The Role of Human-Centered Design in Insulin Pen Innovation and the Future of Insulin Delivery

Insulin pens have made a dramatic impact on diabetes care, with evidence suggesting that they promote performance of self-care and reduce negative health outcomes for people with diabetes. Human-centered design (HCD), practiced by IDEO for over 40 years and together with Eli Lilly for over 15 years, has helped to design insulin pens that evolved with the needs of people with diabetes. HCD employs unique methods that help to uncover people’s needs and design with them in mind. The future of diabetes care is bright with the ongoing application of HCD methodology in this space.     

Pregnancy and arterial compliance

OBJECTIVE: To examine the hypothesis that pregnancy is associated with vascular remodeling, leading to an increased vascular compliance that can be observed in subsequent pregnancies. STUDY DESIGN: Chart review of41 multiparous deliveries at our institution from a 2-month period in 2004. Charts examined were from patients with uncomplicated, singleton pregnancies who were nulliparous during their prior delivery. Patients with blood pressure recordings in all 3 trimesters during both pregnancies were included. The mean arterial pressure (MAP) in the index and prior pregnancy was compared. RESULTS: There were no significant MAP differences noted, other than in the late third trimester (MAP, 85.05 vs. 80.15, p < 0.001). When we plotted the difference in >34 weeks MAP against the time between pregnancies, we did not see any statistically significant correlation (Pearson Correlation -0.147, p = 0.35). We examined the mean pulse pressure at >34 weeks. We found no statistically significant differences between the first and second pregnancies (mean pulse pressure, 42.27 vs. 43.55, p = 0.5). CONCLUSION: Our data does not support the hypothesis that pregnancy is associated with vascular remodeling, leading to an increased vascular compliance that can be observed in subsequent pregnancies. This could be due to demographic differences between our population and previously studied populations.     

Expression of indoleamine 2,3-dioxygenase in the rhesus monkey and common marmoset

Indoleamine 2,3-dioxygenase (IDO) catalyzes the initial and rate-limiting step of tryptophan degradation along the kynurenine pathway, and is hypothesized to limit tryptophan availability at embryo implantation and prevent maternal T cell activation at the maternal-fetal interface. To determine if nonhuman primates are suitable models for investigating the role of IDO during pregnancy, we defined the expression of IDO in the rhesus monkey and common marmoset with particular attention to the female reproductive tract and placenta. IDO mRNA was detected by RT-PCR in the rhesus monkey term placenta, lung, small intestine, spleen, lymph node and nonpregnant uterus, and also in the common marmoset placenta. Immunohistochemical analysis of rhesus monkey tissues localized IDO to glandular epithelium of nonpregnant endometrium and first trimester decidua, vessel endothelium of nonpregnant myometrium, first trimester decidua and term decidua, and villous vessel endothelium and syncytiotrophoblast of term placenta. Western blot analysis confirmed IDO in rhesus monkey term placenta. In the common marmoset, IDO was detected in glandular epithelium of the nonpregnant uterus and in the decidua at day 60 and day 128 of gestation. IDO activity was higher in rhesus monkey and common marmoset decidua and placentas than in other tissues. Confirmation of IDO expression in rhesus monkey and common marmoset uterine and placental tissues supports the hypothesis that this enzyme regulates immune activation at the maternal-fetal interface and demonstrates that nonhuman primates may provide models with distinct similarities to human placentation to study the role of IDO in maternal-fetal immune dialogue.     

Maternal hydration status affects renal pelvic-calyceal diameter in pregnancy

Our objective was to evaluate the effect of maternal hydration status on the maternal renal collecting system during the third trimester of pregnancy. Thirty-five patients with uncomplicated singleton pregnancies were studied between 28 and 40 weeks of gestation. Ultrasound of the maternal kidneys was performed at baseline and after oral hydration with 1 L of water. Renal pelvic dilation was defined as a mean pelvic-calyceal diameter of > 10 mm. Results were analyzed with the Student paired T test and the McNemar test for comparing correlated proportions; P < 0.05 was considered significant. Prior to hydration, 19 patients (54%) had renal pelvic dilation: 7 on the right side, 2 on the left side, and 10 bilateral. Sixty minutes after hydration, 33 patients (94%) had renal pelvic dilation: 7 on the right side, 1 on the left side, and 25 bilateral. Renal pelvic dilation peaked 60 to 90 minutes after oral hydration. We concluded that hydration status substantially affects maternal renal imaging studies during the third trimester of pregnancy.     

To the point: medical education reviews--providing feedback

Formative feedback is an essential component of effective teaching and learning. Without it, the learner flounders. Furthermore, the Liaison Committee on Medical Education requires formative feedback within the clerkship and specifies that students must have the time and ability to remediate deficiencies before completing the clerkship. Few articles in the medical literature address how to give effective feedback. However, the themes within these articles are consistent. Formative feedback should be an interactive activity between the teacher and learner. Feedback must be approached with mutual respect and should be provided in a safe environment. Quality feedback is timely, specific to the situation, constructive, based on direct observation and nonjudgmental. With effective feedback, learners (and teachers) can discover what to improve, as well as which behaviors and skills to reinforce and augment. Learners appreciate and request specific feedback. In addition, learners tend to rate teachers who provide feedback more highly than they rate teachers who do not provide feedback. This article in the "To the Point" series will focus on the components of effective feedback and provide a practical and effective approach to giving feedback.