Variation in the achievement of HbA1c, blood pressure and LDL cholesterol targets in type 2 diabetes in general practice and characteristics associated with risk factor control.

Aims To identify population, general practitioner, and practice characteristics associated with the achievement of HbA1c, blood pressure and LDL cholesterol targets, and to describe variation in the achievement of risk factor control. Methods We conducted a cross‐sectional survey of 9342 people with type 2 diabetes, 281 general practitioners and 77 general practices in Norway. Missing values (7.4%) were imputed using multiple imputation by chained equations. We used three‐level logistic regression with the achievement of HbA1c, blood pressure and LDL cholesterol targets as dependent variables, and factors related to population, general practitioners, and practices as independent variables. Results Treatment targets were achieved for HbA1c in 64%, blood pressure in 50%, and LDL cholesterol in 52% of people with type 2 diabetes, and 17% met all three targets. There was substantial heterogeneity in target achievement among general practitioners and among practices; the estimated proportion of a GPs diabetes population at target was 55–73% (10–90 percentiles) for HbA1c, 36–63% for blood pressure, and 47–57% for LDL cholesterol targets. The models explained 11%, 5% and 14%, respectively, of the total variation in the achievement of HbA1c, blood pressure and LDL cholesterol targets. Use among general practitioners of a structured diabetes form was associated with 23% higher odds of achieving the HbA1c target (odds ratio 1.23, 95% confidence interval (CI) 1.02–1.47) and 17% higher odds of achieving the LDL cholesterol target (odds ratio 1.17, 95% CI 1.01–1.35). Conclusions Clinical diabetes management is difficult, and few people meet all three risk factor control targets. The proportion of people reaching target varied among general practitioners and practices. Several population, general practitioner and practice characteristics only explained a small part of the total variation. The use of a structured diabetes form is recommended.publishedVersio

Development of a framework for radiographer online clinical education (FORCE): the specifc strand of nuclear medicine within this european project

The overall aim of the FORCE project is to develop virtual web-based learning resources where Radiography undergraduates can engage in interactive, problem-based development of radiographic knowledge, ability and professional awareness. This European-funded project is internally divided in three diferent strands (Radiology Diagnostic Imaging, Radiotherapy and Nuclear Medicine). The aim of this presentation is to present the global project, mainly focusing developments, achievements and challenges within the Nuclear Medicine specifc strand.info:eu-repo/semantics/publishedVersio

The added value of immediate breast reconstruction to health-related quality of life of breast cancer patients

Background: Postmastectomy immediate breast reconstruction (IBR) may improve the quality of life (QoL) of breast cancer patients. Guidelines recommend to discuss the option IBR with all patients undergoing mastectomy. However, substantial hospital variation in IBR-rates was previously observed in the Netherlands, influenced by patient, tumour and hospital factors and clinicians’ believes. Information provision about IBR may have a positive effect on receiving IBR and therefore QoL. This study investigated patient-reported QoL of patients treated with mastectomy with and without IBR. Methods: An online survey, encompassing the validated BREAST-Q questionnaire, was distributed to a representative sample of 1218 breast cancer patients treated with mastectomy. BREAST-Q scores were compared between patients who had undergone mastectomy either with or without IBR. Results: A total of 445 patients were included for analyses: 281 patients with and 164 without IBR. Patients who had received IBR showed significantly higher BREAST-Q scores on “psychosocial well-being” (75 versus 67, p < 0.001), “sexual well-being” (62 versus 52, p < 0.001) and “physical well-being” (77 versus 74, p = 0.021) compared to patients without IBR. No statistically significant difference was found for “satisfaction with breasts” (64 versus 62, p = 0.21). Similar results were found after multivariate regression analyses, revealing IBR to be an independent factor for a better patient-reported QoL. Conclusions: Patients diagnosed with breast cancer with IBR following mastectomy report a better QoL on important psychosocial, sexual and physical well-being domains. This further supports the recommendation to discuss the option of IBR with all patients with an indication for mastectomy and to enable shared decision-making

Neutron-proton effective mass splitting and thermal evolution in neutron rich matter

The thermal evolution of properties of neutron rich asymmetric nuclear matter such as entropy density, internal energy density, free energy density and pressure are studied in the non-relativistic mean field theory using finite range effective interactions. In this framework the thermal evolution of nuclear matter properties is directly connected to the neutron and proton effective mass properties. Depending on the magnitude of neutron-proton effective mass splittings, two distinct behaviours in the thermal evolution of nuclear matter properties are noticed.Comment: 19 pages, 9 figures, Submitted to J.Phys.G:Nucl.Part.Phy

Phase transitions of hadronic to quark matter at finite T and \mu_B

The phase transition of hadronic to quark matter and the boundaries of the mixed hadron-quark coexistence phase are studied within the two Equation of State (EoS) model. The relativistic effective mean field approach with constant and density dependent meson-nucleon couplings is used to describe hadronic matter, and the MIT Bag model is adopted to describe quark matter. The boundaries of the mixed phase for different Bag constants are obtained solving the Gibbs equations. We notice that the dependence on the Bag parameter of the critical temperatures (at zero chemical potential) can be well reproduced by a fermion ultrarelativistic quark gas model, without contribution from the hadron part. At variance the critical chemical potentials (at zero temperature) are very sensitive to the EoS of the hadron sector. Hence the study of the hadronic EoS is much more relevant for the determination of the transition to the quark-gluon-plasma at finite baryon density and low-T. Moreover in the low temperature and finite chemical potential region no solutions of the Gibbs conditions are existing for small Bag constant values, B < (135 MeV)^4. Isospin effects in asymmetric matter appear relevant in the high chemical potential regions at lower temperatures, of interest for the inner core properties of neutron stars and for heavy ion collisions at intermediate energies.Comment: 24 pages and 16 figures (revtex4

