Outcomes of a Pharmacist-Managed Clinic for Underserved Persons with Unmanaged Type 2 Diabetes Mellitus

Background A multidisciplinary approach is recommended for the management of type 2 diabetes mellitus (DM). Aim To evaluate the impact of a pharmacist intervention on haemoglobin A1c (HbA1c), systolic blood pressure (SBP), diastolic blood pressure (DBP), and diabetes-related hospitalisations in an underserved cohort with unmanaged type 2 DM. Methods This analysis was a retrospective cohort study. Criteria for inclusion were persons with unmanaged type 2 DM defined as HbA1c values ≥8% at time of enrolment, ≥18 years old, and enrolment in a pharmacist-managed clinic for ≥12 months. Pre- and post-intervention differences in HbA1c, SBP and DBP values were assessed using repeated measures analysis of variance (ANOVA). The risk of diabetes-related hospitalisations was estimated during the 12 months prior and during the 12 months post-intervention, and the relative risk (RR) was calculated. Results Mean HbA1c values at 3, 6 and 12 months post-intervention were lower than baseline values (p \u3c 0.05). There was no significant difference in mean HbA1c values at 6 or 12 months compared to 3 months post intervention. Mean SBP values at 3, 6 and 12 months were lower than baseline (p \u3c 0.05). Likewise, mean DBP values at 6 and 12 months were lower than baseline (p \u3c 0.05). The estimated RR of diabetes-related hospitalisations was 0.40 (95% CI: 0.20–0.83; p = 0.013). Conclusion Enrolment in a pharmacist-managed diabetes program was associated with a significant reduction in HbA1c, SBP and DBP and reduction in risk of diabetes-related hospitalisations in an underserved cohort of patients with diabetes over a 12-month period

Weak multiplicativity for random quantum channels

It is known that random quantum channels exhibit significant violations of multiplicativity of maximum output p-norms for any p>1. In this work, we show that a weaker variant of multiplicativity nevertheless holds for these channels. For any constant p>1, given a random quantum channel N (i.e. a channel whose Stinespring representation corresponds to a random subspace S), we show that with high probability the maximum output p-norm of n copies of N decays exponentially with n. The proof is based on relaxing the maximum output infinity-norm of N to the operator norm of the partial transpose of the projector onto S, then calculating upper bounds on this quantity using ideas from random matrix theory.Comment: 21 pages; v2: corrections and additional remark

Generalized parton distributions and transversity from full lattice QCD

We present here the latest results from the QCDSF collaboration for moments of generalized parton distributions and transversity in two-flavour QCD, including a preliminary analysis of the pion mass dependence.Comment: Talks presented by Ph.Hagler and J.Zanotti at BARYONS 2004, Paris, Oct. 25-29, 2004, 8 pages, 5 figure

Effects of Delayed Cord Clamping on 4-Month Ferritin Levels, Brain Myelin Content, and Neurodevelopment: A Randomized Controlled Trial

Objective To evaluate whether placental transfusion influences brain myelination at 4 months of age. Study design A partially blinded, randomized controlled trial was conducted at a level III maternity hospital in the US. Seventy-three healthy term pregnant women and their singleton fetuses were randomized to either delayed umbilical cord clamping (DCC, \u3e5 minutes) or immediate clamping (ICC, \u3c20 \u3eseconds). At 4 months of age, blood was drawn for ferritin levels. Neurodevelopmental testing (Mullen Scales of Early Learning) was administered, and brain myelin content was measured with magnetic resonance imaging. Correlations between myelin content and ferritin levels and group-wise DCC vs ICC brain myelin content were completed. Results In the DCC and ICC groups, clamping time was 172 ± 188 seconds vs 28 ± 76 seconds (P \u3c .002), respectively; the 48-hour hematocrit was 57.6% vs 53.1% (P \u3c .01). At 4 months, infants with DCC had significantly greater ferritin levels (96.4 vs 65.3 ng/dL, P = .03). There was a positive relationship between ferritin and myelin content. Infants randomized to the DCC group had greater myelin content in the internal capsule and other early maturing brain regions associated with motor, visual, and sensory processing/function. No differences were seen between groups in the Mullen testing. Conclusion At 4 months, infants born at term receiving DCC had greater ferritin levels and increased brain myelin in areas important for early life functional development. Endowment of iron-rich red blood cells obtained through DCC may offer a longitudinal advantage for early white matter development

