A needs assessment of people living with diabetes and diabetic retinopathy

BACKGROUND: The Kilimanjaro Diabetic Programme was initiated in response to the needs of people living with diabetes (PWLD) to identify barriers to uptake of screening for diabetic retinopathy, to improve management of diabetes, and establish an affordable, sustainable eye screening and treatment programme for diabetic retinopathy. Intervention Mapping was used as the framework for the needs assessment. METHODS: A mixed methods approach was used. Five psychometric measures, Diabetes Knowledge Questionnaire, Diabetes Health Beliefs, Self-Efficacy scale, Problem Areas in Diabetes scale, and Hopkins Scale Checklist-25 and a structured interview relating to self-efficacy, addressing disclosure of living with diabetes and life-style changes were used to triangulate the quantitative findings. These were administered to 26 PWLD presenting to rural district hospitals. RESULTS: The interviewees demonstrated low levels of perceived stigma regarding disclosure of living with diabetes and high levels of self-efficacy in raising community awareness of diabetes, seeking on going treatment from Western medicine over traditional healers and in seeking care on sick days. Self-efficacy was high for adjusting diet, although comprehensive dietary knowledge was poor. Negative emotions expressed at diagnosis, changes in life style and altered quality of life were reflected in high levels of anxiety and depression. CONCLUSIONS: Low levels of stigma surrounding living with diabetes were linked to a desire to raise community awareness of diabetes, help others live with diabetes and to secure social support to access hospital services. Confusion over what constituted a healthy diet showed the importance of comprehensive, accessible diabetes education, essential to ensuring good glycaemic control, and preventing diabetic complications, including diabetic retinopathy. Low levels of self-efficacy along with high levels of anxiety and depression may have a negative impact on the uptake of screening for Diabetic Retinopathy. The findings of this needs assessment led to the planning and delivery of a comprehensive health intervention programme for PLWD in Kilimanjaro Region. The programme has provided them with support, resources, education, and screening for diabetic retinopathy at the regional hospital and at district level with mobile digital retinal cameras, an electronic diabetic database and computerised follow up to ensure continuity of care

Geology of the Llanidloes district : British Geological Survey Sheet 164

This Sheet Explanation provides a summary of the geology of the district covered by Geological 1:50 000 Series Map Sheet 164 (Llanidloes), published in 2010 as a Bedrock and Superficial Deposits edition. The district mostly lies within the county of Powys, but includes small parts of Ceredigion in the extreme west and south-west. Much of the western part of the district is occupied by the deeply dissected uplands of the Cambrian Mountains, a designated Area of Outstanding Natural Beauty. In this area the land rises to 740 m on the flanks of Plynlimon (Pumlumon Fawr), the highest summit in the range. It falls away towards the eastern part of the district into rolling countryside that includes the important catchment of the River Severn (Afon Hafren) and its tributaries, the largest of which are the rivers Carno, Trannon, Cerist, Clywedog and Dulas. A major reservoir (Llyn Clywedog) occupies the upper reaches of the Clywedog valley, its purpose being to regulate river discharge and groundwater levels within the catchment. The south-western part of the district is drained by the River Wye (Afon Gwy) and its tributaries, that flow south-eastwards via Llangurig. The sources of both the Severn and Wye are situated on the eastern flanks of Plynlimon within the western part of the district. The town of Llanidloes is the main centre of population, with smaller settlements at Llangurig, Carno, Trefeglwys, Caersws and Staylittle; the Newtown conurbation impinges on the eastern part of the district. Much of the district is given over to beef and dairy farming, although sheep are reared in the remote upland areas in the west and extensive forestry plantations have been developed in places. The Ordovician and Silurian rocks of the district have been exploited locally, in the past, as a source of building material and, recently, commercial quantities of sandstone aggregate have been excavated at Penstrowed Quarry [SO 0680 9100]. The district includes part of the Central Wales Mining Field from which substantial volumes of lead and zinc ore were extracted during the 19th and early 20th centuries. A number of former mine sites are still visible, notably along the Van, Nant-y-ricket, Dylife, Dyfngwm and Llanerchyraur lodes (Jones, 1922[1]; IGS, 1974), and the historic Bryntail Mine, below the Clywedog Dam has been restored as a site of industrial archaeological interest. The district is underlain by a succession of Late Ordovician (Ashgill) to Silurian sedimentary rocks, over 5 km thick, deposited between 450 and 420 million years ago in the Early Palaeozoic Welsh Basin (Figure P930911). The basin developed on a fragment of the ancient supercontinent of Gondwana, known as Eastern Avalonia (e.g. Pickering et al., 1988[2]), that drifted northwards to collide with the continents of Baltica and Laurentia during the Late Ordovician and Silurian (Soper and Hutton, 1984[3]; Soper and Woodcock, 1990[4]; Woodcock and Strachan, 2000[5]). To the east and the south of the basin lay the Midland Platform, a relatively stable shallow marine shelf that was subject to periodic emergence. The basinal sediments are predominantly deep marine turbiditic facies that were introduced into the district by density currents from southerly, south-easterly and north-westerly quadrants. Coeval shallower-water ‘shelfal’ sediments were deposited north and east of the district, and locally impinge on its northern margins. Thickness variations within the major sedimentary units suggest that, at times, syndepositional fault movements were an important control on their distribution. During late Silurian (Ludlow) times, shallowing of the basin occurred, and sandstones, variably interpreted as a turbiditic (Cave and Hains, 2001[6]) or storm-generated facies (Tyler and Woodcock, 1987[7]), were laid down over the eastern part of the district and adjacent areas. The shallowing was a result of tectonic reconfiguration of the basin, a precursor to the late Caledonian (Acadian) Orogeny that affected the region during the late Early Devonian, around 400 million years ag

