Screening and identifying diabetes in optometric practice: a prospective study

Background: Unconventional settings, outside general medical practice, are an underutilised resource in the attempt to identify the large numbers of people with undiagnosed diabetes worldwide. Aim: The study investigated the feasibility of using optometry practices (opticians) as a setting for a diabetes screening service. Design and setting: Adults attending high street optometry practices in northern England who self-reported at least one risk factor for diabetes were offered a random capillary blood glucose (rCBG) test. Those with raised rCBG levels were asked to visit their GP for further investigations. Results: Of 1909 adults attending practices for sight tests, 1303 (68.2%) reported risk factors for diabetes, of whom 1002 (76.9%) had rCBG measurements taken. Of these, 318 (31.7%) were found to have a rCBG level of ≥6.1 mmol/l, a level where further investigations are recommended by Diabetes UK; 1.6% of previously undiagnosed individuals were diagnosed with diabetes or pre-diabetes as a result of the service. Refining the number of risk factors for inclusion would have reduced those requiring screening by half and still have identified nearly 70% of the new cases of diabetes and pre-diabetes. Conclusion: Screening in optometric practices provides an efficient opportunity to screen at-risk individuals who do not present to conventional medical services, and is acceptable and appropriate. Optometrists represent a skilled worldwide resource that could provide a screening service. This service could be transferable to other settings

Evidence for Avian Intrathoracic Air Sacs in a New Predatory Dinosaur from Argentina

Background: Living birds possess a unique heterogeneous pulmonary system composed of a rigid, dorsally-anchored lung and several compliant air sacs that operate as bellows, driving inspired air through the lung. Evidence from the fossil record for the origin and evolution of this system is extremely limited, because lungs do not fossilize and because the bellow-like air sacs in living birds only rarely penetrate (pneumatize) skeletal bone and thus leave a record of their presence. Methodology/Principal Findings: We describe a new predatory dinosaur from Upper Cretaceous rocks in Argentina, Aerosteon riocoloradensis gen. et sp. nov., that exhibits extreme pneumatization of skeletal bone, including pneumatic hollowing of the furcula and ilium. In living birds, these two bones are pneumatized by diverticulae of air sacs (clavicular, abdominal) that are involved in pulmonary ventilation. We also describe several pneumatized gastralia (‘‘stomach ribs’’), which suggest that diverticulae of the air sac system were present in surface tissues of the thorax. Conclusions/Significance: We present a four-phase model for the evolution of avian air sacs and costosternal-driven lung ventilation based on the known fossil record of theropod dinosaurs and osteological correlates in extant birds: (1) Phase I—Elaboration of paraxial cervical air sacs in basal theropods no later than the earliest Late Triassic. (2) Phase II—Differentiation of avian ventilatory air sacs, including both cranial (clavicular air sac) and caudal (abdominal air sac) divisions, in basal tetanurans during the Jurassic. A heterogeneous respiratory tract wit

Screening and diagnosing diabetes in optometrists’ practices: an evaluation of perceptions, attitudes and beliefs

In the UK, optometrists examine 17 million people yearly, many of whom will not have consulted a doctor and may have undiagnosed diabetes. Selective testing in optometry practices presents a new detection strategy. The purpose of this research was to ascertain optometrists' perceptions, attitudes and beliefs towards diabetes and screening, prior to evaluating a pilot service. Focus groups and interviews were conducted with 21 optometrists in Northern England. Analysis was based on grounded theory. Four themes emerged: varying awareness of diabetes and its early diagnosis, a reluctance in accepting a screening role, organisational barriers in implementing such a service, and controversies around the changing roles of optometrists. Although optometrists' awareness of diabetes was varied, all had seen patients they suspected of having diabetes and felt that the public under‐estimated risks of diabetes. Some felt that diagnosis of asymptomatic diabetes was unnecessary, although most felt that early diagnosis would be beneficial. Optometrists believed that the public and doctors had mixed attitudes to their possible involvement in screening. Specific barriers included additional cost, time, remuneration and litigation fears. However, optometrists felt that their professional role has evolved and that a greater, extended clinical involvement would be positive. In conclusion, optometrists are willing to carry out capillary blood glucose tests, provided that the scheme is simple, is supported by other health care professionals and is properly funded. There is a clear advantage in identifying undiagnosed diabetes in people attending optometry practices who are not accessing other health care providers

Screening for diabetes in unconventional locations: resource implications and economics of screening in optometry practices

Objectives: Unconventional locations outwith general medical practice may prove opportunities for screening. The aim was to determine the resource implications and economics of a screening service using random capillary blood glucose (rCBG) tests to detect raised blood glucose levels in the 'at risk' population attending high street optometry practices. Method: A screening service was implemented in optometry practices in North East England: the cost of the service and the implication of different screening strategies was estimated. Results: The cost of a screening test was £5.53–£11.20, depending on the screening strategy employed and who carried out the testing. Refining the screening strategy to target those ≥40years with BMI of ≥25kg/m2 and/or family history of diabetes resulted in a cost per case referred to the GP of £14.38–£26.36. Implementing this strategy in half of optometric practices in England would have the potential to identify up to 150,000 new cases of diabetes and prediabetes a year. Conclusions: Optometry practices provide an effective way of identifying people who would benefit from further investigation for diabetes. Effectiveness could be improved further by improving cooperation and communication between optometrists and medical practitioners

Trade and environment in the EU and WTO: legitimacy, proportionality and institutional power play

The relationship between trade and environment is complex. Notwithstanding that these interests are fundamentally interdependent, the Court of Justice (Court) and WTO Appellate Body (AB) have both had to balance trade liberalisation and environmental protection, typically in cases involving a challenge to trade-restrictive national environmental regulation, where setting aside such regulation would contribute to negative integration. Such judicial balancing raises legitimacy questions relating to three areas of tension: first, substantively, between trade liberalisation and environmental protection; secondly concerning the relationship between supra/international rules and national regulation; and thirdly, relating to a supra/international judicial body (potentially) setting aside a national regulator’s act. The ongoing credibility of the EU and WTO is dependent upon mitigating these questions, an imperative intensified by the emergence of ‘popular globalisation scepticism’ in contemporary politics. Building upon recent scholarship on conceptualisations of legitimacy in international law, this paper first critically scrutinises the legitimacy questions arising from such judicial balancing, contextualising the problem in contemporary political events. Secondly, the respective roles of the Court and AB are examined, and the significance of the scope of their authority evaluated. Thirdly, the reasoning of the Court and AB is analysed. In conclusion, the political importance of the Court and AB’s language on proportionality and ‘weighing and balancing’, indicating sensitivity to national values, is highlighted. It is however recognised that to satisfy administrative due process, key to input legitimacy, the objective judicial analysis which underpins the Courts’ tests is crucial, and it is this which will contribute to output legitimacy

Evidence Synthesis on the occurrence, causes, consequences, prevention and management of bullying and harassing behaviours to inform decision-making in the NHS

Workplace bullying is a persistent problem in the NHS with negative implications for individuals, teams, and organisations. Bullying is a complex phenomenon and there is a lack of evidence on the best approaches to manage the problem. Aims: Research questions: What is known about the occurrence, causes, consequences and management of bullying and inappropriate behaviour in the workplace? Objectives: Summarise the reported prevalence of workplace bullying and inappropriate behaviour. Summarise the empirical evidence on the causes and consequences of workplace bullying and inappropriate behaviour. Describe any theoretical explanations of the causes and consequences of workplace bullying and inappropriate behaviour. Synthesise evidence on the preventative and management interventions that address workplace bullying interventions and inappropriate behaviour