Limited biomass recovery from gold mining in Amazonian forests

1. Gold mining has rapidly increased across the Amazon Basin in recent years, especially in the Guiana shield, where it is responsible for >90% of total deforestation. However, the ability of forests to recover from gold mining activities remains largely unquantified. 2. Forest inventory plots were installed on recently abandoned mines in two major mining regions in Guyana, and re‐censused 18 months later, to provide the first ground‐based quantification of gold mining impacts on Amazon forest biomass recovery. 3. We found that woody biomass recovery rates on abandoned mining pits and tailing ponds are among the lowest ever recorded for tropical forests, with close to no woody biomass recovery after 3–4 years. 4. On the overburden sites (i.e. areas not mined but where excavated soil is deposited), however, above‐ground biomass recovery rates (0.4–5.4 Mg ha−1 year−1) were within the range of those recorded in other secondary forests across the Neotropics following abandonment of pastures and agricultural lands. 5. Our results suggest that forest recovery is more strongly limited by severe mining‐induced depletion of soil nutrients, especially nitrogen, than by mercury contamination, due to slowing of growth in nutrient‐stripped soils. 6. We estimate that the slow recovery rates in mining pits and ponds currently reduce carbon sequestration across Amazonian secondary forests by ~21,000 t C/year, compared to the carbon that would have accumulated following more traditional land uses such as agriculture or pasture. 7. Synthesis and applications. To achieve large‐scale restoration targets, Guyana and other Amazonian countries will be challenged to remediate previously mined lands. The recovery process is highly dependent on nitrogen availability rather than mercury contamination, affecting woody biomass regrowth. The significant recovery in overburden zones indicates that one potential active remediation strategy to promote biomass recovery may be to backfill mining pits and ponds with excavated soil

Different methodological approaches to the assessment of in vivo efficacy of three artemisinin-based combination antimalarial treatments for the treatment of uncomplicated falciparum malaria in African children.

BACKGROUND: Use of different methods for assessing the efficacy of artemisinin-based combination antimalarial treatments (ACTs) will result in different estimates being reported, with implications for changes in treatment policy. METHODS: Data from different in vivo studies of ACT treatment of uncomplicated falciparum malaria were combined in a single database. Efficacy at day 28 corrected by PCR genotyping was estimated using four methods. In the first two methods, failure rates were calculated as proportions with either (1a) reinfections excluded from the analysis (standard WHO per-protocol analysis) or (1b) reinfections considered as treatment successes. In the second two methods, failure rates were estimated using the Kaplan-Meier product limit formula using either (2a) WHO (2001) definitions of failure, or (2b) failure defined using parasitological criteria only. RESULTS: Data analysed represented 2926 patients from 17 studies in nine African countries. Three ACTs were studied: artesunate-amodiaquine (AS+AQ, N = 1702), artesunate-sulphadoxine-pyrimethamine (AS+SP, N = 706) and artemether-lumefantrine (AL, N = 518).Using method (1a), the day 28 failure rates ranged from 0% to 39.3% for AS+AQ treatment, from 1.0% to 33.3% for AS+SP treatment and from 0% to 3.3% for AL treatment. The median [range] difference in point estimates between method 1a (reference) and the others were: (i) method 1b = 1.3% [0 to 24.8], (ii) method 2a = 1.1% [0 to 21.5], and (iii) method 2b = 0% [-38 to 19.3].The standard per-protocol method (1a) tended to overestimate the risk of failure when compared to alternative methods using the same endpoint definitions (methods 1b and 2a). It either overestimated or underestimated the risk when endpoints based on parasitological rather than clinical criteria were applied. The standard method was also associated with a 34% reduction in the number of patients evaluated compared to the number of patients enrolled. Only 2% of the sample size was lost when failures were classified on the first day of parasite recurrence and survival analytical methods were used. CONCLUSION: The primary purpose of an in vivo study should be to provide a precise estimate of the risk of antimalarial treatment failure due to drug resistance. Use of survival analysis is the most appropriate way to estimate failure rates with parasitological recurrence classified as treatment failure on the day it occurs

Sorting nexin-27 regulates AMPA receptor trafficking through the synaptic adhesion protein LRFN2

The endosome-associated cargo adaptor sorting nexin-27 (SNX27) is linked to various neuropathologies through sorting of integral proteins to the synaptic surface, most notably AMPA receptors. To provide a broader view of SNX27-associated pathologies, we performed proteomics in rat primary neurons to identify SNX27-dependent cargoes, and identified proteins linked to excitotoxicity, epilepsy, intellectual disabilities, and working memory deficits. Focusing on the synaptic adhesion molecule LRFN2, we established that SNX27 binds to LRFN2 and regulates its endosomal sorting. Furthermore, LRFN2 associates with AMPA receptors and knockdown of LRFN2 results in decreased surface AMPA receptor expression, reduced synaptic activity, and attenuated hippocampal long-term potentiation. Overall, our study provides an additional mechanism by which SNX27 can control AMPA receptor-mediated synaptic transmission and plasticity indirectly through the sorting of LRFN2 and offers molecular insight into the perturbed function of SNX27 and LRFN2 in a range of neurological conditions

