The emotional context of self-management in chronic illness: a qualitative study of the role of health professionals support in the self-management of type 2 diabetes

© 2008 Furler et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Background Support for patient self-management is an accepted role for health professionals. Little evidence exists on the appropriate basis for the role of health professionals in achieving optimum self-management outcomes. This study explores the perceptions of people with type 2 diabetes about their self-management strategies and how relationships with health professionals may support this. Methods Four focus groups were conducted with people with type 2 diabetes: two with English-speaking and one each with Turkish and Arabic-speaking. Transcripts from the groups were analysed drawing on grounded hermeneutics and interpretive description. Results We describe three conceptually linked categories of text from the focus groups based on emotional context of self management, dominant approaches to self management and support from health professionals for self management. All groups described important emotional contexts to living with and self-managing diabetes and these linked closely with how they approached their diabetes management and what they looked for from health professionals. Culture seemed an important influence in shaping these linkages. Conclusion Our findings suggest people construct their own individual self-management and self-care program, springing from an important emotional base. This is shaped in part by culture and in turn determines the aims each person has in pursuing self-management strategies and the role they make available to health professionals to support them. While health professionals' support for self-care strategies will be more congruent with patients' expectations if they explore each person's social, emotional and cultural circumstances, pursuit of improved health outcomes may involve a careful balance between supporting as well as helping shift the emotional constructs surrounding a patient life with diabetes

Measuring the speed of light using beating longitudinal modes in an open-cavity HeNe laser

We describe an undergraduate laboratory that combines an accurate measurement of the speed of light, a fundamental investigation of a basic laser system, and a nontrivial use of statistical analysis. Students grapple with the existence of longitudinal modes in a laser cavity as they change the cavity length of an adjustable-cavity HeNe laser and tune the cavity to produce lasing in the TEM$_{00}$ mode. For appropriate laser cavity lengths, the laser gain curve of a HeNe laser allows simultaneous operation of multiple longitudinal modes. The difference frequency between the modes is measured using a self-heterodyne detection with a diode photodetector and a radio frequency spectrum analyzer. Asymmetric effects due to frequency pushing and frequency pulling, as well as transverse modes, are minimized by simultaneously monitoring and adjusting the mode structure as viewed with a Fabry-Perot interferometer. The frequency spacing of longitudinal modes is proportional to the inverse of the cavity length with a proportionality constant equal to half the speed of light. By changing the length of the cavity, without changing the path length within the HeNe gas, the speed of light in air can be measured to be ($2.9972 \pm0.0002) \times 10^{8}$ m/s, which is to high enough precision to distinguish between the speed of light in air and that in a vacuum.Comment: 6 pages; 6 figures; Published in the American Journal of Physic

Three-dimensional flow structure and bed morphology in large elongate meander loops with different outer bank roughness characteristics

© 2016. American Geophysical Union. All Rights Reserved. Few studies have examined the three-dimensional flow structure and bed morphology within elongate loops of large meandering channels. The present study focuses on the spatial patterns of three-dimensional flow structure and bed morphology within two elongate meander loops and examines how differences in outer bank roughness influence near-bank flow characteristics. Three-dimensional velocities were measured during two different events—a near-bankfull flow and an overbank event. Detailed data on channel bathymetry and bed form geometry were obtained during a near-bankfull event. Flow structure within the loops is characterized by strong topographic steering by the point bar, by the development of helical motion associated with flow curvature, and by acceleration of flow where bedrock is exposed along the outer bank. Near-bank velocities during the overbank event are less than those for the near-bankfull flow, highlighting the strong influence of the point bar on redistribution of mass and momentum of the flow at subbankfull stages. Multiple outer bank pools are evident within the elongate meander loop with low outer bank roughness, but are not present in the loop with high outer bank roughness, which may reflect the influence of abundant large woody debris on near-bank velocity characteristics. The positions of pools within both loops can be linked to spatial variations in planform curvature. The findings indicate that flow structure and bed morphology in these large elongate loops is similar to that in small elongate loops, but differs somewhat from flow structure and bed morphology reported for experimental elongate loops

How special are Brightest Group and Cluster Galaxies?

