Management of acute and chronic iliofemoral venous outflow obstruction: a multidisciplinary team consensus.

The aim of this manuscript was to establish a consensus for the management of acute and chronic venous obstruction among specialists in the UK. Specialist physicians representing vascular surgery, interventional radiology and hematology were invited to 3 meetings to discuss management of acute and chronic iliofemoral obstruction. The meetings outlined controversial areas, included a topic-by-topic review; and on completion reached a consensus when greater than 80% agreement was reached on each topic. Physicians from 19 UK hospitals agreed on treatment protocols and highlighted areas that need development. Potential standard treatment algorithms were created. It was decided to establish a national registry of venous patients led by representatives from the treating multidisciplinary teams. Technical improvements have facilitated invasive treatment of patients with acute and chronic venous obstruction; however, the evidence guiding treatment is weak. Treatment should be conducted in centers with multi-disciplinary input; robust, coordinated data collection; and regular outcome analysis to ensure safe and effective treatment and a basis for future evolvement.

Dynamic Interactive Educational Diabetes Simulations Using the World Wide Web: An Experience of More Than 15 Years with AIDA Online.

Background. AIDA is a widely available downloadable educational simulator of glucose-insulin interaction in diabetes. Methods. A web-based version of AIDA was developed that utilises a server-based architecture with HTML FORM commands to submit numerical data from a web-browser client to a remote web server. AIDA online, located on a remote server, passes the received data through Perl scripts which interactively produce 24 hr insulin and glucose simulations. Results. AIDA online allows users to modify the insulin regimen and diet of 40 different prestored "virtual diabetic patients" on the internet or create new "patients" with user-generated regimens. Multiple simulations can be run, with graphical results viewed via a standard web-browser window. To date, over 637,500 diabetes simulations have been run at AIDA online, from all over the world. Conclusions. AIDA online's functionality is similar to the downloadable AIDA program, but the mode of implementation and usage is different. An advantage to utilising a server-based application is the flexibility that can be offered. New modules can be added quickly to the online simulator. This has facilitated the development of refinements to AIDA online, which have instantaneously become available around the world, with no further local downloads or installations being required.

Incorporating a generic model of subcutaneous insulin absorption into the AIDA v4 diabetes simulator. 3. Early plasma insulin determinations.

INTRODUCTION: AIDA is an interactive educational diabetes simulator that has been available without charge via the Internet for over 12 years. Recent articles have described the incorporation of a novel generic model of insulin absorption into AIDA as a way of enhancing its capabilities. The basic model components to be integrated have been overviewed, with the aim being to provide simulations of regimens utilizing insulin analogues, as well as insulin doses greater than 40 IU (the current upper limit within the latest release of AIDA [v4.3a]). Some preliminary calculated insulin absorption results have also recently been described. METHODS: This article presents the first simulated plasma insulin profiles from the integration of the generic subcutaneous insulin absorption model, and the currently implemented model in AIDA for insulin disposition. Insulin absorption has been described by the physiologically based model of Tarín and colleagues. A single compartment modeling approach has been used to specify how absorbed insulin is distributed in, and eliminated from, the human body. To enable a numerical solution of the absorption model, a spherical subcutaneous depot for the injected insulin dose has been assumed and spatially discretized into shell compartments with homogeneous concentrations, having as its center the injection site. The number of these compartments will depend on the dose and type of insulin. Insulin inflow arises as the sum of contributions to the different shells. For this report the first bench testing of plasma insulin determinations has been done. RESULTS: Simulated plasma insulin profiles are provided for currently available insulin preparations, including a rapidly acting insulin analogue (e.g., lispro/Humalog or aspart/Novolog), a short-acting (regular) insulin preparation (e.g., Actrapid), intermediate-acting insulins (both Semilente and neutral protamine Hagedorn types), and a very long-acting insulin analogue (e.g., glargine/Lantus), as well as for insulin doses up to 50 IU. DISCUSSION: The methodology to be adopted for implementing the generic absorption model within AIDA has been overviewed, and the first plasma insulin profiles based on this approach have been demonstrated. Ideas for future work and development are discussed. It is expected that an updated release of AIDA (v4.5), based on this collaborative approach, will become available for free--in due course--via the www.2aida.org Web site. Readers who wish to be informed when the new software is launched can join the very low volume AIDA announcement list by sending a blank email note to subscribe@2aida.org.

