Clinician Driven Disparities in the Care of Black/African American Patients with Diabetes: Low Density Lipoproteins in an Urban Clinic

This quantitative, non-experimental, retrospective chart review investigated the possible presence of clinician driven disparities in the care of Black/African American patients with diabetes at an urban clinic. The study was a response to the Institute of Medicine’s call to address patient, system, and clinician issues that negatively impact management of patients with chronic diseases including diabetes. The goal is to improve patient outcomes using system wide care guidelines to increase success at meeting the nationally accepted Diabetes 5 (D5) measures. During a twelve month period, clinician response to elevated low density lipoproteins (LDLs) was assessed while considering patient preferences, side effects of medications, economic issues, and patient adherence. Patients were divided into groups with either government or private insurance and by race/ethnicity. The sample consisted of 75 individuals, 41 Caucasian, 19 African Americans, and 15 Eastern Africans. The study used an unvalidated diabetes chart assessment tool developed by the researcher. Information regarding other LDL related comorbidities were tracked including body mass index and hypertension. The study was guided by the social justice theory and Wagner’s Chronic Care Model. Findings of the study did not support clinician driven disparities. However, it was evident there is room for improvement in LDL management of patients in the study regardless of race or socioeconomic status. The research makes several recommendations for systems changes to improve outcomes of diabetes management of all patients at the clinic

Health Literacy in the Everyday Lives of Older Adults in Greece, Hungary, and the Netherlands

Health literacy (HL) encompasses someone’s knowledge and abilities to access and use health information in order to make appropriate health decisions in life. HL is particularly valuable in later life when health challenges grow. An individual’s HL is typically considered a fixed and skills-based characteristic, without taking into account how these are situated in the context of everyday life. Also, lay perspectives on health literacy are relatively scarce. Therefore, the aim of this article is to explore the context-specific perspectives of older adults and health professionals on HL in later life in Greece, Hungary, and the Netherlands. We adopted a qualitative methodology and conducted 12 focus groups: seven with 50 older adults and five with 30 health professionals to gain insight into individual perspectives on HL as situated in the health care and everyday life contexts. An informed grounded theory approach was used in analyzing the data. The results are structured in three themes: (1) interactions with health professionals, (2) perceived quality of the health care system, and (3) managing health in the context of everyday life. An overarching finding is that, for older adults, HL reflects the demands placed on them when managing their health. In the experience of older adults, these demands are placed upon them by healthcare professionals, the healthcare system, as well as their everyday lives. Our findings underscore the importance of Critical Health Literacy (CHL) as that concept foregrounds that HL is context specific. Also, CHL has been argued to be a community characteristic, which is why we call for community-based approaches to improve H

The use of gender in the trials of Myra Hindley and Rose West.

Available from British Library Document Supply Centre-DSC:DXN049381 / BLDSC - British Library Document Supply CentreSIGLEGBUnited Kingdo

Development and testing of a risk indexing framework to determine field-scale critical source areas of faecal bacteria on grassland.

This paper draws on lessons from a UK case study in the management of diffuse microbial pollution from grassland farm systems in the Taw catchment, south west England. We report on the development and preliminary testing of a field-scale faecal indicator organism risk indexing tool (FIORIT). This tool aims to prioritise those fields most vulnerable in terms of their risk of contributing FIOs to water. FIORIT risk indices were related to recorded microbial water quality parameters (faecal coliforms [FC] and intestinal enterococci [IE]) to provide a concurrent on-farm evaluation of the tool. There was a significant upward trend in Log[FC] and Log[IE] values with FIORIT risk score classification (r2 =0.87 and 0.70, respectively and P<0.01 for both FIOs). The FIORIT was then applied to 162 representative grassland fields through different seasons for ten farms in the case study catchment to determine the distribution of on-farm spatial and temporal risk. The high risk fields made up only a small proportion (1%, 2%, 2% and 3% for winter, spring, summer and autumn, respectively) of the total number of fields assessed (and less than 10% of the total area), but the likelihood of the hydrological connection of high FIO source areas to receiving watercourses makes them a priority for mitigation efforts. The FIORIT provides a preliminary and evolving mechanism through which we can combine risk assessment with risk communication to end-users and provides a framework for prioritising future empirical research. Continued testing of FIORIT across different geographical areas under both low and high flow conditions is now needed to initiate its long term development into a robust indexing tool

Minimizing Cumulative Batch Processing Time for an Industrial Oven Scheduling Problem

We introduce the Oven Scheduling Problem (OSP), a new parallel batch scheduling problem that arises in the area of electronic component manufacturing. Jobs need to be scheduled to one of several ovens and may be processed simultaneously in one batch if they have compatible requirements. The scheduling of jobs must respect several constraints concerning eligibility and availability of ovens, release dates of jobs, setup times between batches as well as oven capacities. Running the ovens is highly energy-intensive and thus the main objective, besides finishing jobs on time, is to minimize the cumulative batch processing time across all ovens. This objective distinguishes the OSP from other batch processing problems which typically minimize objectives related to makespan, tardiness or lateness. We propose to solve this NP-hard scheduling problem via constraint programming (CP) and integer linear programming (ILP) and present corresponding CP- and ILP-models. For an experimental evaluation, we introduce a multi-parameter random instance generator to provide a diverse set of problem instances. Using state-of-the-art solvers, we evaluate the quality and compare the performance of our CP- and ILP-models, which could find optimal solutions for many instances. Furthermore, using our models we are able to provide upper bounds for the whole benchmark set including large-scale instances

Dominantly Inherited Amyotrophic Lateral Sclerosis (Motor Neuron Disease)