We use the Sloan Digital Sky Survey to construct a sample of 625 brightest group and cluster galaxies (BCGs) together with control samples of non-BCGs matched in stellar mass, redshift, and color. We investigate how the systematic properties of BCGs depend on stellar mass and on their privileged location near the cluster center. The groups and clusters that we study are drawn from the C4 catalogue of Miller et al. (2005) but we have developed improved algorithms for identifying the BCG and for measuring the cluster velocity dispersion. Since the SDSS photometric pipeline tends to underestimate the luminosities of large galaxies in dense environments, we have developed a correction for this effect which can be readily applied to the published catalog data. We find that BCGs are larger and have higher velocity dispersions than non-BCGs of the same stellar mass, which implies that BCGs contain a larger fraction of dark matter. In contrast to non-BCGs, the dynamical mass-to-light ratio of BCGs does not vary as a function of galaxy luminosity. Hence BCGs lie on a different fundamental plane than ordinary elliptical galaxies. BCGs also follow a steeper Faber-Jackson relation than non-BCGs, as suggested by models in which BCGs assemble via dissipationless mergers along preferentially radial orbits. We find tentative evidence that this steepening is stronger in more massive clusters. BCGs have similar mean stellar ages and metallicities to non-BCGs of the same mass, but they have somewhat higher alpha/Fe ratios, indicating that star formation may have occurred over a shorter timescale in the BCGs. Finally, we find that BCGs are more likely to host radio-loud active galactic nuclei than other galaxies of the same mass, but are less likely to host an optical AGN. The differences we find are more pronounced for the less massive BCGs.Comment: Replaced with slightly modified version accepted by MNRAS. 28 pages, 25 figures. Version with full resolution figures available at http://www.mpa-garching.mpg.de/~anja/bcgs_avdl.pd

Mothers after gestational diabetes in Australia Diabetes Prevention Program (MAGDA-DPP) post-natal intervention: study protocol for a randomized controlled trial

Background:Gestational diabetes mellitus (GDM) is defined as glucose intolerance with its onset or first recognition during pregnancy. Post-GDM women have a life-time risk exceeding 70% of developing type 2 diabetes mellitus (T2DM). Lifestyle modifications reduce the incidence of T2DM by up to 58% for high-risk individuals.Methods/Design:The Mothers After Gestational Diabetes in Australia Diabetes Prevention Program (MAGDA-DPP) is a randomized controlled trial aiming to assess the effectiveness of a structured diabetes prevention intervention for post-GDM women. This trial has an intervention group participating in a diabetes prevention program (DPP), and a control group receiving usual care from their general practitioners during the same time period. The 12-month intervention comprises an individual session followed by five group sessions at two-week intervals, and two follow-up telephone calls. A total of 574 women will be recruited, with 287 in each arm. The women will undergo blood tests, anthropometric measurements, and self-reported health status, diet, physical activity, quality of life, depression, risk perception and healthcare service usage, at baseline and 12 months. At completion, primary outcome (changes in diabetes risk) and secondary outcome (changes in psychosocial and quality of life measurements and in cardiovascular disease risk factors) will be assessed in both groups.Discussion:This study aims to show whether MAGDA-DPP leads to a reduction in diabetes risk for post-GDM women. The characteristics that predict intervention completion and improvement in clinical and behavioral measures will be useful for further development of DPPs for this population.</span

Challenges of diabetes prevention in the real world : results and lessons from the Melbourne diabetes prevention study

OBJECTIVE: To assess effectiveness and implementability of the public health programme Life! Taking action on diabetes in Australian people at risk of developing type 2 diabetes. RESEARCH DESIGN AND METHODS: Melbourne Diabetes Prevention Study (MDPS) was a unique study assessing effectiveness of Life! that used a randomized controlled trial design. Intervention participants with AUSDRISK score &ge;15 received 1 individual and 5 structured 90 min group sessions. Controls received usual care. Outcome measures were obtained for all participants at baseline and 12 months and, additionally, for intervention participants at 3 months. Per protocol set (PPS) and intention to treat (ITT) analyses were performed. RESULTS: PPS analyses were considered more informative from our study. In PPS analyses, intervention participants significantly improved in weight (-1.13 kg, p=0.016), waist circumference (-1.35 cm, p=0.044), systolic (-5.2 mm Hg, p=0.028) and diastolic blood pressure (-3.2 mm Hg, p=0.030) compared with controls. Based on observed weight change, estimated risk of developing diabetes reduced by 9.6% in the intervention and increased by 3.3% in control participants. Absolute 5-year cardiovascular disease (CVD) risk reduced significantly for intervention participants by 0.97 percentage points from 9.35% (10.4% relative risk reduction). In control participants, the risk increased by 0.11 percentage points (1.3% relative risk increase). The net effect for the change in CVD risk was -1.08 percentage points of absolute risk (p=0.013). CONCLUSIONS: MDPS effectively reduced the risk of diabetes and CVD, but the intervention effect on weight and waist reduction was modest due to the challenges in recruiting high-risk individuals and the abbreviated intervention

The role of discharge variability in determining alluvial stratigraphy

We illustrate the potential for using physics-based modeling to link alluvial stratigraphy to large river morphology and dynamics. Model simulations, validated using ground penetrating radar data from the Río Paraná, Argentina, demonstrate a strong relationship between bar-scale set thickness and channel depth, which applies across a wide range of river patterns and bar types. We show that hydrologic regime, indexed by discharge variability and flood duration, exerts a first-order influence on morphodynamics and hence bar set thickness, and that planform morphology alone may be a misleading variable for interpreting deposits. Indeed, our results illustrate that rivers evolving under contrasting hydrologic regimes may have very similar morphology, yet be characterized by marked differences in stratigraphy. This realization represents an important limitation on the application of established theory that links river topography to alluvial deposits, and highlights the need to obtain field evidence of discharge variability when developing paleoenvironmental reconstructions. Model simulations demonstrate the potential for deriving such evidence using metrics of paleocurrent variance