Incorporating a generic model of subcutaneous insulin absorption into the AIDA v4 diabetes simulator: 1. a prospective collaborative development plan.

INTRODUCTION: AIDA v4 is an interactive educational diabetes simulator that has been made available, for over a decade, without charge via the Internet. The software is currently freely accessible at http://www.2aida.org. This report sets out a collaborative development plan to enhance the program with a new model of subcutaneous insulin absorption, which permits the simulation of rapidly acting and very long-acting insulin analogues, as well as insulin injection doses larger than 40 units. METHODS: A novel, generic, physiological subcutaneous insulin absorption model is overviewed and a methodology is proposed by which this can be substituted in place of the previously adopted insulin absorption model utilized within AIDA v4.3a. Apart from this substitution it is proposed to retain the existing model of the glucoregulatory system currently used in AIDA v4.3a. RESULTS: Initial simulation results based on bench testing of this approach using MATLAB are presented for the exogenous insulin flow profile (I(ex)) following subcutaneous injections of a rapidly acting insulin analogue, a short-acting (regular) insulin preparation, intermediate-acting insulins (both Semilente and neutral protamine Hagedorn types), and a very long-acting insulin analogue. DISCUSSION: It is proposed to implement this collaborative development plan-first by bench testing the approach in MATLAB and then by integrating the generic subcutaneous insulin absorption I(ex) model into the AIDA simulator in Pascal. The aim is to provide enhanced functionality and educational simulations of regimens utilizing novel insulin analogues, as well as injections larger than 40 units of insulin.

Incorporating a generic model of subcutaneous insulin absorption into the AIDA v4 diabetes simulator: 2. preliminary bench testing.

BACKGROUND: The AIDA interactive educational diabetes simulator has been available without charge for over a decade via the Internet (see www.2aida.org). Part 1 of this report [J Diabetes Sci Technol. 2007;1(3):423-35] described the model components to be integrated to enhance the utility of the software, with the aim being to provide enhanced functionality and educational simulations of regimens utilizing insulin analogues, as well as insulin doses greater than 40 units. This report provides some preliminary subcutaneous insulin absorption bench testing results for the updated modeling prototype. METHODS: An analysis has been done of the spatial distribution of insulin in the region of the injection site for different classes of insulin preparations and times after the administration of a set insulin injection. Demonstrations of the proportion of residual insulin in depot versus time after a subcutaneous bolus have also been simulated for different insulin injection volumes and concentrations, as well as to show the proportions of hexameric, dimeric, and bound insulin over time after an injection. RESULTS: Some early bench testing results are highlighted following subcutaneous injections of a rapidly acting insulin analogue (such as lispro/Humalog or aspart/NovoLog), a short-acting (regular) insulin preparation (e.g., Actrapid), intermediate-acting insulins (both Semilente and neutral protamine Hagedorn types), and a very long-acting insulin analogue (such as glargine/Lantus). The transformation, dissociation/association, and absorption processes by which insulin moves from the subcutaneous injection site to the plasma are also illustrated. DISCUSSION: This report demonstrates how enhanced capabilities may be added to AIDA once a new model of subcutaneous insulin absorption is incorporated. The revised approach, once fully implemented, should permit the simulation of plasma insulin profiles for rapidly acting and very long-acting insulin analogues, as well as insulin injections greater than 40 units.

Teaching diabetes to Middle-School students with the www.2aida.net AIDA online diabetes software simulator.

