Optimising Insulin Injection Techniques to Improve Diabetes Outcomes.

The effectiveness of therapy in patients with diabetes depends on the correct use of the insulin injection technique. However, despite many established recommendations and evidence that an effective insulin injection technique is essential to improve glycaemic control and minimise the risk associated with diabetes, there is still a need to identify impediments to the insulin injection technique among patients and create awareness among patients and healthcare professionals about the importance of the optimisation of insulin injection techniques. This review focuses on the recent advancements in delivery devices, insulin injection technique teaching methods, monitoring, and complication management and highlights regional best practices and recommendations for optimising injection techniques to improve diabetes outcomes.

Needlestick Injuries With Insulin Injections: Risk Factors, Concerns, and Implications of the Use of Safety Pen Needles in the Asia-Pacific Region.

Globally, health care workers (HCWs) are at a high risk of occupational exposure to needlestick injuries (NSIs). Needlestick injuries not only are associated with an increased risk of infections caused by bloodborne pathogens but are also a primary source of emotional distress and job burnout for HCWs and patients. Insulin injection-related NSIs are common among HCWs working in hospitals in the Asia-Pacific (APAC) region and impose a significant burden. Insulin pen needles have a high risk of transmitting infections (at both the patient-end and cartridge end of the sharp) after use. Recapping a needle after administering an insulin injection poses a major risk to HCWs. Currently, several safety-engineered needle devices (SENDs) are available with active or passive safety mechanisms. Passive insulin safety pen needles with dual-ended protection and automatic recapping capabilities have resulted in a significant drop in accidental punctures to HCWs while administering insulin to patients with diabetes. In this article, we have reviewed the burden and common causes of NSIs with insulin injections among HCWs in the APAC region. We have discussed current approaches to address the issues associated with NSIs and the benefits of introducing SENDs in health care settings, including long-term care facilities, nursing homes, and home care settings where patients may require assisted insulin injections. This review also summarizes key strategies/recommendations to prevent NSIs in HCWs and patients with diabetes in the APAC region.

Modelling of arsenic (III) removal from aqueous solution using film theory combined Spiegler-Kedem model: pilot-scale study.

Arsenic contamination in drinking water is recognized as major health hazard worldwide. As reported in literature, more than 19% Indians are consuming lethal levels of arsenic for drinking purposes. In this work, arsenic (III) removal was studied using HFN300 polyethersulfone nanofiltration membrane in spiral wound configuration. Various membrane parameters such as hydraulic permeability (4.87 L m-2 h-1 bar-1), mass transfer coefficient (0.957*10-6 m s-1), reflection coefficient (0.9), and solute permeability (2*10-9 m s-1) were estimated using film theory combined Spiegler-Kedem (FTCSK) model. The higher value of reflection coefficient suggested the impervious nature of nanofiltration (NF) membrane used for arsenic (III) solute rejection. The influence of various operating parameters such as transmembrane pressure, initial feed concentration, and feed flowrate on membrane performance was also examined. It was found that arsenic (III) rejection was dependent on pressure and feed concentration. Result showed that more than 96.4% arsenic (III) rejection was achieved for 50 mg L-1 of feed at optimized conditions. As HFN300 membrane was negatively charged at pH 8 and arsenic (III) was available in neutral solute form, electro-migration was not considered for solute rejection mechanism. Solution diffusion with significant coupling between solute and solvent, steric hindrance effect, convection, and solute-membrane affinity interactions were considered dominant factors for the possible solute rejection mechanism. Rejection efficiency (% R) and permeate flowrate (Q2) were simulated and compared with experimental results. It was found that simulated results were in excellent agreement with the experimental results. The maximum error obtained was within 10% for both % R and Q2. This confirms the efficacy of FTCSK model in predicting arsenic (III) removal using NF membrane. The annualized cost per cubic metre of treated water was estimated as 3.32 $/m3. This further confirms the feasibility of using NF process in removing arsenic from contaminated water.

Thermal decomposition kinetics and properties of grafted barley husk reinforced PVA/starch composite films for packaging applications.