Allosteric control of Ubp6 and the proteasome via a bidirectional switch

The interplay of the proteasome and deubiquitinase Ubp6 is crucial for the degradation of ubiquitylated substrates. Here, the authors provide structural insights into the allosteric mechanism by which the activities of both Ubp6 and the proteasome are regulated. The proteasome recognizes ubiquitinated proteins and can also edit ubiquitin marks, allowing substrates to be rejected based on ubiquitin chain topology. In yeast, editing is mediated by deubiquitinating enzyme Ubp6. The proteasome activates Ubp6, whereas Ubp6 inhibits the proteasome through deubiquitination and a noncatalytic effect. Here, we report cryo-EM structures of the proteasome bound to Ubp6, based on which we identify mutants in Ubp6 and proteasome subunit Rpt1 that abrogate Ubp6 activation. The Ubp6 mutations define a conserved region that we term the ILR element. The ILR is found within the BL1 loop, which obstructs the catalytic groove in free Ubp6. Rpt1-ILR interaction opens the groove by rearranging not only BL1 but also a previously undescribed network of three interconnected active-site-blocking loops. Ubp6 activation and noncatalytic proteasome inhibition are linked in that they are eliminated by the same mutations. Ubp6 and ubiquitin together drive proteasomes into a unique conformation associated with proteasome inhibition. Thus, a multicomponent allosteric switch exerts simultaneous control over both Ubp6 and the proteasome

What factors influence training opportunities for older workers? Three factorial surveys exploring the attitudes of HR professionals

The core research questions addressed in this paper are: what factors influence HR professionals in deciding whether to approve training proposals for older workers? What kind of training are they more likely to recommend for older employees and in which organizational contexts? We administered three factorial surveys to 66 HR professionals in Italy. Participants made specific training decisions based on profiles of hypothetical older workers. Multilevel analyses indicated that access to training decreases strongly with age, while highly-skilled older employees with low absenteeism rates are more likely to enjoy training opportunities. In addition, older workers displaying positive performance are more likely to receive training than older workers who perform poorly, suggesting that training late in working life may serve as a reward for good performance rather than as a means of enhancing productivity. The older the HR professional evaluating training proposals, the higher the probability that older workers will be recommended for training. keywords: training; older workers; HR professionals; factorial survey; multilevel model

Minimal Cooling of Neutron Stars: A New Paradigm

A new classification of neutron star cooling scenarios, involving either ``minimal'' cooling or ``enhanced'' cooling is proposed. The minimal cooling scenario replaces and extends the so-called standard cooling scenario to include neutrino emission from the Cooper pair breaking and formation process. This emission dominates that due to the modified Urca process for temperatures close to the critical temperature for superfluid pairing. Minimal cooling is distinguished from enhanced cooling by the absence of neutrino emission from any direct Urca process, due either to nucleons or to exotica. Within the minimal cooling scenario, theoretical cooling models can be considered to be a four parameter family involving the equation of state of dense matter, superfluid properties of dense matter, the composition of the neutron star envelope, and the mass of the neutron star. Consequences of minimal cooling are explored through extensive variations of these parameters. Results are compared with the inferred properties of thermally-emitting neutron stars in order to ascertain if enhanced cooling occurs in any of them. All stars for which thermal emissions have been clearly detected are at least marginally consistent with the lack of enhanced cooling. The two pulsars PSR 0833-45 (Vela) and PSR 1706-44 would require enhanced cooling in case their ages and/or temperatures are on the lower side of their estimated values whereas the four stars PSR 0656+14, PSR 1055-52, Geminga, and RX J0720.4-3125 may require some source of internal heating in case their age and/or luminosity are on the upper side of their estimated values. The new upper limits on the thermal luminosity of PSR J0205+6449 and RX J0007.0+7302 are indicative of the occurrence of some enhanced neutrino emission beyond the minimal scenario.Comment: Version to appear in ApJ Supplements. Minor modifications in text and discussion of updated data with new figure

Impact of age norms and stereotypes on managers' hiring decisions of retirees

Purpose -Our study investigates the role of managers in the re-employment of early retirees and asks what the effect is of managers’ age norms and stereotypes on managers’ employment decisions. Design/methodology/approach- A combination of a factorial study and a survey was conducted. First, information on the age norms and stereotypes was collected. Secondly, profiles of hypothetical retired job applicants were presented to the employers, who were asked to make a specific hiring decision. The information collected during both studies was combined in the analysis and multilevel models were estimated. Findings -The results indicate that higher age norms result in a higher propensity to hire an early retiree. Stereotypes, by contrast, do not influence managers’ decisions. Early retirees’ chances for re-employment are also related to their own circumstances (physical appearance and relevant experience) and organisational forces, as they are hired when organisations face labour force shortages. Research limitation / implications – with the use of vignettes study we deal with hypothetical hiring situation. Originality value- Although the effect of age norms and age stereotypes has been often suggested, not much empirical evidence was presented to support this notion. Our study estimates the effect of age norms and stereotypes on hiring decision. key words: bridge employment; early retirees; age norms; age stereotypes; multilevel models.