INTRODUCTION: The lifetime risk of developing diabetes for students born in the new millennium in the United States is estimated to be 27% to 52%. Many students need to learn about diabetes for their personal care, or desire to learn about diabetes to develop a career in healthcare. Most teenagers are adept at learning through Web-based computer tools. METHODS: Twenty-one students entering 8(th) and 9(th) grades (aged 12 to 14 years old) enrolled in a Biotechnology Summer Camp focused on diabetes. Lectures on pathophysiology and clinical aspects of diabetes were followed by simulated cases using the AIDA online diabetes software simulator accessed via the internet at www.2aida.net. Two cases demonstrated glycemic effects and pharmacokinetics of insulin administration, diet, and exercise in insulin-dependent (Type 1) diabetes and non-insulin-dependent (Type 2) diabetes. Students filled out standardized evaluations at the end of the session to assess receptiveness to this type of learning; opinions on the utility, information, and ease of use; and perceived risks of using the online simulator to understand diabetes. RESULTS: All students were receptive to this educational tool. The majority found AIDA online useful (17/21 [81%]), educational (21/21 [100%]), worthy of wider distribution (20/21 [95%]), and would recommend the program to others with diabetes or wanting to learn about diabetes (18/21 [86%]). A minority (2/21 [9.5%]) found the program risky regarding the information given to the students. Positive comments included the ability to visualize concepts being taught in earlier lectures, and recognized the rigors required to manage diabetes. Fewer negative comments reflected frustration with the web-based user interface, the course materials, or difficulty in achieving good simulated glycemic control. DISCUSSION: Teaching pathophysiology of diabetes and pharmacology of insulin to middle school students is enhanced with the AIDA online diabetes simulator. Future versions of this program, and development of similar programs, could be useful in teaching adolescents who have diabetes, and might help stimulate interested students to learn more about the care of people with diabetes.

Retrospective pilot feedback survey of 200 users of the AIDA Version 4 Educational Diabetes Program. 1--Quantitative Survey Data.

This column reports a detailed, questionnaire-based, post-release feedback survey of 200 users of the AIDA version 4 educational diabetes simulator. AIDA is a freeware computer program that permits the interactive simulation of plasma insulin and blood glucose profiles for educational, demonstration, self-learning, and research purposes. Since its Internet launch in 1996 over 700,000 visits have been logged to the AIDA Websites-including www.2aida.org-and over 200,000 program copies have been downloaded free-of-charge. The main goals of the current study were: (1) to establish what people have thought about the AIDA program, (2) to assess the utility of the software, and (3) to ascertain how much people have actually used it. An analysis was therefore undertaken of the first 200 feedback forms that were returned by AIDA users. The questionnaire-based survey methodology was found to be robust and reliable. Feedback forms were received from participants in 21 countries. One hundred six of 209 responses (50.7%) were received from people with diabetes, and 36 of 209 (17.2%) from relatives of patients, with lesser numbers from doctors, students, diabetes educators, nurses, pharmacists, and other end users. Please note some respondents fulfilled more than one end-user category, hence the denominator <200; for example, someone with diabetes who was also a doctor. This study has established the feasibility of using a simple feedback form to survey a substantial number of diabetes software users. In addition, it has yielded interesting data in terms of who are the main users of the AIDA program, and has also provided technical (computer) information that has aided the release of a freeware upgrade to the software. In general, users reported finding the program to be of educational value. The majority also felt it would be of interest to diabetes educators and people with diabetes. Most were clear about its limitations as a simulator-based learning tool. The implications of these findings will be discussed.

Interactive educational diabetes/insulin tutorial at www.2aida.info.

The World Wide Web now hosts a multitude of diabetes educational materials in various formats. Of particular interest is the diabetes/insulin tutorial available at the AIDA Website (accessible directly at: www.2aida.info). The tutorial combines textual or "static" information with an interactive diabetes simulator-AIDA online-to provide an engaging and effective educational tool. AIDA online (accessible directly at: www.2aida.net) enables the simulation of plasma insulin and blood glucose levels from user-defined insulin injection and carbohydrate intake data. A haemoglobin A1c value is also computed, giving an indication of overall blood glucose control in the virtual patient with diabetes. The diabetes/insulin tutorial is currently composed of four sections: the first two cover in considerable depth insulin injection regimens and insulin dosage adjustment; the third section introduces the principles of carbohydrate counting and, specifically, matching insulin doses to carbohydrate intake; and the fourth section illustrates the relationship between blood glucose levels and renal excretion of glucose. The simulator runs alongside the tutorial, and allows various concepts described in the text to be explored freely by the user and simulated interactively. This introduces a novel way of learning how injected insulin and dietary carbohydrate interact in various insulin injection regimens. A fifth section- for which any offers of assistance would be gratefully received-is planned. This will consider the use of insulin pumps and rapidly acting and very long-acting insulin analogues. Further improvements that may strengthen the existing tutorial and/or use of the online simulator are discussed in this column.

Diabetes website review: www.2aida.org.