Thermal degradation kinetics was performed on thermogravimetric (TGA) curves of crosslinked PVA/starch composite films reinforced with barley husk (BH) and grafted BH (using lauric acid) obtained by heating samples in an inert atmosphere with different heating rates (5, 10, 15 and 20 °C/min). The activation energy for composite films was determined using Flynn-Wall-Ozawa (FWO) Kissinger-Akahira-Sunose (KAS), Friedman (FR) and modified Coasts Redfern (CR) methods. The results showed that activation energy for thermal degradation of grafted BH composite film was higher than of BH. Incorporation of grafted BH into crosslinked PVA/starch matrix improved the mechanical performance of the films compared to BH and showed 30 % increase in tensile strength after reinforcement. Grafted BH composite films showed higher barrier properties for light, water vapor and oxygen as required for packaging applications. Biodegradability of the films improved significantly after incorporation of BH into the polymer matrix and showed 70 % degradation after 180 days.

Application of ANN and RSM on fluoride removal using chemically activated D. sissoo sawdust.

Response surface methodology (RSM) and artificial neural network (ANN) were used to generate a model for the optimization of fluoride removal using chemically activated Dalbergia sissoo sawdust (CADS). The single and collective effects of process parameters, i.e., solution pH, CADS dose, initial fluoride concentration, and contact time, were studied. The point of zero charge was found to be 4.2 with zeta potential analysis. In the first phase, a single-parameter study was performed to reveal dependency of fluoride removal on a particular process parameter. Positive effects of increment in CADS dose and contact time and negative effects of solution pH and initial fluoride concentration were observed. The second phase included RSM in which analysis of variance (ANOVA) was applied to test the feasibility of the mathematical model. The F value 1.91, R2 value 0.87, and P value 0.11 show significance of the proposed model. Results obtained from the experiment set for central composite design (CCD) were used to predict the ANN response. Reasonable acceptable values of regression for training, test, and validation (0.76, 0.93, and 0.37) represent the suitability of the model. The ANN predicted 22.1% fluoride removal, which was close to the actual value (20.1%) and was comparable with CCD prediction (25.0%). BET surface area of CADS was found to be 76.33 m2/g. FTIR was performed to recognize the functional groups available for fluoride binding while SEM and EDX were conducted to ensure the changes in adsorbent surface morphology. Regeneration of CADS was feasible using an alkali medium. This study shows that CADS can be used for fluoride removal from aqueous stream in an efficient way.

Challenges and unmet needs in basal insulin therapy: lessons from the Asian experience.

Basal insulin therapy can improve glycemic control in people with type 2 diabetes. However, timely initiation, optimal titration, and proper adherence to prescribed basal insulin regimens are necessary to achieve optimal glycemic control. Even so, glycemic control may remain suboptimal in a significant proportion of patients. Unique circumstances in Asia (eg, limited resources, management of diabetes primarily in nonspecialist settings, and patient populations that are predominantly less educated) coupled with the limitations of current basal insulin options (eg, risk of hypoglycemia and dosing time inflexibility) amplify the challenge of optimal basal insulin therapy in Asia. Significant progress has been made with long-acting insulin analogs (insulin glargine 100 units/mL and insulin detemir), which provide longer coverage and less risk of hypoglycemia over intermediate-acting insulin (Neutral Protamine Hagedorn insulin). Furthermore, recent clinical evidence suggests that newer long-acting insulin analogs, new insulin glargine 300 units/mL and insulin degludec, may address some of the unmet needs of current basal insulin options in terms of risk of hypoglycemia and dosing time inflexibility. Nevertheless, more can be done to overcome barriers to basal insulin therapy in Asia, through educating both patients and physicians, developing better patient support models, and improving accessibility to long-acting insulin analogs. In this study, we highlight the unique challenges associated with basal insulin therapy in Asia and, where possible, propose strategies to address the unmet needs by drawing on clinical experiences and perspectives in Asia.

Optimizing Glycemic Control Through Titration of Insulin Glargine 100 U/mL: A Review of Current and Future Approaches with a Focus on Asian Populations.

