Patient reactions to a web-based cardiovascular risk calculator in type 2 diabetes: a qualitative study in primary care.

Use of risk calculators for specific diseases is increasing, with an underlying assumption that they promote risk reduction as users become better informed and motivated to take preventive action. Empirical data to support this are, however, sparse and contradictory

Impacts of Deep Water Structuring on Seabed Pollution Levels: Evidence from Radiogenic Isotopes (Pb-Sr-Nd) in Surface Sediments Along the Reykjanes Ridge (Southern Iceland)

Significant proportions of debris containing pollutants are present in remote and unknown areas of the deep seabed. Although identified amongst the top threats to marine ecosystem and human health, the mechanisms that particulate materials entered rapidly these deep ocean systems are still matter of debate. This study use depicting radiogenic isotopes (Sr, Nd, Pb) to question the relationship between the seabed sediment contamination levels and ambient stratification in the North Atlantic Ocean. On this basis, we studied sedimentary inputs and related mechanisms from more recent sequences collected at three locations representing different deep-sea hydrodynamics along the Reykjanes Ridge. Sm-Nd concentrations, as well as Sm-Nd-Sr-Pb isotopic compositions, were determined in digested and purified fraction of the sediment cores by Thermal Ionization Mass Spectrometry (TIMS). The Sm-Nd-Sr-Pb data simply reflect the scale of the perturbation of upper part (0-15 cm) of the sequences, which is much more pronounced in east flank than crossing and west bordering ridge areas. The Pb-Pb systematics show that the intensity of water mass mixing modulates degree of contamination and induced the modal transport of detrital components. As consequence of ambient stratification in this region, two major transport processes of pollutant downwards to the sediments are proposed: (i) sediments entrainment in the eastern flank and over ridge axis primarily dominated by vertical flux of particulates controlled by repackage and dislocation by strong mechanical mixing; and (ii) in the west flank, advection of abyssal waters, due to well-stratified mixing layer, provides particulates from the NEADW1 and DSOW

Optimal seismic upgrade timing in seaports with increasing throughput demand via real options

A real options (RO) formulation is proposed for decision-making on the timing to upgrade the seismic performance of existing seaports with increasing throughput demand in earthquake prone areas. The pay-off of the seismic upgrade investment option is estimated based on projected net earnings, repair cost, and downtime for a damaging reference seismic event having a pre-specified annual probability of occurrence. These projections inform a discrete-time RO binomial tree, following the American option valuation framework, which propagates the probability of the reference seismic event assuming Poisson temporal distribution of earthquake occurrence. The net present value of the expected annual payoff of the considered investment is used as an index supporting risk-informed decision-making discounted by the weighted average cost of capital (WACC). Numerical examples pertaining to decision makers with different capital cost, namely port authorities and terminal operators, operating in different economic environments typical of developed and developing countries are furnished to illustrate the applicability of the proposed RO formulation. It is found that high WACC and/or low throughput growth bring the optimal seismic upgrade timing forward, while earthquake consequences and upgrade cost have almost no influence on this timing

Health care professionals' views towards self-management and self-management education for people with type 2 diabetes

Objectives Significant problems with patients engaging with diabetes self-management education (DSME) exist. The role of healthcare professionals (HCPs) has been highlighted, with a lack of enthusiasm, inadequate information provision and poor promotion of available programmes all cited as affecting patients’ decisions to attend. However, little is known about HCPs’ views towards DSME. This study investigates the views of HCPs towards self-management generally and self-management in the context of DSME more specifically. Design A qualitative study using semi-structured interviews to investigate HCPs views of type 2 diabetes self-management and DSME. Data were analysed thematically and emergent themes were mapped on to the constructs of Normalisation Process Theory (NPT). Setting Two boroughs in London, UK. Participants Sampling was purposive to recruit a diverse range of professional roles including GPs, practice nurses, diabetes specialist nurses, healthcare assistants (HCAs), receptionists and commissioners of care. Results Interviews were conducted with 22 participants. The NPT analysis demonstrated that while a selfmanagement approach to diabetes care was viewed by HCPs as necessary and, in principle, valuable, the reality is much more complex. HCPs expressed ambivalence about pushing certain patients into self-managing, preferring to retain responsibility. There was a lack of awareness among HCPs about the content of DSME and benefits to patients. Commitment to and engagement with DSME was tempered by concerns about suitability for some patients. There was little evidence of communication between providers of group-based DSME and HCPs or of HCPs engaging in work to follow-up non-attenders. Conclusions HCPs have concerns about the appropriateness of DSME for all patients and discussed challenges to engaging with and performing the tasks required to embed the approach within practice. DSME, as a means of supporting self-management, was considered important in theory, but there was little evidence of HCPs seeing their role as extending beyond providing referrals

Evaluating the implementation of HeLP-Diabetes within NHS services:Study protocol

Self-management by people with type 2 diabetes is central to good health outcomes and the prevention of associated complications. Structured education to teach self-management is recommended by the National Institute for Heath and Clinical Excellence; however, only a small proportion of patients report being offered this education and even fewer attend. This study aims to evaluate the implementation of a new internet-based self-management intervention: HeLP-Diabetes (Healthy Living for People with type 2 Diabetes) within the National Health Service. Specific objectives are to a) determine the uptake and use of HeLP-Diabetes by services and patients; b) identify the factors which inhibit or facilitate use; c) identify the resources needed for effective implementation; d) explore possible effects of HeLP-Diabetes use on self-reported patient outcome measures

