Acupuncture in the Treatment of Painful Diabetic Neuropathy

Diabetic peripheral neuropathy (DPN) is the most common cause of peripheral neuropathy and affects up to one third of patients with diabetes. The pathophysiology of DPN is unknown, making it difficult to treat. Pharmacological treatments have limited efficacy and substantial side effects. Acupuncture has been practiced for thousands of years in China and other Asian countries and is accepted by Western culture as a complimentary therapy for pain relief. Though further research is needed, existing studies evaluating acupuncture as a treatment for DPN look promising. With a positive risk-benefit ratio compared to other available treatments, acupuncture is a viable treatment option for DPN. The purposes of this paper are to review the literature on the use of acupuncture for the treatment of DPN and to offer recommendations for nurse practitioners in the United States. This paper examines the literature on (1) the disease characteristics and management of DPN, (2) the physiology and use of acupuncture in Eastern and Western health care, and (3) the evidence supporting the effectiveness of acupuncture for the treatment of peripheral neuropathy and DPN. Recommendations for nurse practitioners in the United States and for further research are then discussed

Increased food provisioning by female Montagu's Harriers in years with food shortage weakens sex-specific roles in parental care

n many owl and raptor species, sexes have distinct parental roles. Females incubate the eggs and raise the chicks until independence, while males provide females and their chicks with food. This is believed to reduce sexual conflict over parental care as tasks do not overlap. The level of parental care is also shaped by parent-offspring conflict. The scarcity of empirical data on parental investment in species with sex-specific parental roles was our motivation to study parental care in the Montagu’s Harrier Circus pygargus in relation to natural annual variation in food availability (vole abundance). By tracking individual birds using GPS-trackers, several aspects of parental care (the number of food provisioning trips, home range size and nest attendance) could be quantified for different nesting phases. We found that in food-poor years, males spent less time near the nest, and had lower food provisioning rates during the incubation and nestling phases. In addition, males had larger home ranges in food-poor years, a possible indicator of increased foraging effort. In contrast, females increased their contribution to food provisioning in food-poor years, as shown by higher food provisioning rates and larger home ranges. This increased foraging effort came at the cost of lower nest attendance by females. Our data suggest that, when food abundance declines, Montagu’s Harriers shift from a system with almost strict sex-specific parental roles towards a system where both parents provide the same type of care with possibly increased sexual conflict

Increased food provisioning by female Montagu's Harriers in years with food shortage weakens sex-specific roles in parental care

n many owl and raptor species, sexes have distinct parental roles. Females incubate the eggs and raise the chicks until independence, while males provide females and their chicks with food. This is believed to reduce sexual conflict over parental care as tasks do not overlap. The level of parental care is also shaped by parent-offspring conflict. The scarcity of empirical data on parental investment in species with sex-specific parental roles was our motivation to study parental care in the Montagu’s Harrier Circus pygargus in relation to natural annual variation in food availability (vole abundance). By tracking individual birds using GPS-trackers, several aspects of parental care (the number of food provisioning trips, home range size and nest attendance) could be quantified for different nesting phases. We found that in food-poor years, males spent less time near the nest, and had lower food provisioning rates during the incubation and nestling phases. In addition, males had larger home ranges in food-poor years, a possible indicator of increased foraging effort. In contrast, females increased their contribution to food provisioning in food-poor years, as shown by higher food provisioning rates and larger home ranges. This increased foraging effort came at the cost of lower nest attendance by females. Our data suggest that, when food abundance declines, Montagu’s Harriers shift from a system with almost strict sex-specific parental roles towards a system where both parents provide the same type of care with possibly increased sexual conflict

Infection control measures on ships and in ports during the early stage of pandemic influenza A (H1N1) 2009

Shipping companies were surveyed to evaluate the effect of public health measures during the influenza A (H1N1) pandemic of 2009 on ship and port operations. Of 31 companies that operated 960 cruise, cargo, and other ships, 32% experienced health-screening measures by port health authorities. Approximately a quarter of ports (26%) performed screening at embarkation and 77% of shipping companies changed procedures during the early stage of the pandemic. Four companies reported outbreaks of pandemic influenza A (H1N1) 2009 on ships, which were ultimately stopped through infection control practices. Public health measures did not interfere substantially with port and ship operations with the exception of some port authorities that delayed embarking and disembarking procedures in a few ships. However, in the shipping companies’ experience, measures were inconsistent between port health authorities. Access to antiviral drugs and pandemic vaccine was not provided in all ports. Current guidelines on medical care, hygiene, and emergency procedures on ships need to address pandemic influenza preparedness in future revisions

Félix Candela. En memoria (1910-1997). Del cascarón de hormigón a las estructuras ligeras del s. XXI

January 27th of this year, 2010, was the centenary of the birth of a famous architect of Spanish origin, Félix Candela, one of the most prominent players in modern architecture’s thin shell adventure. His international fame was based on precisely that, the construction of over 800 thin concrete shells characterized not only by their rationality and optimal strength, but also by their striking sculptural beauty. Architects such as Frei Otto, Ove Arup and David Billington justifiably called his work“structural art”. In addition analyzing Félix Candela’s contribution to modern architecture, the present article explores new lightweight structures as the ongoing pursuit of the optimization of structural form with different materials and technologies. That pursuit, both past and present, constitutes the focus of attention of the International Association for Structural Shells, IASS, founded by Eduardo Torroja in 1959 and fully operational today.El 27 de enero de 2010 se cumplió el centenario del nacimiento de célebre arquitecto de origen español Félix Candela, uno de los más destacados protagonistas de la Aventura Laminar de la Arquitectura Moderna. Su fama internacional la adquirió a través de la construcción de más de 800 cascarones de hormigón armado dotados, no sólo de una racional y óptima forma resistente, sino también de una impactante y escultural belleza. No en vano, Frei Otto, Ove Arup y David Billington han descrito su obra como un “Arte Estructural”. Al hilo del análisis de las aportaciones realizadas por Félix Candela, el presente artículo analiza también nuevas estructuras ligeras, como continuidad histórica de esa racional búsqueda de la optimización de la forma resistente con diferentes materiales y tecnologías. Evolución y destino contemplado por la Internacional Association for Structural Shells IASS, fundada por Eduardo Torroja en 1959 y que hoy continúa en plena actividad