Various data have demonstrated inadequate glycemic control amongst Asians with type 2 diabetes mellitus (T2DM), possibly on account of suboptimal titration of basal insulin-an issue which needs to be further examined. Here we review the available global and Asia-specific data on titration of basal insulin, with a focus on the use of insulin glargine 100 U/mL (Gla-100). We also discuss clinical evidence on the efficacy and safety of titrating Gla-100, different approaches to titration, including some of the latest technological advancements, and guidance on the titration of basal insulin from international and local Asian guidelines. The authors also provide their recommendations for the initiation and titration of basal insulin for Asian populations. Discussion of the data included in this review and in relation to the authors' clinical experience with treating T2DM in Asian patients is also included. Briefly, clinical studies demonstrate the achievement of adequate glycemic control in adults with T2DM through titration of Gla-100. However, studies investigating approaches to titration, specifically in Asian populations, are lacking and need to be conducted. Given that the management of insulin therapy is a multidisciplinary team effort involving endocrinologists, primary care physicians, nurse educators, and patients, greater resources and education targeted at these groups are needed regarding the optimal titration of basal insulin. Technological advancements in the form of mobile or web-based applications for automated dose adjustment can aid different stakeholders in optimizing the dose of basal insulin, enabling a larger number of patients in Asia to reach their target glycemic goals with improved outcomes.

Effect of cross linking of PVA/starch and reinforcement of modified barley husk on the properties of composite films.

Barley husk (BH) was graft copolymerized by palmitic acid. The crystalline behavior of BH decreased after grafting. Poly vinyl alcohol (PVA)/starch (St) blend film, urea formaldehyde cross linked PVA/St films and composite films containing natural BH, grafted BH were prepared separately. The effect of urea/starch ratio, content of BH and grafted BH on the mechanical properties, water uptake (%), and biodegradability of the composite films was observed. With increase in urea: starch ratio from 0 to 0.5 in the blend, tensile strength of cross linked film increased by 40.23% compared to the PVA/St film. However, in grafted BH composite film, the tensile strength increased by 72.4% than PVA/St film. The degradation rate of natural BH composite film was faster than PVA/St film. Various films were characterized by SEM, FT-IR and thermal analysis.

The economic burden of self-reported and undiagnosed cardiovascular diseases and diabetes on Indonesian households.

OBJECTIVES: The goal of this study is: (1) to estimate the current direct out-of-pocket (OOP) and indirect non-communicable diseases (NCD) burden on Indonesian households and (2) to project NCD prevalence and burden in 2020 focusing specifically on hypertension, diabetes, heart problems and stroke. METHODS: This study relies on econometric analyses based on four waves of the Indonesian Family Life Survey (IFLS). RESULTS: In aggregate, of the NCDs studied, heart problems exert the greatest economic burden on households, costing Int$1.56 billion in OOP and indirect burden in 2010. This was followed by hypertension (Int$1.36 billion), diabetes (Int$0.81 billion) and stroke (Int$0.29 billion). The OOP and indirect burden of these conditions is estimated to be Int$4.02 billion. Diabetes and stroke are expected to have the largest proportional increases in burden by 2020; 56.0% for diabetes and 56.9% for stroke to total Int$1.27 billion and Int$0.45 billion respectively. The burden of heart problems in 2020 is expected to increase by 34.4% to total Int$2.09 billion and hypertension burden will increase by 46.1% to Int$1.99 billion. In 2020, these conditions are expected to impose an economic burden of Int$5.80 billion. CONCLUSION: In conclusion, this study demonstrates the significant burden of 4 primary NCDs on Indonesian households. In addition to the indirect burden, hypertension, diabetes, heart problems and stroke account for 8% of the nation's OOP healthcare expenditure, and due to rising disease prevalence and an aging population, this figure is expected to increase to 12% by 2020 without a significant health intervention.

Assessment of baseline characteristics, glycemic control and oral antidiabetic treatment in Asian patients with diabetes: The Registry for Assessing OAD Usage in Diabetes Management (REASON) Asia study.