Commensurate Scale Relations in Quantum Chromodynamics

We use the BLM method to show that perturbatively-calculable observables in QCD can be related to each other without renormalization scale or scheme ambiguity. We define and study the commensurate scale relations. We show that the commensurate scales satisfy the renormalization group transitivity rule which ensures that predictions in PQCD are independent of the choice of an intermediate renormalization scheme. We generalize the BLM procedure to higher order. The application of this procedure to relate known physical observables in QCD gives surprisingly simple results. In particular, the annihilation ratio $R_{e^+e^-}$ and the Bjorken sum rule for polarized electroproduction are related through simple coefficients, which reinforces the idea of a hidden symmetry between these two observables.Comment: 35 pages (RevTeX), one PostScript figure included at the end. SLAC-PUB-6481, UMD Preprint #94-13

The Gross--Llewellyn Smith Sum Rule in the Analytic Approach to Perturbative QCD

We apply analytic perturbation theory to the Gross--Llewellyn Smith sum rule. We study the $Q^2$ evolution and the renormalization scheme dependence of the analytic three-loop QCD correction to this sum rule, and demonstrate that the results are practically renormalization scheme independent and lead to rather different $Q^2$ evolution than the standard perturbative correction possesses.Comment: 17 pages, 9 eps figures, REVTe

Triplet Exciton Generation in Bulk-Heterojunction Solar Cells based on Endohedral Fullerenes

Organic bulk-heterojunctions (BHJ) and solar cells containing the trimetallic nitride endohedral fullerene 1-[3-(2-ethyl)hexoxy carbonyl]propyl-1-phenyl-Lu3N@C80 (Lu3N@C80-PCBEH) show an open circuit voltage (VOC) 0.3 V higher than similar devices with [6,6]-phenyl-C[61]-butyric acid methyl ester (PC61BM). To fully exploit the potential of this acceptor molecule with respect to the power conversion efficiency (PCE) of solar cells, the short circuit current (JSC) should be improved to become competitive with the state of the art solar cells. Here, we address factors influencing the JSC in blends containing the high voltage absorber Lu3N@C80-PCBEH in view of both photogeneration but also transport and extraction of charge carriers. We apply optical, charge carrier extraction, morphology, and spin-sensitive techniques. In blends containing Lu3N@C80-PCBEH, we found 2 times weaker photoluminescence quenching, remainders of interchain excitons, and, most remarkably, triplet excitons formed on the polymer chain, which were absent in the reference P3HT:PC61BM blends. We show that electron back transfer to the triplet state along with the lower exciton dissociation yield due to intramolecular charge transfer in Lu3N@C80-PCBEH are responsible for the reduced photocurrent

Big conductance calcium-activated potassium channel openers control spasticity without sedation.

BACKGROUND AND PURPOSE: Our initial aim was to generate cannabinoid agents that control spasticity, occurring as a consequence of multiple sclerosis (MS), whilst avoiding the sedative side effects associated with cannabis. VSN16R was synthesized as an anandamide (endocannabinoid) analogue in an anti-metabolite approach to identify drugs that target spasticity. EXPERIMENTAL APPROACH: Following the initial chemistry, a variety of biochemical, pharmacological and electrophysiological approaches, using isolated cells, tissue-based assays and in vivo animal models, were used to demonstrate the activity, efficacy, pharmacokinetics and mechanism of action of VSN16R. Toxicological and safety studies were performed in animals and humans. KEY RESULTS: VSN16R had nanomolar activity in tissue-based, functional assays and dose-dependently inhibited spasticity in a mouse experimental encephalomyelitis model of MS. This effect occurred with over 1000-fold therapeutic window, without affecting normal muscle tone. Efficacy was achieved at plasma levels that are feasible and safe in humans. VSN16R did not bind to known CB1 /CB2 /GPPR55 cannabinoid-related receptors in receptor-based assays but acted on a vascular cannabinoid target. This was identified as the major neuronal form of the big conductance, calcium-activated potassium (BKCa ) channel. Drug-induced opening of neuronal BKCa channels induced membrane hyperpolarization, limiting excessive neural-excitability and controlling spasticity. CONCLUSIONS AND IMPLICATIONS: We identified the neuronal form of the BKCa channel as the target for VSN16R and demonstrated that its activation alleviates neuronal excitability and spasticity in an experimental model of MS, revealing a novel mechanism to control spasticity. VSN16R is a potential, safe and selective ligand for controlling neural hyper-excitability in spasticity

A digital self-management intervention for adults with type 2 diabetes: Combining theory, data and participatory design to develop HeLP-Diabetes

Background Digital health interventions have potential to contribute to better health outcomes, better healthcare and lower costs. However, evidence for their effectiveness is variable. The development and content of digital health interventions are often not described in enough detail to enable others to replicate the research or improve on previous interventions. This has led to a call for transparent reporting of intervention content and development. Purpose To describe the development process and content of a digital self-management intervention for people with type 2 diabetes (HeLP-Diabetes) that has been found to achieve its target clinical outcome, the reduction of HbA1c, a measure of glycaemic control. Method We synthesised theory, data from existing research evidence and international guidelines, and new qualitative data from target users to identify the determinants of self-management and the content to be included in HeLP-Diabetes. Using an ongoing iterative participatory design approach the content of the intervention was written, produced, reviewed and changed. Conclusion It is possible to develop and transparently report self-management programmes for long-term conditions, which reflect current best evidence, theoretical underpinning and user involvement. We intend that reporting the development process and content will inform future digital intervention development