Previous Diabetes Information Technology & WebWatch columns have addressed the use of diabetes simulators, and, in particular, aspects of the AIDA software. AIDA is a freeware computer program, which simulates the interaction of carbohydrates and insulin administered in people with insulin-dependent (type 1) diabetes mellitus. The program is intended to be used as an educational support tool, and is available via the Internet without charge from www.2aida.org. In this article, the AIDA Website is described and reviewed in terms of both content and functionality. This popular non-commercial Internet site provides free access to a downloadable PC version of AIDA, as well as access to a Web-based version of the simulator that can be run online (accessible directly at: www.2aida.net). User feedback suggests that the Website and the AIDA software have been of significant interest and value to many patients, their relatives and carers, students, and a variety of health-care professionals and researchers. The interactive and dynamic nature of the simulations adds a real-life dimension to the Web-based educational material, and the software is complemented by a substantial amount of supporting information at the Website. The on-going collection of subjective feedback continues to provide anecdotal evidence of the utility of the software, and this will hopefully be corroborated by results from more formal and objective evaluations. The future potential of diabetes simulators, in both education and research, is becoming increasingly apparent, and the AIDA Website is evolving accordingly.

Website review: diabetes insight--www.diabetes-insight.info.

In previous Diabetes Information Technology & WebWatch columns some different diabetes Websites have been highlighted. In this issue we focus on one particular site and use this to illustrate how such Internet-based repositories of information can provide important and useful resources for people with diabetes and their carers. Diabetes is perhaps unique in the fact that much of the day-to-day responsibility for care rests with individuals themselves. Successful therapy demands considerable understanding of the condition by the person with diabetes, or his or her carer, and this can only be made possible with access to appropriate information. Provision of information via a Website is now recognised to be cost-effective and convenient, available 24 hours a day, 365 days a year-and access to the Internet by the general public has grown rapidly in recent years. The increasing way in which the Internet is being used to supply individuals with tools and information for their self-care is exemplified by the Diabetes Insight Website (at: www.diabetes-insight.info).

Diabetes and the World Wide Web.

The World Wide Web has become remarkably quickly an alternative source of information for patients and their relatives, as well as students and health-care professionals. A whole plethora of websites and Internet-based applications related to diabetes have appeared in recent years. In this column, selected issues surrounding the use of such websites are considered and the need for more evaluation of such diabetes sites, as well as the Internet medium itself, is highlighted.

Computerised decision-support tools in diabetes care: hurdles to implementation.

In this Diabetes Information Technology & WebWatch column hurdles to the use of computerised decision-support tools in clinical diabetes care will be considered. The clinical background with respect to insulin-dependent (type 1) diabetes mellitus and the Diabetes Control and Complications Trial is reviewed, and an overview is given of various computer applications. The use of decision-support tools is discussed, and the importance of identifying the proposed user, e.g., health-care professional, student, or patient, is highlighted. Validation/evaluation issues are considered as important topics that remain to be properly addressed for many decision-support prototypes. The column concludes by highlighting that in this era of evidence-based medicine well-conducted, rigorous evaluation and validation studies are required to inform decisions about whether or not to make use of current computerised decision-support prototypes.

British Diabetic Association review of the AIDA v4 diabetes software simulator program.

AIDA is a diabetes-computing program freely available from www.2aida.org on the Web. The software is intended to serve as an educational support tool, and can be used by anyone who has an interest in diabetes, whether they be patients, relatives, health-care professionals, or students. In 1996, during the beta-testing phase of the AIDA v4 project, the British Diabetic Association (BDA)-now called Diabetes UK-was approached and offered the AIDA software by the author, without charge, as a noncommercial contribution to continuing diabetes education. The BDA undertook their own independent assessment of the program, which involved distributing AIDA to a panel of potential end-users (health-care professionals and patients). Comments were solicited regarding the utility, clarity, and perceived safety of the software from users outside the BDA, as well as from various internal assessors. As a result of the feedback, a decision was taken by the BDA to offer AIDA to health-care professionals through the BDA's health-care professional brochure. One thousand copies of the software were produced on diskette, and 1,000 copies of the BDA's version of the program's user guide-printed as a small book-were made available for distribution by post. In this Diabetes Information Technology & WebWatch column an overview is given of the anonymous feedback provided to the BDA by some of the external evaluators. Looking back, nearly 8 years after the launch of AIDA, it is interesting to review some of the comments received and compare these with what has actually happened with the software. To date over 400,000 visits have been logged at the AIDA Web pages, and over 80,000 copies of the program have been downloaded free-of-charge. It is highlighted that this widespread downloading of, and interest in, the AIDA software seems to largely have been fuelled by the program's free availability on the Internet. The use of the World Wide Web to enhance the distribution of other medical (diabetes) programs is highlighted.

