Self-care coping strategies in people with diabetes: a qualitative exploratory study

<p>Abstract</p> <p>Background</p> <p>The management of diabetes self-care is largely the responsibility of the patient. With more emphasis on the prevention of complications, adherence to diabetes self-care regimens can be difficult. Diabetes self-care requires the patient to make many dietary and lifestyle changes. This study will explore patient perceptions of diabetes self-care, with particular reference to the burden of self-care and coping strategies among patients.</p> <p>Methods</p> <p>A maximum variation sample of 17 patients was selected from GP practices and diabetes clinics in Ireland to include patients with types 1 and 2 diabetes, various self-care regimens, and a range of diabetes complications. Data were collected by in-depth interviews; which were tape-recorded and transcribed. The transcripts were analysed using open and axial coding procedures to identify main categories, and were reviewed by an independent corroborator. Discussion of the results is made in the theoretical context of the health belief, health value, self-efficacy, and locus of control frameworks.</p> <p>Results</p> <p>Patients' perceptions of their self-care varied on a spectrum, displaying differences in self-care responsibilities such as competence with dietary planning, testing blood sugar and regular exercise. Three patient types could be distinguished, which were labeled: "proactive manager," a patient who independently monitors blood glucose and adjusts his/her self-care regime to maintain metabolic control; "passive follower," a patient who follows his/her prescribed self-care regime, but does not react autonomously to changes in metabolic control; and "nonconformist," a patient who does not follow most of his/her prescribed self-care regimen.</p> <p>Conclusion</p> <p>Patients have different diabetes self-care coping strategies which are influenced by their self-care health value and consequently may affect their diet and exercise choices, frequency of blood glucose monitoring, and compliance with prescribed medication regimens. Particular attention should be paid to the patient's self-care coping strategy, and self-care protocols should be tailored to complement the different patient types.</p

Thermal transport measurements of individual multiwalled nanotubes

The thermal conductivity and thermoelectric power of a single carbon nanotube were measured using a microfabricated suspended device. The observed thermal conductivity is more than 3000 W/K m at room temperature, which is two orders of magnitude higher than the estimation from previous experiments that used macroscopic mat samples. The temperature dependence of the thermal conductivity of nanotubes exhibits a peak at 320 K due to the onset of Umklapp phonon scattering. The measured thermoelectric power shows linear temperature dependence with a value of 80 $\mu$V/K at room temperature.Comment: 4 pages, figures include

Design by immersion: A transdisciplinary approach to problem-driven visualizations

While previous work exists on how to conduct and disseminate insights from problem-driven visualization work and design studies, the literature does not address how to accomplish these goals in transdisciplinary teams in ways that advance all disciplines involved. In this paper we introduce and define a new methodological paradigm we call design by immersion, which provides an alternative perspective on problem-driven visualization work. Design by immersion embeds transdisciplinary experiences at the center of the visualization process by having visualization researchers participate in the work of the target domain (or domain experts participate in visualization research). Based on our own combined experiences of working on cross-disciplinary, problem-driven visualization projects, we present six case studies that expose the opportunities that design by immersion enables, including (1) exploring new domain-inspired visualization design spaces, (2) enriching domain understanding through personal experiences, and (3) building strong transdisciplinary relationships. Furthermore, we illustrate how the process of design by immersion opens up a diverse set of design activities that can be combined in different ways depending on the type of collaboration, project, and goals. Finally, we discuss the challenges and potential pitfalls of design by immersion

Assessing Medical Student Fear and Shame as Barriers to Active Participation on the Wards

**Purpose**: Imposter syndrome is common among medical trainees, who have been shown to experience self-doubt and burnout at alarming rates. Trainees also experience anxiety and fear about asking and answering questions on their clinical rotations, which may affect engagement and ability to learn. This study seeks to characterize fear and shame that fourth year medical students have felt during their time on clinical rotations, as well as the effect that this has had on their willingness to participate in clinical discussions. **Method**: The authors sent a survey to all fourth-year medical students at a US medical school. Survey questions included assessment of experiencing fear and anxiety while being asked questions during ward rounds. Students completed the survey using a web link to 10 questions on a 5-point Likert scale. **Results**: 58 students completed the questionnaire. Fifty one (87.9%) of the students responded they experienced stress or anxiety when an attending physician asked them questions at least sometimes. Forty five (77.6%) experienced fear when questioned on rounds. Fourty four (75.9%) did not answer questions for fear of being wrong and exposing lack of knowledge. Thirty five (60.3%) experienced shame when questioned on rounds. Over 50% reported they were afraid to answer questions in specialties they were interested in. Most cited specialties that caused fear were Internal Medicine, Emergency Medicine, Surgery, and Obstetrics and Gynecology. **Conclusions**: Though attempts are being made to improve the clinical learning environment and reduce the effects of imposter syndrome and anxiety in medical education, fear still plays a role in medical students' minds when choosing to ask or answer questions on the wards. Larger studies are needed to further look at the prevalence of this phenomenon and efforts should continue to be made to mitigate fear on the wards