Peer-led walking programme to increase physical activity in inactive 60- to 70-year-olds: Walk with Me pilot RCT

Background Levels of physical activity decline with age. Some of the most disadvantaged individuals in society, such as those with a lower rather than a higher socioeconomic position, are also the most inactive. Peer-led physical activity interventions may offer a model to increase physical activity in these older adults and thus help reduce associated health inequalities. This study aims to develop and test the feasibility of a peer-led, multicomponent physical activity intervention in socioeconomically disadvantaged community-dwelling older adults. Objectives The study aimed to develop a peer-led intervention through a rapid review of previous peer-led interventions and interviews with members of the target population. A proposed protocol to evaluate its effectiveness was tested in a pilot randomised controlled trial (RCT). Design A rapid review of the literature and the pilot study informed the intervention design; a pilot RCT included a process evaluation of intervention delivery. Setting Socioeconomically disadvantaged communities in the South Eastern Health and Social Care Trust and the Northern Health and Social Care Trust in Northern Ireland. Participants Fifty adults aged 60–70 years, with low levels of physical activity, living in socioeconomically disadvantaged communities, recruited though community organisations and general practices. Interventions ‘Walk with Me’ is a 12-week peer-led walking intervention based on social cognitive theory. Participants met weekly with peer mentors. During the initial period (weeks 1–4), each intervention group participant wore a pedometer and set weekly step goals with their mentor’s support. During weeks 5–8 participants and mentors met regularly to walk and discuss step goals and barriers to increasing physical activity. In the final phase (weeks 9–12), participants and mentors continued to set step goals and planned activities to maintain their activity levels beyond the intervention period. The control group received only an information booklet on active ageing. Main outcome measures Rates of recruitment, retention of participants and completeness of the primary outcome [moderate- and vigorous-intensity physical activity measured using an ActiGraph GT3X+ accelerometer (ActiGraph, LLC, Pensacola, FL, USA) at baseline, 12 weeks (post intervention) and 6 months]; acceptability assessed through interviews with participants and mentors. Results The study planned to recruit 60 participants. In fact, 50 eligible individuals participated, of whom 66% (33/50) were female and 80% (40/50) were recruited from general practices. At 6 months, 86% (43/50) attended for review, 93% (40/43) of whom returned valid accelerometer data. Intervention fidelity was assessed by using weekly step diaries, which were completed by both mentors and participants for all 12 weeks, and checklists for the level of delivery of intervention components, which was high for the first 3 weeks (range 49–83%). However, the rate of return of checklists by both mentors and participants diminished thereafter. Outcome data indicate that a sample size of 214 is required for a definitive trial. Limitations The sample was predominantly female and somewhat active. Conclusions The ‘Walk with Me’ intervention is acceptable to a socioeconomically disadvantaged community of older adults and a definitive RCT to evaluate its effectiveness is feasible. Some modifications are required to ensure fidelity of intervention delivery is optimised. Future research needs to identify methods to recruit males and less active older adults into physical activity interventions

Social marketing and social influences: Using social ecology as a theoretical framework

Social marketing has traditionally been dominated by an individualistic model of design. In this work, the authors apply a social ecology model to the theory and practice of social marketing, demonstrating that a multilevel framework is required to fully expose and account for the complexity of sociocultural and environmental effects. The authors have generated a diagnostic tool for this use. The paper then provides a detailed demonstration of the potential power of the tool by applying it to three illustrative case studies: one on encouraging safer driving, the second promoting sustainable travel, and the third increasing early detection of lung cancer. © 2010 Westburn Publishers Ltd

<i>WhatsApp</i> use among African international distance education (IDE) students: transferring, translating and transforming educational experiences

Much of the research on how social media is embedded into the educational practices of higher education students has a Western orientation. In concentrating on a case study of the varied ways in which African International Distance Education (IDE) students actively use social media to shape their learning experiences, we discuss an under-researched group. The paper draws on analysis of 1295 online questionnaires and 165 in-depth interviews with IDE students at UNISA, South Africa, one of the largest providers of IDE globally. WhatsApp emerges as ‘the’ key social media tool that opens up opportunities for IDE students to transfer, translate and transform their educational journey when studying ‘at a distance’. Although WhatsApp does provide a ‘space of opportunity’ for some students, this is framed through socio-technical marginalisation, itself a reflection of demographic legacies of inequality. Exploring social media practices though the case of African IDE students places these students centre stage and adds to the awareness of the multiple centres from which international education is practiced