Patients’ perspectives on the medical primary-secondary care interface : systematic review and synthesis of qualitative research

Funding NHS Highland Research, Development & Innovation Department, Aberdeen University, and Stirling University provided funds to meet publication costs.Peer reviewedPublisher PD

Managing Supply Chain Networks: A Framework for Achieving Superior Performance through Leadership Capabilities Development in Supply Chain Node

Leadership capability is acknowledged as a major challenge for organizations and a pre-requisite for sustaining high levels of organizational performance and supply chain competitiveness. Recent research highlights how globalisation has led to the extension of domestic supply chains, particularly SME ones, to include both suppliers and customers globally. This paper examines the role capabilities development in managers and leaders as nexus of their supply chain networks have to play in achieving better performance through case studies. Once banished to the backburners of business management thinking, leveraging core leadership competencies is now critical to company‟s superior performance in supply chain networks

Aligned macroporous monoliths with intrinsic microporosity via a frozen-solvent-templating approachd

Aligned macroporous monoliths of an organic cage, a polymer of intrinsic microporosity (PIM-1), and a metal–organic framework (HKUST-1) are prepared by a controlled freezing approach. In addition to macropores, all the monoliths contain the intrinsic micropores.</p

Shape and intrusion history of the Late Caledonian Newry Igneous Complex, Northern Ireland

The Tellus high-resolution airborne magnetic and radiometric maps define previously unmapped zones within the Newry Igneous Complex, County Down. High-precision uranium–lead zircon dating of nine rock samples from different parts of the complex provides a robust set of age constraints (c.414–407 Ma), which confirm that the different plutons of the complex young towards the south-west. Combined, these new data allow an innovative model of intrusion to be developed, with intrusion beginning in the north-east and progressing towards the south-west

Warm Molecular Hydrogen in the Galactic Wind of M82

We report the detection of a complex of extraplanar warm H_2 knots and filaments extending more than ~3 kpc above and below the galactic plane of M82, roughly coincident with the well-known galactic wind in this system. Comparisons of these data with published results at other wavelengths provide quantitative constraints on the topology, excitation, heating, and stability against disruption of the wind-entrained molecular ISM in this prototypical galactic wind. Deep H_2 2.12 um observations such as these represent a promising new method to study the elusive but potentially important molecular component of galactic winds.Comment: Accepted for publication in the Astrophysical Journal Letters. Paper with high-resolution figures is available at http://www.astro.umd.edu/~veilleux/pubs/m82.pd

Development of a brief, reliable and valid diet assessment tool for impaired glucose tolerance and diabetes:The UK Diabetes and Diet Questionnaire

OBJECTIVE: Dietary advice is fundamental in the prevention and management of type 2 diabetes (T2DM). Advice is improved by individual assessment but existing methods are time-consuming and require expertise. We developed a twenty-five-item questionnaire, the UK Diabetes and Diet Questionnaire (UKDDQ), for quick assessment of an individual’s diet. The present study examined the UKDDQ’s repeatability and relative validity compared with 4 d food diaries. DESIGN: The UKDDQ was completed twice with a median 3 d gap (interquartile range=1–7 d) between tests. A 4 d food diary was completed after the second UKDDQ. Diaries were analysed and food groups were mapped on to the UKDDQ. Absolute agreement between total scores was examined using intra-class correlation (ICC). Agreement for individual items was tested with Cohen’s weighted kappa (κ (w)). SETTING: South West of England. SUBJECTS: Adults (n 177, 50·3 % women) with, or at high risk for, T2DM; mean age 55·8 (sd 8·6) years, mean BMI 34·4 (sd 7·3) kg/m(2); participants were 91 % White British. RESULTS: The UKDDQ showed excellent repeatability (ICC=0·90 (0·82, 0·94)). For individual items, κ (w) ranged from 0·43 (‘savoury pastries’) to 0·87 (‘vegetables’). Total scores from the UKDDQ and food diaries compared well (ICC=0·54 (0·27, 0·70)). Agreement for individual items varied and was good for ‘alcohol’ (κ (w)=0·71) and ‘breakfast cereals’ (κ (w)=0·70), with no agreement for ‘vegetables’ (κ (w)=0·08) or ‘savoury pastries’ (κ (w)=0·09). CONCLUSIONS: The UKDDQ is a new British dietary questionnaire with excellent repeatability. Comparisons with food diaries found agreements similar to those for international dietary questionnaires currently in use. It targets foods and habits important in diabetes prevention and management

The Impact of Sleep Debt on Excess Adiposity and Insulin Sensitivity in Patients with Early Type 2 Diabetes Mellitus