The term amyotrophic lateral sclerosis was first introduced by Charcot to describe cases with mixed upper and lower motor neuron signs without sensory impairment. Later the syndromes of progressive bulbar palsy (PBP) and progressive muscular atrophy (PMA) were recognized to be variations of the same pathological process, and ALS was used as an inclusive term to refer to these syndromes as well. Although some authors reserve the term ALS for the specific syndrome of mixed upper and lower motor neuron lesions and use the term “motor neuron disease” to refer to the constellation of syndromes, most of the literature on familial cases uses ALS as a generic title. We will adhere to this convention

Personalized immunosuppression in elderly renal transplant recipients

The number of elderly people has increased considerably over the last decades, due to a rising life expectancy and ageing populations. As a result, an increased number of elderly with end-stage-renal-disease are diagnosed, for which the preferred treatment is renal transplantation. Over the past years the awareness of the elderly as a specific patient population has grown, which increases the importance of research in this group.Elderly patients often receive kidneys from elderly donors while younger donor kidneys are preferentially reserved for younger recipients. Although the rate of acute rejection after transplantation is lower in the elderly, these rejections may lead to graft loss more frequently, as kidneys from elderly donors have marginal reserve capacity. To prevent acute rejection, immunosuppressive therapy is needed. On the other hand, elderly patients have a higher risk to die from infectious complications, and thus less immunosuppression would be preferable.Immunosuppressive treatm

Seasonal persistence of faecal indicator organisms in soil following dairy slurry application to land by surface broadcasting and shallow injection

Dairy farming generates large volumes of liquid manure (slurry), which is ultimately recycled to agricultural land as a valuable source of plant nutrients. Different methods of slurry application to land exist; some spread the slurry to the sward surface whereas others deliver the slurry under the sward and into the soil, thus helping to reduce greenhouse gas (GHG) emissions from agriculture. The aim of this study was to investigate the impact of two slurry application methods (surface broadcast versus shallow injection) on the survival of faecal indicator organisms (FIOs) delivered via dairy slurry to replicated grassland plots across contrasting seasons. A significant increase in FIO persistence (measured by the half-life ofE.coliand intestinal enterococci) was observed when slurry was applied to grassland via shallow injection, and FIO decay rates were significantly higher for FIOs applied to grassland in spring relative to summer and autumn. Significant differences in the behaviour ofE.coliand intestinal enterococci over time were also observed, withE.colihalf-lives influenced more strongly by season of application relative to the intestinal enterococci population. While shallow injection of slurry can reduce agricultural GHG emissions to air it can also prolong the persistence of FIOs in soil, potentially increasing the risk of their subsequent transfer to water. Awareness of (and evidence for) the potential for &lsquo;pollution-swapping&rsquo; is critical in order to guard against unintended environmental impacts of agricultural management decisions

Englacial Architecture of Lambert Glacier, East Antarctica

The analysis of englacial layers using radio-echo sounding data enables the characterisation and reconstruction of current and past ice-sheet flow. Despite the Lambert Glacier catchment being one of the largest in Antarctica, discharging ~16 % of East Antarctica&rsquo;s ice, its englacial architecture has been little analysed. Here, we present a comprehensive analysis of Lambert Glacier&rsquo;s englacial architecture using radio-echo sounding data collected by the Antarctica's Gamburtsev Province Project (AGAP) North survey. We used an &ldquo;internal-layering continuity index&rdquo; (ILCI) to characterise the internal architecture of the ice and identify four macro-scale ILCI zones with distinct glaciological contexts. Whilst the catchment is dominated by continuous englacial layering, disrupted or discontinuous layering is highlighted by the ILCI at both the onset of enhanced ice flow (defined here as &gt;15 ma&minus;1) and along the shear margin, revealing the transition from internal-deformation-controlled to basal-sliding-dominated ice flow. These zones are characterised by buckled and folded englacial layers which align with the current ice-flow regime, and which we interpret as evidence that the flow direction of the Lambert Glacier trunk has changed little, if at all, during the Holocene. However, disturbed englacial layers along a deep subglacial channel that does not correspond to modern ice-flow routing suggest that ice-flow change has occurred in a former tributary which fed Lambert Glacier from grid north. As large outlet systems such as Lambert Glacier are likely to play a vital role in the future drainage of the East Antarctic Ice Sheet, constraining their englacial architecture to reconstruct their past ice flow and assess basal conditions is important.</p

Toe clearance when walking in people with unilateral transtibial amputation: Effects of passive hydraulic ankle

YesMost clinically available prosthetic feet have a rigid attachment or incorporate an “ankle” device allowing elastic articulation during stance, with the foot returning to a “neutral” position at toe-off. We investigated whether using a foot with a hydraulically controlled articulating ankle that allows the foot to be relatively dorsiflexed at toe-off and throughout swing would increase minimum toe clearance (MTC). Twenty-one people with unilateral transtibial amputation completed overground walking trials using their habitual prosthetic foot with rigid or elastic articulating attachment and a foot with a hydraulic ankle attachment (hyA-F). MTC and other kinematic variables were assessed across multiple trials. When using the hyA-F, mean MTC increased on both limbs (p= 0.03). On the prosthetic limb this was partly due to the device being in its fully dorsiflexed position at toe-off, which reduced the “toes down” foot angle throughout swing (p = 0.01). Walking speed also increased when using the hyA-F (p = 0.001) and was associated with greater swing-limb hip flexion on the prosthetic side (p = 0.04), which may have contributed to the increase in mean MTC. Variability in MTC increased on the prosthetic side when using the hyA-F (p = 0.03), but this did not increase risk of tripping