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

WTEC panel report on European nuclear instrumentation and controls

Control and instrumentation systems might be called the 'brain' and 'senses' of a nuclear power plant. As such they become the key elements in the integrated operation of these plants. Recent developments in digital equipment have allowed a dramatic change in the design of these instrument and control (I&C) systems. New designs are evolving with cathode ray tube (CRT)-based control rooms, more automation, and better logical information for the human operators. As these new advanced systems are developed, various decisions must be made about the degree of automation and the human-to-machine interface. Different stages of the development of control automation and of advanced digital systems can be found in various countries. The purpose of this technology assessment is to make a comparative evaluation of the control and instrumentation systems that are being used for commercial nuclear power plants in Europe and the United States. This study is limited to pressurized water reactors (PWR's). Part of the evaluation includes comparisons with a previous similar study assessing Japanese technology

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

Severe combined hyperlipidaemia and retinal lipid infiltration in a patient with Type 2 diabetes mellitus

Severe combined hyperlipidaemia has occasionally been associated with infiltration of tissues in addition to arteries and the skin. We report a woman with Type 2 diabetes mellitus (DM) and severe combined hyperlipidaemia who developed retinal lipid infiltration, resulting in blindness. A 61-year-old woman with a 15-year history of Type 2 DM was admitted following a two-week history of progressive visual loss. Examination identified lipid infiltration into the retina. Phenotypically she had severe combined hyperlipidaemia with elevated IDL cholesterol and a broad beta band on lipoprotein electrophoresis, raising the possibility of familial dysbetalipoproteinaemia. However, gene sequencing analysis indicated that the patient was homozygous for the E3/E3 allele of the ApoE gene with no mutations detected in either the coding region or intron-exon boundaries. Her lipid profile improved following dietary therapy and gemfibrozil treatment, but this had little effect on either her fundal appearances or her visual acuity. Type 2 DM plays a vital role both in allowing expression of severe combined hyperlipoproteinaemia, in addition to serving as a risk factor for complications such as tissue infiltration

Depression: An Important Comorbidity With Metabolic Syndrome in a General Population

OBJECTIVE—There is a recognized association among depression, diabetes, and cardiovascular disease. The aim of this study was to examine in a sample representative of the general population whether depression, anxiety, and psychological distress are associated with metabolic syndrome and its components

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

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

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

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