The Attitudes about Complex Therapy Scale (ACTS) in Type 2 Diabetes and Cardiovascular Disease: Development, Validity and Reliability

Background: Type 2 diabetes is associated with cardiovascular disease, and patients with both conditions are prescribed complex medication regimens. Aim: The aim was to develop a reliable and valid measure of attitudes associated with the prescription and management of multiple medicines in patients with Type 2 diabetes and cardiovascular disease. Methods: Principal component analysis (PCA) and Cronbach alpha assessed the reliability of the Attitudes about Complex Therapy Scale (ACTS). Examinations of relationships with related measures inform concurrent validity. Questionnaires were sent to a cross-sectional sample of 480 people prescribed multiple medicines for co-morbid Type 2 diabetes. Results: Cronbach alpha was 0.76, indicating the scale had good internal reliability. PCA rotated a four factor model accounting for 37% of the variance. Four subscales identified; 1. Concerns about multiple medicines and increasing numbers of medicines; 2.Anxiety over missed medicines; 3. Desires to substitute medicines and reduce the number of medicines prescribed and; 4. Perceptions related to organising and managing complex therapy. The ACTS showed significant relationships with measures of anxiety, depression, general beliefs about medicines and self-efficacy. Also, the ACTS significantly correlated with adherence to medicines, showing good predictive validity. Conclusion: The ACTS was designed to assess negative attitudes towards complex therapy and multiple medication management. This tool could aid prescribing decisions and may identify people who are intentionally non-adherent to all or some of their medicines

Preterm birth : can we do better?

Preterm birth (PTB) remains the most serious complication in obstetrics and a substantial excess burden in US healthcare economics. The etiology of PTB is complex and likely has multiple physiological pathways. Unfortunately, current antenatal care screening methods have not been successful in predicting and, eventually, preventing PTB. Although treatments such as progesterone, cerclage and pessary are available for patients with historical risk factors and shortened cervix, these treatments are not universally efficacious. Antenatal care is in great need of new prediction and prevention strategies. The role of more global methods of screening and treatment is still undefined. Most women with clinical risk factors will not deliver early, and aggressive interventions in large segments of the population may not be warranted or cost effective. Furthermore, over half of women who experience PTB have no historical risk factors. Even second-trimester cervical length (CL) has only modest ability to predict which women will experience PTB. There is thus a clear need to identify biomarkers that provide quantitative, individualized assessment of risk early in pregnancy that is specific for each individual woman. The ideal biomarkers would be indicative of the pathway leading to PTB, require no special testing equipment, have a low false positive and negative rate, and offer early identification, allowing adequate time to intervene. We need an aggressive and comprehensive approach to see a dramatic reduction in rates of preterm delivery in the U.

Extension rates across the northern Shanxi Grabens, China, from Quaternary geology, seismicity and geodesy

Discrepancies between geological, seismic and geodetic rates of strain can indicate that rates of crustal deformation, and hence seismic hazard, are varying through time. Previous studies in the northern Shanxi Grabens, at the northeastern corner of the Ordos Plateau in northern China, have found extension rates of anywhere between 0 and 6 mm a−1 at an azimuth of between 95° and 180°. In this paper we determine extension rates across the northern Shanxi Grabens from offset geomorphological features and a variety of Quaternary dating techniques (including new IRSL and Ar-Ar ages), a Kostrov summation using a 700 yr catalogue of historical earthquakes, and recent campaign GPS measurements. We observe good agreement between Quaternary, seismic and geodetic rates of strain, and we find that the northern Shanxi Grabens are extending at around 1–2 mm a−1 at an azimuth of ≈151°. The azimuth of extension is particularly well constrained and can be reliably inferred from catalogues of small earthquakes. We do not find evidence for any substantial variations in extension rate through time, though there is a notable seismic moment rate deficit since 1750. This deficit could indicate complex fault interactions across large regions, aseismic accommodation of deformation, or that we are quite late in the earthquake cycle with the potential for larger earthquakes in the relatively near future

Thyroid hormones correlate with resting metabolic rate, not daily energy expenditure, in two charadriiform seabirds