BACKGROUND: To assess baseline characteristics, glycemic control, and treatment with oral antidiabetic drugs (OAD) in type 2 diabetes mellitus (T2DM) patients. METHODS: This multinational, observational study recruited patients ≥ 21 years of age who were newly diagnosed and/or treated with OAD monotherapy for <6 months but were inadequately controlled. In cross-sectional phase, data on demographics, medical history, diabetic complications and comorbidities, OAD treatment, glycosylated hemoglobin (HbA1c), and fasting blood glucose (FBG) were collected. In longitudinal phase evaluating 6-month follow-up of sulfonylurea (SU)-treated patients, additional data on reasons for not achieving HbA1c targets were collected. RESULTS: Of 1487 patients (mean [± SD] age 52.0 ± 11.6 years; 46.7% men; mean BMI 25.8 ± 4.4 kg/m(2) ) recruited, 75.9% were newly diagnosed, 73.3% had central obesity, 43.8% had hypertension, and 60.5% had dyslipidemia. The mean HbA1c was 9.8 ± 2.4%, and the mean FBG was 11.3 ± 4.3 mmol/L. At T0 (baseline) and T6 (month 6 visit), 99.8% (n=1066) and 97.1% (n=830) patients received SU, respectively. There was decrease from T0 to T6 in mean HbA1c (10.2% vs 7.3%, respectively; P<0.0001) and mean FBG (12.0 vs 7.6 mmol/L, respectively; P<0.0001). Number of patients with HbA1c <7% increased from T0 (4.5%) to T6 (46.8%). Reasons for not achieving target HbA1c included poor diabetes education (50.7%), non-compliance to OADs (21.4%), and fear of hypoglycemia (19.7%). CONCLUSION: Marked reductions in HbA1c and FBG are achievable in T2DM patients managed with OADs. However, patient education and compliance are important for achieving and maintaining treatment targets.

Application of Central Composite Design approach for removal of chromium (VI) from aqueous solution using weakly anionic resin: modeling, optimization, and study of interactive variables.

In this paper, response surface methodology (RSM) approach using Central Composite Design (CCD) is applied to develop mathematical model and optimize process parameters for Cr (VI) removal from aqueous streams using weakly anionic resin Amberlite IRA 96. The individual and combined effect of four process parameters, i.e. contact time, initial solution pH, initial Cr (VI) concentration and resin dose on Cr adsorption were studied. Analysis of variance (ANOVA) showed the relative significance of process parameters in removal process. Initial solution pH and resin dose were found to be more significant than contact time and initial Cr (VI) concentration. The second-order regression model was developed to predict the removal efficiency using Design Expert software. The optimal conditions to remove Cr from aqueous solution at constant temperature of 30°C and stirring speed of 250 rpm were found to be contact time 62.5 min, pH 1.96, initial Cr (VI) concentration 145.4 mg/L, and resin dose 8.51 g/L. At these conditions, high removal efficiency (93.26%) was achieved. FTIR and EDX analysis were conducted to interpret the functional groups involved during the Cr-resin interaction.

Security risk assessment: applying the concepts of fuzzy logic.

Chemical process industries (CPI) handling hazardous chemicals in bulk can be attractive targets for deliberate adversarial actions by terrorists, criminals and disgruntled employees. It is therefore imperative to have comprehensive security risk management programme including effective security risk assessment techniques. In an earlier work, it has been shown that security risk assessment can be done by conducting threat and vulnerability analysis or by developing Security Risk Factor Table (SRFT). HAZOP type vulnerability assessment sheets can be developed that are scenario based. In SRFT model, important security risk bearing factors such as location, ownership, visibility, inventory, etc., have been used. In this paper, the earlier developed SRFT model has been modified using the concepts of fuzzy logic. In the modified SRFT model, two linguistic fuzzy scales (three-point and four-point) are devised based on trapezoidal fuzzy numbers. Human subjectivity of different experts associated with previous SRFT model is tackled by mapping their scores to the newly devised fuzzy scale. Finally, the fuzzy score thus obtained is defuzzyfied to get the results. A test case of a refinery is used to explain the method and compared with the earlier work.