Rare case of an adult male Montagu's Harrier Circus pygargus over-summering in West Africa, as revealed by GPS tracking

Over-summering within or near the African wintering range by immature, non-breeding individuals occurs regularly in several species of long-distance migratory raptors, yet the extent of over-summering in Africa by adult birds remains unclear. In this study, we describe a case of an adult Montagu's Harrier over-summering in Africa, as revealed by GPS tracking. By relating detailed knowledge of the bird's movements to remotely sensed environmental data (normalized difference vegetation index, NDVI), we show that over-summering in this case was likely related to an exceptionally difficult breeding season the previous year rather than an effect of adverse weather conditions encountered during the winter or a failed attempt to migrate. Various factors are discussed as potential driving forces behind the bird's intra-African movements. Finally, we relate the documented case to a large number of North European Montagu's Harriers studied by telemetry and show that over-summering in Africa by adult individuals is indeed a rare event

A multi-reflection time-of-flight mass spectrometer for the offline ion source of the PUMA experiment

The antiProton Unstable Matter Annihilation experiment (PUMA) at CERN aims at investigating the nucleon composition in the matter density tail of radioactive as well as stable isotopes by use of low-energy antiproton-nucleon annihilation processes. For this purpose, antiprotons provided by the Extra Low ENergy Antiproton (ELENA) facility will be trapped together with the ions of interest. While exotic ions will be obtained by the Isotope mass Separator On-Line DEvice (ISOLDE), stable ions will be delivered from an offline ion source setup designed for this purpose. This allows the proposed technique to be applied to a variety of stable nuclei and for reference measurements. For beam purification, the ion source setup includes a multi-reflection time-of-flight mass spectrometer (MR-ToF MS). Supported by SIMION simulations, an earlier MR-ToF MS design has been modified to meet the requirements of PUMA. During commissioning of the new MR-ToF device with Ar$^+$ ions, mass resolving powers in excess of 50,000 have been obtained after 150 revolutions, limited by the chopping of the continuous beam from an electron impact ionisation source

May Measurement Month 2019: an analysis of blood pressure screening results from Australia.

May Measurement Month (MMM) is an annual global blood pressure (BP) screening campaign aimed at obtaining standardized BP measurements and other relevant health information from members of the community to increase awareness of elevated BP and the associated risks. Adults (≥18 years) were recruited through opportunistic sampling across the various Australian states during May 2019. Three BP readings were recorded in a standardized manner for each participant, and data on lifestyle factors and comorbidities were collected. Hypertension was defined as a systolic BP ≥140 mmHg, or a diastolic BP ≥90 mmHg (according to the MMM protocol) or taking antihypertensive medication. Multiple imputation was used to estimate participants' mean BP where three readings were not available. Of the 2877 participants, 901 (31.3%) had hypertension of whom 455 (50.5%) were aware of their condition, and 366 (40.6%) were on antihypertensive medication. Of those taking antihypertensive medication, 54.3% were controlled to <140/90 mmHg with the remaining 45.7% of participants inadequately treated. Approximately 74% of treated patients were on a single antihypertensive medication. The MMM campaign provides an important platform for standardized compilation of BP data and creation of BP awareness in Australia and other nations worldwide. Data from the 2019 MMM campaign highlight that BP control rates in Australia remain unacceptably low

Ultra-low-dose quadruple combination blood pressure lowering therapy in patients with hypertension: The QUARTET randomized controlled trial protocol.

High blood pressure is the leading cause of preventable morbidity and mortality globally. Many patients remain on single-drug treatment with poor control although guidelines recognize that most require combination therapy for blood pressure control. Our hypothesis is that a single-pill combination of four blood pressure- lowering agents each at a quarter dose may provide a simple, safe and effective blood pressure lowering solution which may also improve long term-adherence. The QUARTET (Quadruple UltrA-low-dose tReaTment for hypErTension) double-blind, active controlled, randomized clinical trial will examine whether ultra-low-dose quadruple combination therapy is more effective than guideline recommended standard care, in lowering blood pressure. QUARTET will enroll 650 participants with high blood pressure, either on no treatment or on monotherapy. Participants will be randomized 1:1 and allocated to intervention therapy of a single pill (quadpill) containing irbesartan 37.5 mg, amlodipine 1.25 mg, indapamide 0.625 mg and bisoprolol 2.5 mg or to control therapy of a single identical appearing pill containing irbesartan 150 mg. In both arms step up therapy of open-label amlodipine 5mg will be provided if BP is >140/90 at 6weeks. The primary outcome is the difference between groups in the change from baseline in mean unattended automated office systolic blood pressure at 12weeks follow-up. The primary outcome and some secondary outcomes will be assessed at 12weeks, there is an optional 12months extension phase to assess longer term efficacy and tolerability. Our secondary aims are to assess if this approach is safe, has fewer adverse effects and better tolerability compared to standard care control. QUARTET will therefore provide evidence for the effectiveness and safety of a new paradigm in the management of high blood pressure