Efeito de diferentes níveis de suplementação de proteína e de energia em borregas alimentadas com feno de plantas forrageiras de pasto nativo, no ganho de peso e consumo de feno

In Santa Maria, Rio Grande do Sul, Brazil, the influence of different levels of protein and energy supplementation were studied, using sheep fed native pasture hay. Fifty-six Corriedale ewe hoggets weighing approximately 24 kg were adapted to individual wooden pens and fed native grass hay for 10 days. Two supplementary rations were prepared with cracked corn and soybean meal, to provide approximately 15 and 30% crude protein, and similar TDN levels. The hoggets were randomly distributed in seven treatments. Evenumbered treatments received the first ration, while odd-numbered treatments (with the exception of treatment 1) received the second ration. All animals were offered ad libitum native grass hay. The supplementary rations were fed once daily in separate feed bunks at the rate of 0, 75, 150 or 300 g per head. The experimental design allowed the study of protein and/or energy at various levels. Weight gain and hay consumption were measured on days 14, 29 and 54 of the trial. Mean weight gains over the whole trial, for treatments 1 through 7, were: 52.1, - 20.8, - 5.8, 25.5, 25.5, 48.6 and 75.2 g daily. The greatest gains were observed during the first period, when significant treatment differences were observed (P < 0.05). During the second period highly significant (P < 0.01) treatment differences occurred, but animals on those treatments receiving the lower levels of supplementary feed lost weight, while during the third period all treatments showed a loss in weight. Consumption of native grass hay showed a significant (P < 0.05) treatment effect only during the second period, with a tendency for hay consumption to decrease with higher levels of supplementation. When the effects of protein and energy supplementation were studied separately, it was evident that energy appeared to be a more critical factor than protein for the hoggets consuming native grass hay. These results and their implications toward extensive sheep production are discussed.Em Santa Maria, Rio Grande do Sul, foram usadas 56 borregas de dois dentes da raça Corriedale com peso médio de 24 kg, confinadas em boxes individuais, para estudar a influência da alimentação com feno de pastagem nativa com suplementação por duas rações à base de milho quebrado e farelo de soja, contendo 16,34% (ração 1) e 31,44% (ração 2) de PB e teor de NDT estimado em 80%, em ambas. As borregas foram distribuídas ao acaso em sete tratamentos, a saber: 1) testemunha (feno à vontade, sem suplementação); 2, 4 e 6) feno à vontade e ração 1 nas doses de 75, 150 e 300 g/dia/cabeça; 3, 5 e 7) feno à vontade e ração 2 nas mesmas doses da ração 1; o feno e as rações suplementares foram distribuídos diariamente em comedouros separados. Os animais foram previamente submetidos a dez dias de adaptação, com confinamento e o mesmo feno à vontade, porém, sem suplementação. O delineamento permitiu analisar o efeito parcelado de proteína e/ou NDT em diversos níveis alimentares. Foram medidos o ganho de peso e o consumo de ração aos 14, 29 e 54 dias do experimento, que comportou, assim, três períodos. Os ganhos médios diários de peso para os tratamentos 1 a 7, foram, respectivamente, -52,1, -20,8, - 5,8, 25,5, 25,5, 48,6 e 75,2 g. Os maiores ganhos registraram-se no primeiro período, sendo significativo (P < 0,05) o efeito de tratamento. No segundo período o efeito de tratamento foi altamente significativo (P < 0,01), mas os animais que recebiam os menores níveis de suplementação perderam peso, enquanto que no terceiro período todas as borregas perderam peso. Houve efeito significativo (P < 0,05) de tratamento no consumo de feno apenas no segundo período; foi notada diminuição do consumo de feno nos tratamentos que receberam a maior quantidade de ração suplementar. Quando os efeitos de energia e de proteína foram estudados isoladamente, notou-se tendência de ser a energia um fator mais crítico do que a proteína para as borregas alimentadas com feno de plantas forrageiras nativas