Development of a method for the determination of ultra-trace level mercury in adipose tissue by cold vapour atomic fluorescence spectrometry

A method for the determination of total mercury in rat adipose tissue by cold vapour atomic fluorescence spectrometry (CVAFS) has been developed. Adipose samples were initially subjected to a lyophilization procedure in order to facilitate the homogenization and accurate weighing of small tissue aliquots (~50 mg). A closed vessel microwave digestion procedure using a mixture of sulphuric and nitric acids was used to liberate mercury from the adipose matrix. All mercury species were quantitatively oxidized to Hg(II) by a potassium bromate/bromide oxidation, then reduced to Hg(0) vapour by stannous chloride prior to fluorescence detection. The CVAFS exhibited a linear range of 10 pg Hg/ml to 120 pg Hg/ml. The method detection limit in solution was 2 pg Hg/ml, or 1 ng Hg/g adipose tissue, based on a nominal 50 mg sample and a final volume of 25 ml. A reference material from the National Research Council of Canada (DOLT-2, trace metals in dogfish liver) was prepared in quadruplicate in order to assess the accuracy and precision of the method. Mercury in this material was recovered at 2.22 ± 0.08 μ g/g, which is 104% of the certified level (2.14 ± 0.10 μ g/g)

Invariant classification and the generalised invariant formalism: conformally flat pure radiation metrics, with zero cosmological constant

Metrics obtained by integrating within the generalised invariant formalism are structured around their intrinsic coordinates, and this considerably simplifies their invariant classification and symmetry analysis. We illustrate this by presenting a simple and transparent complete invariant classification of the conformally flat pure radiation metrics (except plane waves) in such intrinsic coordinates; in particular we confirm that the three apparently non-redundant functions of one variable are genuinely non-redundant, and easily identify the subclasses which admit a Killing and/or a homothetic Killing vector. Most of our results agree with the earlier classification carried out by Skea in the different Koutras-McIntosh coordinates, which required much more involved calculations; but there are some subtle differences. Therefore, we also rework the classification in the Koutras-McIntosh coordinates, and by paying attention to some of the subtleties involving arbitrary functions, we are able to obtain complete agreement with the results obtained in intrinsic coordinates. In particular, we have corrected and completed statements and results by Edgar and Vickers, and by Skea, about the orders of Cartan invariants at which particular information becomes available.Comment: Extended version of GRG publication, with some typos etc correcte

Invariant construction of solutions to Einstein's field equations - LRS perfect fluids II

The properties of LRS class II perfect fluid space-times are analyzed using the description of geometries in terms of the Riemann tensor and a finite number of its covariant derivatives. In this manner it is straightforward to obtain the plane and hyperbolic analogues to the spherical symmetric case. For spherically symmetric static models the set of equations is reduced to the Tolman-Oppenheimer-Volkoff equation only. Some new non-stationary and inhomogeneous solutions with shear, expansion, and acceleration of the fluid are presented. Among these are a class of temporally self-similar solutions with equation of state given by $p=(\gamma-1)\mu, 1<\gamma<2$, and a class of solutions characterized by $\sigma=-\Theta/6$. We give an example of geometry where the Riemann tensor and the Ricci rotation coefficients are not sufficient to give a complete description of the geometry. Using an extension of the method, we find the full metric in terms of curvature quantities.Comment: 24 pages, 1 figur

Real-Time Feedback of Air Quality in Children’s Bedrooms Reduces Exposure to Secondhand Smoke

Introduction:Secondhand smoke (SHS) exposure creates health risks for nonsmokers and is especially detrimental to children. This study evaluated whether immediate feedback in response to poor indoor air quality in children’s bedrooms can reduce the potential for SHS exposure, as measured by adherence to a World Health Organization (WHO) indoor air standard.Methods:Homes that contained children and an adult who regularly smoked inside (n=298) had an air particle monitor installed in the child’s bedroom. These devices measured the concentration of particulate matter (PM2.5) for approximately three months and, for half of the participants, immediately provided aversive feedback in response to elevated PM2.5. Hierarchical linear models were fit to the data to assess whether the intervention increased the probability that: 1) a given day was below the WHO guideline for daily exposure, and 2) a household established and maintained a smoke-free home (SFH), operationalized as achieving 30 consecutive days below the WHO guideline. The intervention’s impact was calculated as groupby- time effects.Results:The likelihood that a child’s bedroom met the WHO indoor air quality standard on a given day increased such that the baseline versus post-baseline odds ratio (OR) of maintaining indoor PM2.5 levels below the WHO guideline was 2.38 times larger for participants who received the intervention. Similarly, the baseline versus post-baseline OR associated with achieving an SFH was 3.49 times larger for participants in the intervention group.Conclusions:The real-time intervention successfully drove clinically meaningful changes in smoking behavior that mitigated indoor PM2.5 levels in children’s bedrooms and thereby reduced SHS exposure. These results demonstrate the effectiveness of targeting sensitive microenvironments by giving caregivers actionable information about children’s SHS risks. Future extensions should examine additional microenvironments and focus on identifying the potential for SHS exposure before it occurs