STUDY OBJECTIVES: We examined cross-sectional and prospective associations between sleep debt and adiposity measures, as well as homeostatic model assessment-insulin resistance (HOMA-IR) in early type 2 diabetes. METHODS: Prospective data analysis from participants of a randomized controlled trial based on an intensive lifestyle intervention (usual care, diet, or diet and physical activity). Data were collected at baseline, 6 months, and 12 months post-intervention. The study was performed across five secondary care centers in the United Kingdom. Patients (n = 593) with a recent diagnosis of type 2 diabetes were recruited. Objective height and weight were ascertained for obesity status (body mass index [BMI]; ≥ 30 kg/m(2)), waist circumference (cm) for central adiposity, and fasting blood samples drawn to examine insulin resistance (IR). Seven-day sleep diaries were used to calculate weekday sleep debt at baseline, calculated as average weekend sleep duration minus average weekday sleep duration. RESULTS: At baseline, compared to those without weekday sleep debt, those with weekday sleep debt were 72% more likely to be obese (OR = 1.72 [95% CI:1.03–2.88]). At six months, weekday sleep debt was significantly associated with obesity and IR after adjustment, OR = 1.90 (95% CI:1.10–3.30), OR = 2.07 (95% CI:1.02–4.22), respectively. A further increase at 12 months was observed for sleep debt with obesity and IR: OR = 2.10 (95% CI:1.14–3.87), OR = 3.16 (95% CI:1.38–7.24), respectively. For every 30 minutes of weekday sleep debt, the risk of obesity and IR at 12 months increased by 18% and 41%, respectively. CONCLUSIONS: Sleep debt resulted in long-term metabolic disruption, which may promote the progression of type 2 diabetes in newly diagnosed patients. Sleep hygiene/education could be an important factor for future interventions to target early diabetes. CITATION: Arora T, Chen MZ, Cooper AR, Andrews RC, Taheri S. The impact of sleep debt on excess adiposity and insulin sensitivity in patients with early type 2 diabetes mellitus. J Clin Sleep Med 2016;12(5):673–680

Behaviour change techniques in brief interventions to prevent HIV, STI and unintended pregnancies : a systematic review

Background : Behaviour-change interventions have been consistently considered an essential part of comprehensive HIV, STI and unintended pregnancy prevention. In 2015, the World Health Organization reviewed and assessed existing evidence on brief behavioural interventions, leading to the publication of Brief sexuality-related communication: recommendations for a public health approach. This guideline recommends the use of brief behaviour intervention and communication programmes to promote sexual health and to prevent HIV, STIs, and unintended pregnancies in primary health services, particularly sexual and reproductive health services. Objective : With the purpose of informing the development of a brief behaviour intervention in sexual and reproductive health, we conducted a systematic review of brief intervention to prevent HIV, STI and unintended pregnancies, to identify behaviour change techniques (BCTs) used in health care settings. Methods : Participants from all ages and genders were included. Brief interventions delivered in <= 60 minutes were included. Data was extracted, and interventions were coded following the Behaviour Change Techniques Taxonomy (BCTTv1) guidelines. Results : Of the 6.687 articles identified, 355 were reviewed and 37 studies were included. In effective interventions, we identified 48 behaviour change techniques (BCTs). A core set of 8 frequently used behaviour change techniques was identified: "Problem solving", "Feedback on behaviour", "Social support (unspecified)", "Instructions on how to perform the behaviour", "Information about health consequences", "Information about social and environmental consequences", "Demonstration of the behaviour" and "Credible source". Conclusions : The technical content of brief behaviour interventions was identified in a reliable and standardized way providing preliminary indications on potentially effective techniques to achieve behaviour change

Porous organic cages for sulfur hexafluoride separation

A series of porous organic cages is examined for the selective adsorption of sulfur hexafluoride (SF6) over nitrogen. Despite lacking any metal sites, a porous cage, CC3, shows the highest SF6/N2 selectivity reported for any material at ambient temperature and pressure, which translates to real separations in a gas breakthrough column. The SF6 uptake of these materials is considerably higher than would be expected from the static pore structures. The location of SF6 within these materials is elucidated by X-ray crystallography, and it is shown that cooperative diffusion and structural rearrangements in these molecular crystals can rationalize their superior SF6/N2 selectivity

Psychiatry, subjectivity and emotion - deepening the medical model

Morale among psychiatrists continues to be seriously challenged in the face of recruitment difficulties, unfilled posts, diagnostic controversies, service reconfigurations and public criticism of psychiatric care, in addition to other difficulties. In this article, we argue that the positivist paradigm that continues to dominate British psychiatry has led to an undervaluing of subjectivity and of the role of emotions within psychiatric training and practice. Reintegrating the subjective perspective and promoting emotional awareness and reflection may go some way towards restoring faith in the psychiatric specialty