk of bias for most indicators. Meta-analysis of studies including patients with a diabetes duration of one year or more showed a statistically significant SMBG induced decrease in HbA(1c) at up to six months follow-up (-0.3; 95% confidence interval (CI) -0.4 to -0.1; 2324 participants, nine trials), yet an overall statistically non-significant SMBG induced decrease was seen at 12 month follow-up (-0.1; 95% CI -0.3 to 0.04; 493 participants, two trials). Qualitative analysis of the effect of SMBG on well-being and quality of life showed no effect on patient satisfaction, general well-being or general health-related quality of life. Two trials reported costs of self-monitoring: One trial compared the costs of self-monitoring of blood glucose with self-monitoring of urine glucose based on nine measurements per week and with the prices in US dollars for self-monitoring in 1990. Authors concluded that total costs in the first year of self-monitoring of blood glucose, with the purchase of a reflectance meter were 12 times more expensive than self-monitoring of urine glucose ($481 or 361 EURO [11/2011 conversion] versus $40 or 30 EURO [11/2011 conversion]). Another trial reported a full economical evaluation of the costs and effects of self-monitoring. At the end of the trial, costs for the intervention were £89 (104 EURO [11/2011 conversion]) for standardized usual care (control group), £181 (212 EURO [11/2011 conversion]) for the less intensive self-monitoring group and £173 (203 EURO [11/2011 conversion]) for the more intensive self-monitoring group. Higher losses to follow-up in the more intensive self-monitoring group were responsible for the difference in costs, compared to the less intensive self-monitoring group.There were few data on the effects on other outcomes and these effects were not statistically significant. None of the studies reported data on morbidity. From this review, we conclude that when diabetes duration is over one year, the overall effect of self-monitoring of blood glucose on glycaemic control in patients with type 2 diabetes who are not using insulin is small up to six months after initiation and subsides after 12 months. Furthermore, based on a best-evidence synthesis, there is no evidence that SMBG affects patient satisfaction, general well-being or general health-related quality of life. More research is needed to explore the psychological impact of SMBG and its impact on diabetes specific quality of life and well-being, as well as the impact of SMBG on hypoglycaemia and diabetic complications.

Nitrogen remote diagnosis in a creeping bentgrass golf green

Nitrogen fertilization is a key factor of the aesthetics and playability for golf greens. Nitrogen fertilization management is based on predetermined scheduled applications, set rates, or expected improvement in visual quality and green speed. As a consequence, the objective of this study was to obtain seasonal N application models (algorithms) based on remote sensing, optimizing playability and aesthetic quality. A 3-yr field study under Mediterranean conditions was conducted on an experimental ‘L-93’ creeping bentgrass ( Agrostis stolonifera L.) USGA green, to examine effects of seasonal N fertilizer rates on color, clipping yields, and ball roll (green speed). The remote sensors used were a digital camera and reflectance meter (FieldScout CM1000 Chlorophyll Meter). From digital photographs, a dark green color index (DGCI) was calculated. All data were normalized (relative). For all seasons, a third-order polynomial response model was the best when using a CM1000 and a digital camera. Clipping yields and ball roll regressions were linear, increasing and decreasing when the N fertilizer rate increased, respectively. Ball roll and clipping relative values were correlated with both sensors. To fit a seasonal optimum N fertilizer rate model as a function of remote sensors and the other measured parameters, the intersection of models obtained from relative values of CM1000 and digital camera with ball roll and clipping was calculated, but ball roll was considered the most suitable. The model of the digital camera with automatic settings was less accurate and underestimated the optimum N rate. However, because the actual values of digital camera and CM1000 were correlated, converting DGCI values and applying CM1000 models enabled the obtaining of practically the same N fertilizer applications. A practical application procedure of these seasonal models for an entire golf course was also shown. Actual N recommendation applications with a quick remote diagnosis (CM1000) for creeping bentgrass golf green are feasible under similar management practices in Mediterranean environments. A digital camera can also be used successfully, but it should be better when its analysis is based on CM1000 models.

Characterizing maternal glycemic control: a more informative approach using semiparametric regression

Objective: To characterize glucose concentrations measured throughout pregnancy in women with type 1 diabetes using semiparametric regression analysis to examine the gestational time-specific association with fetal outcome. Methods: We conducted a secondary analysis of data from an interdisciplinary program of diabetes in pregnancy of women with type 1 diabetes. Semiparametric regression was used to characterize glucose concentrations measured using reflectance meters throughout pregnancy by examining the time-specific association of maternal glucose with delivery of a large for gestational age (LGA) baby. Results: The optimal model demonstrated that time-specific differences in glycemic profiles of mothers who had LGA versus AGA babies changed at various rates across gestation (p = 0.0007). AGA glucose profiles exceeded LGA profiles in the first trimester and mid pregnancy; conversely LGA glucose profiles exceeded AGA profiles initially during the third trimester. Differences were based on examination of 95% simultaneous confidence bands. Conclusions: Semiparametric regression techniques enabled synchronous inclusion of all glucose concentrations using multi-step modeling. We identified specific periods of gestation where maternal glucose concentrations differ for the LGA and AGA developing fetus, with greatest distinctions appearing in first and third trimesters. Novel statistical approaches that examine time-specific behavior garner insight into longitudinal assessment of maternal glycemic control.