Unifying flipped SU(5) in five dimensions

It is shown that embedding a four-dimensional flipped SU(5) model in a five-dimensional SO(10) model, preserves the best features of both flipped SU(5) and SO(10). The missing partner mechanism, which naturally achieves both doublet-triplet splitting and suppression of d=5 proton decay operators, is realized as in flipped SU(5), while the gauge couplings are unified as in SO(10). The masses of down quarks and charged leptons, which are independent in flipped SU(5), are related by the SO(10). Distinctive patterns of quark and lepton masses can result. The gaugino mass M_1 is independent of M_3 and M_2, which are predicted to be equal.Comment: revised version-to appear in PRD, 23 pages, 3 figures, ReVTeX

Family Unification on an Orbifold

We construct a family-unified model on a Z_2xZ_2 orbifold in five dimensions. The model is based on a supersymmetric SU(7) gauge theory. The gauge group is broken by orbifold boundary conditions to a product of grand unified SU(5) and SU(2)xU(1) flavor symmetry. The structure of Yukawa matrices is generated by an interplay between spontaneous breaking of flavor symmetry and geometric factors arising due to field localization in the extra dimension.Comment: 13 page

The Superpartner Spectrum of Gaugino Mediation

We compute the superpartner masses in a class of models with gaugino mediation (or no-scale) boundary conditions at a scale between the GUT and Planck scales. These models are compelling because they are simple, solve the supersymmetric flavor and CP problems, satisfy all constraints from colliders and cosmology, and predict the superpartner masses in terms of very few parameters. Our analysis includes the renormalization group evolution of the soft-breaking terms above the GUT scale. We show that the running above the GUT scale is largely model independent and find that a phenomenologically viable spectrum is obtained.Comment: 15 page

Model Building with Gauge-Yukawa Unification

In supersymmetric theories with extra dimensions, the Higgs and matter fields can be part of the gauge multiplet, so that the Yukawa interactions can arise from the gauge interactions. This leads to the possibility of gauge-Yukawa coupling unification, g_i=y_f, in the effective four dimensional theory after the initial gauge symmetry and the supersymmetry are broken upon orbifold compactification. We consider gauge-Yukawa unified models based on a variety of four dimensional symmetries, including SO(10), SU(5), Pati-Salam symmetry, trinification, and the Standard Model. Only in the case of Pati-Salam and the Standard Model symmetry, we do obtain gauge-Yukawa unification. Partial gauge-Yukawa unification is also briefly discussed.Comment: 23 page

Geospatial analysis and living urban geometry

This essay outlines how to incorporate morphological rules within the exigencies of our technological age. We propose using the current evolution of GIS (Geographical Information Systems) technologies beyond their original representational domain, towards predictive and dynamic spatial models that help in constructing the new discipline of "urban seeding". We condemn the high-rise tower block as an unsuitable typology for a living city, and propose to re-establish human-scale urban fabric that resembles the traditional city. Pedestrian presence, density, and movement all reveal that open space between modernist buildings is not urban at all, but neither is the open space found in today's sprawling suburbs. True urban space contains and encourages pedestrian interactions, and has to be designed and built according to specific rules. The opposition between traditional self-organized versus modernist planned cities challenges the very core of the urban planning discipline. Planning has to be re-framed from being a tool creating a fixed future to become a visionary adaptive tool of dynamic states in evolution

Castaing Instability and Precessing Domains in Confined Alkali Gases

We explore analogy between two-component quantum alkali gases and spin-polarized helium systems. Recent experiments in trapped gases are put into the frame of the existing theory for Castaing instability in transverse channel and formation of homogeneous precessing domains in spin-polarized systems. Analogous effects have already been observed in spin-polarized $$ and $^{3}He- ^{4}He$ mixtures systems. The threshold effect of the confining potential on the instability is analyzed. New experimental possibilities for observation of transverse instability in a trap are discussed.Comment: 6 RevTex pages, no figure

Composite quarks and leptons in higher space-time dimensions

A new approach towards the composite structure of quarks and leptons in the context of the higher dimensional unified theories is proposed. Owing to the certain strong dynamics, much like an ordinary QCD, every possible vectorlike multiplets of composites appear in higher dimensional bulk space-time, however, through a proper Sherk-Schwarz compactification only chiral set of composite quarks and leptons survive as the massless states in four dimensions. In this scenario restrictions related with the 't Hooft's anomaly matching condition are turned out to be avoided and, as a result, the composite models look rather simple and economic. We demonstrate our approach by an explicit construction of model of preons and their composites unified in the supersymmetric SU(5) GUT in five space-time dimensions. The model predicts exactly three families of the composite quarks and leptons being the triplets of the chiral horizontal symmetry SU(3)_h which automatically appears in the composite spectrum when going to ordinary four dimensions.Comment: 13 pages, tcilatex, no figures, v2 - misprints correcte