Diabetes self-management arrangements in Europe: a realist review to facilitate a project implemented in six countries

Background: Self-management of long term conditions can promote quality of life whilst delivering benefits to the financing of health care systems. However, rarely are the meso-level influences, likely to be of direct relevance to these desired outcomes, systematically explored. No specific international guidelines exist suggesting the features of the most appropriate structure and organisation of health care systems within which to situate self-management approaches and practices. This review aimed to identify the quantitative literature with regard to diabetes self-management arrangements currently in place within the health care systems of six countries (The United Kingdom, The Netherlands, Norway, Spain, Bulgaria, and Greece) and explore how these are integrated into the broader health care and welfare systems in each country. Methods: The methodology for a realist review was followed. Publications of interest dating from 2000 to 2013 were identified through appropriate MeSH terms by a systematic search in six bibliographic databases. A search diary was maintained and the studies were assessed for their quality and risk of bias. Results: Following the multi-step search strategy, 56 studies were included in the final review (the majority from the UK) reporting design methods and findings on 21 interventions and programmes for diabetes and chronic disease self-management. Most (11/21, 52%) of the interventions were designed to fit within the context of primary care. The majority (11/21, 52%) highlighted behavioural change as an important goal. Finally, some (5/21, 24%) referred explicitly to Internet-based tools. Conclusions: This review is based on results which are derived from a total of at least 5,500 individuals residing in the six participating countries. It indicates a policy shift towards patient-centred self-management of diabetes in a primary care context. The professional role of diabetes specialist nurses, the need for multidisciplinary approaches and a focus on patient education emerge as fundamental principles in the design of relevant programmes. Socio-economic circumstances are relevant to the capacity to self-manage and suggest that any gains and progress will be hard to maintain during economic austerity. This realist review should be interpreted within the wider context of a whole systems approach regarding self-care support and chronic illness management

Improved Stability of Polymer Solar Cells in Ambient Air via Atomic Layer Deposition of Ultrathin Dielectric Layers

Polymer solar cells have attracted tremendous interest in the highly competitive solar energy sector, due to the practical advantages they exhibit, such as being lightweight, flexible, and low cost, in stark contrast to traditional photovoltaic technologies. However, their successful commercialization is still hindered by issues related to device instability. Here, atomic layer deposition (ALD) is employed to deposit conformal ultrathin dielectrics, such as alumina (Al2O3) and zirconia (ZrO2), on top of ZnO electron extraction layers to address problems that arise from the defect-rich nature of these layers. The deposition of dielectrics on ZnO significantly improves its interfacial electronic properties, manifested primarily with the decrease in the work function of ZnO and the concomitant reduction of the electron extraction barrier as well as the reduced recombination losses. Significant efficiency enhancement is obtained with the incorporation of six ALD cycles of Al2O3 into inverted devices, using photoactive layers, that consist of poly(3-hexylthiophene):indene-C60-bisadduct or poly({4,8-bis[(2-ethylhexyl)oxy]benzo[1,2-b:4,5-b′]dithiophene-2,6-diyl}{3-fluoro-2-[(2-ethylhexyl)carbonyl] thieno[3,4-b] thiophenediyl}):[6,6]-phenyl-C7 0-butyric acid methyl ester. More importantly, upon performing lifetime studies (over a period of 350 h), a strong improvement in polymer solar cell stability is observed when using the ALD-modified ZnO films. © 2017 WILEY-VCH Verlag GmbH & Co. KGaA, Weinhei

The EPIC nutrient database project (ENDB): a first attempt to standardize nutrient databases across the 10 European countries participating in the EPIC study

Objective: This paper describes the ad hoc methodological concepts and procedures developed to improve the comparability of Nutrient databases ( NDBs) across the 10 European countries participating in the European Prospective Investigation into Cancer and Nutrition ( EPIC). This was required because there is currently no European reference NDB available. Design: A large network involving national compilers, nutritionists and experts on food chemistry and computer science was set up for the ‘EPIC Nutrient DataBase’ ( ENDB) project. A total of 550-1500 foods derived from about 37 000 standardized EPIC 24-h dietary recalls (24-HDRS) were matched as closely as possible to foods available in the 10 national NDBs. The resulting national data sets ( NDS) were then successively documented, standardized and evaluated according to common guidelines and using a DataBase Management System specifically designed for this project. The nutrient values of foods unavailable or not readily available in NDSs were approximated by recipe calculation, weighted averaging or adjustment for weight changes and vitamin/mineral losses, using common algorithms. Results: The final ENDB contains about 550-1500 foods depending on the country and 26 common components. Each component value was documented and standardized for unit, mode of expression, definition and chemical method of analysis, as far as possible. Furthermore, the overall completeness of NDSs was improved (>= 99%), particularly for beta-carotene and vitamin E. Conclusion: The ENDB constitutes a first real attempt to improve the comparability of NDBs across European countries. This methodological work will provide a useful tool for nutritional research as well as end-user recommendations to improve NDBs in the future

Multiple-Input Subject-Specific Modeling of Plasma Glucose Concentration for Feedforward Control

The ability to accurately develop subject-specific, input causation models, for blood glucose concentration (BGC) for large input sets can have a significant impact on tightening control for insulin dependent diabetes. More specifically, for Type 1 diabetics (T1Ds), it can lead to an effective artificial pancreas (i.e., an automatic control system that delivers exogenous insulin) under extreme changes in critical disturbances. These disturbances include food consumption, activity variations, and physiological stress changes. Thus, this paper presents a free-living, outpatient, multiple-input, modeling method for BGC with strong causation attributes that is stable and guards against overfitting to provide an effective modeling approach for feedforward control (FFC). This approach is a Wiener block-oriented methodology, which has unique attributes for meeting critical requirements for effective, long-term, FFC