The Japanese model in retrospective : industrial strategies, corporate Japan and the 'hollowing out' of Japanese industry

This article provides a retrospective look at the Japanese model of industrial development. This model combined an institutional approach to production based around the Japanese Firm (Aoki's, J-mode) and strategic state intervention in industry by the Japanese Ministry of International Trade and Industry (MITI). For a long period, the alignment of state and corporate interests appeared to match the wider public interest as the Japanese economy prospered. However, since the early 1990s, the global ambitions of the corporate sector have contributed to a significant 'hollowing out' of Japan's industrial base. As the world today looks for a new direction in economic management, we suggest the Japanese model provides policy-makers with a salutary lesson in tying the wider public interest with those of the corporate sector

Global parameter search reveals design principles of the mammalian circadian clock

Background: Virtually all living organisms have evolved a circadian (~24 hour) clock that controls physiological and behavioural processes with exquisite precision throughout the day/night cycle. The suprachiasmatic nucleus (SCN), which generates these ~24 h rhythms in mammals, consists of several thousand neurons. Each neuron contains a gene-regulatory network generating molecular oscillations, and the individual neuron oscillations are synchronised by intercellular coupling, presumably via neurotransmitters. Although this basic mechanism is currently accepted and has been recapitulated in mathematical models, several fundamental questions about the design principles of the SCN remain little understood. For example, a remarkable property of the SCN is that the phase of the SCN rhythm resets rapidly after a 'jet lag' type experiment, i.e. when the light/ dark (LD) cycle is abruptly advanced or delayed by several hours. Results: Here, we describe an extensive parameter optimization of a previously constructed simplified model of the SCN in order to further understand its design principles. By examining the top 50 solutions from the parameter optimization, we show that the neurotransmitters' role in generating the molecular circadian rhythms is extremely important. In addition, we show that when a neurotransmitter drives the rhythm of a system of coupled damped oscillators, it exhibits very robust synchronization and is much more easily entrained to light/dark cycles. We were also able to recreate in our simulations the fast rhythm resetting seen after a 'jet lag' type experiment. Conclusion: Our work shows that a careful exploration of parameter space for even an extremely simplified model of the mammalian clock can reveal unexpected behaviours and non-trivial predictions. Our results suggest that the neurotransmitter feedback loop plays a crucial role in the robustness and phase resetting properties of the mammalian clock, even at the single neuron level

Mothers after Gestational Diabetes in Australia (MAGDA): A Randomised Controlled Trial of a Postnatal Diabetes Prevention Program

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Background Gestational diabetes mellitus (GDM) is an increasingly prevalent risk factor for type 2 diabetes. We evaluated the effectiveness of a group-based lifestyle modification program in mothers with prior GDM within their first postnatal year. Methods and Findings In this study, 573 women were randomised to either the intervention (n = 284) or usual care (n = 289). At baseline, 10% had impaired glucose tolerance and 2% impaired fasting glucose. The diabetes prevention intervention comprised one individual session, five group sessions, and two telephone sessions. Primary outcomes were changes in diabetes risk factors (weight, waist circumference, and fasting blood glucose), and secondary outcomes included achievement of lifestyle modification goals and changes in depression score and cardiovascular disease risk factors. The mean changes (intention-to-treat [ITT] analysis) over 12 mo were as follows: −0.23 kg body weight in intervention group (95% CI −0.89, 0.43) compared with +0.72 kg in usual care group (95% CI 0.09, 1.35) (change difference −0.95 kg, 95% CI −1.87, −0.04; group by treatment interaction p = 0.04); −2.24 cm waist measurement in intervention group (95% CI −3.01, −1.42) compared with −1.74 cm in usual care group (95% CI −2.52, −0.96) (change difference −0.50 cm, 95% CI −1.63, 0.63; group by treatment interaction p = 0.389); and +0.18 mmol/l fasting blood glucose in intervention group (95% CI 0.11, 0.24) compared with +0.22 mmol/l in usual care group (95% CI 0.16, 0.29) (change difference −0.05 mmol/l, 95% CI −0.14, 0.05; group by treatment interaction p = 0.331). Only 10% of women attended all sessions, 53% attended one individual and at least one group session, and 34% attended no sessions. Loss to follow-up was 27% and 21% for the intervention and control groups, respectively, primarily due to subsequent pregnancies. Study limitations include low exposure to the full intervention and glucose metabolism profiles being near normal at baseline. Conclusions Although a 1-kg weight difference has the potential to be significant for reducing diabetes risk, the level of engagement during the first postnatal year was low. Further research is needed to improve engagement, including participant involvement in study design; it is potentially more effective to implement annual diabetes screening until women develop prediabetes before offering an intervention. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN1261000033806