Information technology in clinical diabetes care--a look to the future.

In the last Diabetes Information Technology & WebWatch column (Diabetes Technol Ther 2004;6:422-429) various hurdles to the implementation of computerised decision-support tools in clinical diabetes care were highlighted. In this column a look is made to the future, considering ways in which information technology tools may be applied in diabetes clinics, and elsewhere, in years to come. Particular attention is focused on discussion of the ways in which existing technologies are likely to become better integrated--in the short to medium term--to provide benefits to people with diabetes, their relatives, and carers.

Who is downloading the free AIDA v4.3a interactive educational diabetes computer software? A 1-year survey of 3864 downloads.

AIDA is a free diabetes computer program that permits the interactive simulation of plasma insulin and blood glucose profiles for educational, demonstration, self-learning, and research purposes. To date over 70000 copies of the software have been downloaded from the AIDA Website, www.2aida.org. This column documents a survey of downloaders of the latest release of the program (AIDA v4.3a). The Internet-based survey methodology was confirmed to be robust and reliable. Over a 1-year period (from March 2001 to February 2002) in total 3864 responses were received. During the corresponding period some 8578 actual downloads of the software were independently logged via the same route at the AIDA Website, giving a response rate for this survey of 45%. Responses were received from participants in 66 countries - over half of these (n = 2,137; 55.3%) were from the United States and the United Kingdom. There were 2318 responses (60.0%) received from patients with diabetes and 443 (11.5%) from relatives of patients, with fewer responses from doctors, students, diabetes educators, nurses, pharmacists, and other end users. This study highlights considerable interest amongst patients and their relatives to learn more about balancing insulin and diet in diabetes, as well as possibly to get more involved in self-management of insulin dosages. More computer applications that can cater for this interest in diabetes patient self-care need to be developed and made available. The Internet provides an ideal medium for the distribution of such educational tools.

Research use of the AIDA www.2aida.org diabetes software simulation program: a review--part 2. Generating simulated blood glucose data for prototype validation.

The purpose of this review is to describe research applications of the AIDA diabetes software simulator. AIDA is a computer program that permits the interactive simulation of insulin and glucose profiles for teaching, demonstration, and self-learning purposes. Since March/April 1996 it has been made freely available on the Internet as a noncommercial contribution to continuing diabetes education. Up to May 2003 well over 320,000 visits have been logged at the main AIDA Website--www.2aida.org--and over 65,000 copies of the AIDA program have been downloaded free-of-charge. This review (the second of two parts) overviews research projects and ventures, undertaken for the most part by other research workers in the diabetes computing field, that have made use of the freeware AIDA program. As with Part 1 of the review (Diabetes Technol Ther 2003;5:425-438) relevant research work was identified in three main ways: (i) by personal (e-mail/written) communications from researchers, (ii) via the ISI Web of Science citation database to identify published articles which referred to AIDA-related papers, and (iii) via searches on the Internet. Also, in a number of cases research students who had sought advice about AIDA, and diabetes computing in general, provided copies of their research dissertations/theses upon the completion of their projects. Part 2 of this review highlights some more of the research projects that have made use of the AIDA diabetes simulation program to date. A wide variety of diabetes computing topics are addressed. These range from learning about parameter interactions using simulated blood glucose data, to considerations of dietary assessments, developing new diabetes models, and performance monitoring of closed-loop insulin delivery devices. Other topics include evaluation/validation research usage of such software, applying simulated blood glucose data for prototype training/validation, and other research uses of placing technical information on the Web. This review confirms an unexpected but useful benefit of distributing a medical program, like AIDA, for free via the Internet--demonstrating how it is possible to have a synergistic benefit with other researchers--facilitating their own research projects in related medical fields. A common theme that emerges from the research ventures that have been reviewed is the use of simulated blood glucose data from the AIDA software for preliminary computer lab-based testing of other decision support prototypes. Issues surrounding such use of simulated data for separate computer prototype testing are considered further.

Research use of the AIDA www.2aida.org diabetes software simulation program: a review-part 1. decision support testing and neural network training.

