There is, I think, something ethereal about i —the square root of minus one. I remember first hearing about it at school. It seemed an odd beast at that time—an intruder hovering on the edge of reality.

Usually familiarity dulls this sense of the bizarre, but in the case of i it was the reverse: over the years the sense of its surreal nature intensified. It seemed that it was impossible to write mathematics that described the real world in …

I and i

XI. STRATEGIES FOR IMPROVING DIABETES CARE D iabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to Bode (Ed.): Medical Management of Type 1 Diabetes (1), Burant (Ed): Medical Management of Type 2 Diabetes (2), and Klingensmith (Ed): Intensive Diabetes Management (3). The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E.

Standards of Medical Care in Diabetes

The 11th edition of Harrison's Principles of Internal Medicine welcomes Anthony Fauci to its editorial staff, in addition to more than 85 new contributors. While the organization of the book is similar to previous editions, major emphasis has been placed on disorders that affect multiple organ systems. Important advances in genetics, immunology, and oncology are emphasized. Many chapters of the book have been rewritten and describe major advances in internal medicine. Subjects that received only a paragraph or two of attention in previous editions are now covered in entire chapters. Among the chapters that have been extensively revised are the chapters on infections in the compromised host, on skin rashes in infections, on many of the viral infections, including cytomegalovirus and Epstein-Barr virus, on sexually transmitted diseases, on diabetes mellitus, on disorders of bone and mineral metabolism, and on lymphadenopathy and splenomegaly. The major revisions in these chapters and many

Harrison's Principles of Internal Medicine

2016 Alzheimer's disease facts and figures

Dementia prevention, intervention, and care

We studied cognition in the Finnish Diabetes Prevention Study (DPS), a trial of lifestyle intervention that prevented diabetes in persons with impaired glucose tolerance. Cognition was similar in the randomization arms 9 years after the intervention in 364 participants, suggesting that the intervention did not benefit cognition.

Cognition in the Finnish Diabetes Prevention Study

The comments by Ramesh and Haldar (1) point out several limitations of the Northern Manhattan Diabetes Community Outreach Project (NOCHOP), several of which we discussed at length in our original article (2). We do agree with their concern regarding the lack of statistical power, which we believe was mostly due to lower-than-expected intervention fidelity. Our participants experienced great difficulty attending …

https://care.diabetesjournals.org/content/diacare/38/4/e59.full.pdf

Response to Comment on Palmas et al. Results of the Northern Manhattan Diabetes Community Outreach Project: A Randomized Trial Studying a Community Health Worker Intervention to Improve Diabetes Care in Hispanic Adults. Diabetes Care 2014;37:963–969

P3-129: Relation of diabetes to mild cognitive impairment

It has been suggested that low levels of estradiol and testosterone increase dementia risk. However, results of the existing observational studies examining associations of endogenous sex hormones with cognition and dementia are conflicting. A possible explanation for these inconsistent findings could be the involvement of sex hormone-binding globulin (SHBG) in regulating sex hormone levels. In the present study, we examined whether SHBG levels were associated with development of AD and overall dementia in a cohort of elderly men and women free of dementia at baseline. We observed that in both men and women higher levels of SHBG were associated with an increased risk for AD and overall dementia. These results were independent of vascular risk factors and bioactive hormone levels. Whether SHBG is causally related to dementia or whether it is a surrogate marker for rate of biological aging and increased risk or for preclinical stage of dementia has to be elucidated.

P4-044: Sex hormone binding globulin and incident Alzheimer's disease in elderly men and women

giver questionnaires. Formal care activity was grouped into three broad categories: community support services; primary care services; and secondary care services. In respect of informal care provision, the opportunity cost method was adopted for the costing of reported caregiver time input. A vector of Irish unit cost data (Euro (V,:) 2008 prices) was applied to value resource activity and the total formal and informal care costs calculated for each dependence category. Results: The average cost of formal care, when individual resource components were valued and combined, was V,:1,043 for the low dependence group, V,:1,509 for the moderate dependence group, and V,:3,271 for the high dependence group. In regard to informal care, the respective average costs were V,:13, V,:53, and V,:91 per day and V,:2,373, V,:9,673, and V,:16,608 over 6 months. Conclusions: The preliminary results indicate that the costs of formal and informal care services both increased in linewith increasing dependence.While the results obtained were estimated for a small opportunistic sample and are not readily general sable, they do provide a broad sense of the relationship between resource use, cost and dependence for people with dementia and will serve to inform the design of further research in this area in the future.

José A. Luchsinger

Papers

Cognition in the Finnish Diabetes Prevention Study

Response to Comment on Palmas et al. Results of the Northern Manhattan Diabetes Community Outreach Project: A Randomized Trial Studying a Community Health Worker Intervention to Improve Diabetes Care in Hispanic Adults. Diabetes Care 2014;37:963–969

P3-129: Relation of diabetes to mild cognitive impairment

P4-044: Sex hormone binding globulin and incident Alzheimer's disease in elderly men and women

Incidence of Alzheimer's disease and changes of diet