K. Woo, M. Le Vaillant, T. van Nus, and especially A. Wesphal, J. Schultner and I. Dorresteijn, assisted with field work, often under unpleasant conditions. K. Wauthier was instrumental in wrestling the gamma counter into submission. P. Redman and C. Hambly conducted the isotopic analyses. K. Scott and K. Campbell provided the FoxBox. K.H.E. benefited from a Natural Sciences and Engineering Research Council (NSERC) Vanier Scholarship, Association of Canadian Universities for Northern Studies Garfield Weston Northern Studies Award and the Arctic Institute of North America Jennifer Robinson Scholarship. Research support came from Bird Studies Canada/Society of Canadian Ornithologists James Baillie Award, Animal Behavior Society Research Grant, American Ornithologists’ Union Research Grant, Frank Chapman Research Grant, the Waterbird Society Nisbet Grant and NSERC Discovery Grants to J.F.H. and W.G.A. Any use of trade names is for descriptive purposes only and does not imply endorsement by the US Government.Peer reviewedPublisher PD

Bullying and Victimization among Students in Special Education and General Education Curricula

International research established over a decade ago that students who are en-rolled in special education curricula are victimized and perpetrate more bullying than their general education peers. However, few empirical studies have exam-ined bullying rates among American schoolchildren who receive special education services. In the current study, a sample of middle school students (n = 1009) enrolled in general and special education programs completed the Univer-sity of Illinois bullying, fighting, and victimization scales. As hypothesized, students with disabilities reported higher rates of victimization and fighting be-haviours than students without disabilities. Conversely, students with disabilities and their general education peers reported similar rates of bully perpetration

Paying the pipers: mitigating the impact of anticoagulant rodenticides on predators and scavengers

Anticoagulant rodenticides, mainly second-generation forms, or SGARs, dominate the global market for rodent control. Introduced in the 1970s to counter genetic resistance in rodent populations to first-generation compounds such as warfarin, SGARs are extremely toxic and highly effective killers. However, their tendency to persist and accumulate in the body has led to the widespread contamination of terrestrial predators and scavengers. Commercial chemicals that are classified by regulators as persistent, bio-accumulative, and toxic (PBT) chemicals and that are widely used with potential environmental release, such as dichloro-diphenyl-trichloroethane (DDT) or polychlorinated biphenyls (PCBs), have been removed from commerce. However, despite consistently failing ecological risk assessments, SGARs remain in use because of the demand for effective rodent-control options and the lack of safe and humane alternatives. Although new risk-mitigation measures for rodenticides are now in effect in some countries, the contamination and poisoning of nontarget wildlife are expected to continue. Here, we suggest options to further attenuate this problem

Counting calories in cormorants : dynamic body acceleration predicts daily energy expenditure measured in pelagic cormorants

The doubly-labelled water assays and accelerometers were paid for by the authors. Funding to reach Middleton Island was supported through the Animal Behaviour Society Research Grant and the Northern Scientific Training Program of Indigenous and Northern Affairs Canada.Peer reviewedPublisher PD

Adverse outcome pathway and risks of anticoagulant rodenticides to predatory wildlife

Despite a long history of successful use, routine application of some anticoagulant rodenticides (ARs) may be at a crossroad due to new regulatory guidelines intended to mitigate risk. An adverse outcome pathway for ARs was developed to identify information gaps and end points to assess the effectiveness of regulations. This framework describes chemical properties of ARs, established macromolecular interactions by inhibition of vitamin K epoxide reductase, cellular responses including altered clotting factor processing and coagulopathy, organ level effects such as hemorrhage, organism responses with linkages to reduced fitness and mortality, and potential consequences to predator populations. Risk assessments have led to restrictions affecting use of some second-generation ARs (SGARs) in North America. While the European regulatory community highlighted significant or unacceptable risk of ARs to nontarget wildlife, use of SGARs in most EU member states remains authorized due to public health concerns and the absence of safe alternatives. For purposes of conservation and restoration of island habitats, SGARs remain a mainstay for eradication of invasive species. There are significant data gaps related to exposure pathways, comparative species sensitivity, consequences of sublethal effects, potential hazards of greater AR residues in genetically resistant prey, effects of low-level exposure to multiple rodenticides, and quantitative data on the magnitude of nontarget wildlife mortality