The purpose of this two-part review is to overview research use of the AIDA diabetes software simulator. AIDA is a diabetes computer program that permits the interactive simulation of plasma insulin and blood glucose profiles for teaching, demonstration, and self-learning purposes. It has been made freely available, without charge, on the Internet as a noncommercial contribution to continuing diabetes education. Since its launch in 1996 over 300,000 visits have been logged at the main AIDA Website-www.2aida.org-and over 60,000 copies of the AIDA program have been downloaded free-of-charge. This review describes research projects and ventures, undertaken for the most part by other research workers in the diabetes computing field, that have made use of the freeware AIDA software. Relevant research work was identified in three main ways: (i) by personal (e-mail/written) communications from researchers, (ii) via the ISI Web of Science citation database to identify published articles that referred to AIDA-related papers, and (iii) via searches on the Internet. In a number of cases research students who had sought advice about AIDA, and diabetes computing in general, provided copies of their research dissertations/theses upon the completion of their projects. The two reviews highlight some of the many and varied research projects that have made use of the AIDA diabetes simulation software to date. A wide variety of diabetes computing topics have been addressed. In Part 1 of the review, these range from testing decision support prototypes to training artificial neural networks. In Part 2 of the review, issues surrounding dietary assessments, developing new diabetes models, and performance monitoring of closed-loop insulin delivery devices are considered. Overall, research projects making use of AIDA have been identified in Australia, Italy, South Korea, the United Kingdom, and the United States. These reviews confirm an unexpected but useful benefit of distributing medical software, like AIDA, for free via the Internet-demonstrating how it is possible to have a synergistic benefit with other researchers-facilitating their own research projects in related medical fields. The reviews highlight a variety of these projects that have benefited from the free availability of the AIDA diabetes software simulator. In a number of cases these other research projects simply would not have been possible without unrestricted access to the AIDA software and/or technical descriptions of its workings. In addition, some specific common themes begin to emerge from the research ventures that have been reviewed. These include the use of simulated blood glucose data from the AIDA program for preliminary computerlab-based testing of other decision support prototypes. Issues surrounding such use of simulated data for separate prototype testing are discussed further in Part 2 of the review.

Why people download the freeware AIDA v4.3a diabetes software program: a proof-of-concept semi-automated analysis.

AIDA is a diabetes-computing program freely available at www.2aida.org on the Web. The software is intended to serve as an educational support tool and can be used by anyone who has an interest in diabetes, whether they be patients, relatives, health-care professionals, or students. In previous "Diabetes Information Technology & WebWatch" columns various indicators of usage of the AIDA program have been reviewed, and various comments from users of the software have been documented. The purpose of this column is to overview a proof-of-concept semi-automated analysis about why people are downloading the latest version of the AIDA educational diabetes program. AIDA permits the interactive simulation of plasma insulin and blood glucose profiles for teaching, demonstration, self-learning, and research purposes. It has been made freely available, without charge, on the Internet as a noncommercial contribution to continuing diabetes education. Since its launch in 1996 over 300,000 visits have been logged at the main AIDA Website-www.2aida.org-and over 60,000 copies of the AIDA program have been downloaded free-of-charge. This column documents the results of a semi-automated analysis of comments left by Website visitors while they were downloading the AIDA software, before they had a chance to use the program. The Internet-based survey methodology and semi-automated analysis were both found to be robust and reliable. Over a 5-month period (from October 3, 2001 to February 28, 2002) 400 responses were received. During the corresponding period 1,770 actual visits were made to the Website survey page-giving a response rate to this proof-of-concept study of 22.6%. Responses were received from participants in over 54 countries-with nearly half of these (n = 194; 48.5%) originating from the United States, United Kingdom, and Canada; 208 responses (52.0%) were received from patients with diabetes, 50 (12.5%) from doctors, 49 (12.3%) from relatives of patients, with fewer responses from students, diabetes educators, nurses, pharmacists, and other end users. The semi-automated analysis adopted for this study has re-affirmed the feasibility of using the Internet to obtain free-text comments, at no real cost, from a substantial number of medical software downloaders/users. The survey has also offered some insight into why members of the public continue to turn to the Internet for medical information. Furthermore it has provided useful information about why people are actually downloading the AIDA v4.3a interactive educational "virtual diabetes patient" simulator.