Diabetes experts' reasoning about diabetes prevention studies: a questionnaire survey

<p>Abstract</p> <p>Background</p> <p>Presentation of results of diabetes prevention studies as relative risk reductions and the use of diagnostic categories instead of metabolic parameters leads to overestimation of effects on diabetes risk. This survey examines to what extent overestimation of diabetes prevention is related to overestimation of prevention of late complications.</p> <p>Methods</p> <p>Participants of two postgraduate courses in clinical diabetology in Austria (n = 69) and Germany (n = 31) were presented a questionnaire with 8 items at the beginning of the meetings. All 100 questionnaires were returned with 92 filled in completely. Participants were asked 1) to rate the importance of differently framed results of prevention studies and, for comparison, of the United Kingdom Prospective Diabetes Study (UKPDS), 2) to estimate to what extent late complications could be prevented by the achieved reductions in diabetes risk or HbA1c values, respectively.</p> <p>Results</p> <p>Prevention of diabetes by 60% was considered important by 84% of participants and 35% thought that complications could be prevented by ≥ 55%. However, if corresponding HbA1c values were presented (6.0% versus 6.1%) only 19% rated this effect important, and 12% thought that late complications could be prevented by ≥ 55%. The difference in HbA1c of 0.9% over 10 years in the UKPDS was considered important by 75% of participants and 16% thought that complications ('any diabetes related endpoint') were reduced by ≥ 55% (correct answer <15% by 20% participants).</p> <p>Conclusion</p> <p>The novel key message of this study is that the misleading reporting of diabetes prevention studies results in overestimation of effects on late complications.</p

How Private is Android's Private DNS Setting? Identifying Apps by Encrypted DNS Traffic

DNS over TLS (DoT) and DNS over HTTPS (DoH) promise to improve privacy and security of DNS by encrypting DNS messages, especially when messages are padded to a uniform size. Firstly, to demonstrate the limitations of recommended padding approaches, we present Segram, a novel app fingerprinting attack that allows adversaries to infer which mobile apps are executed on a device. Secondly, we record traffic traces of 118 Android apps using 10 different DoT/DoH resolvers to study the effectiveness of Segram under different conditions. According to our results, Segram identifies apps with accuracies of up to 72% with padding in a controlled closed world setting. The effectiveness of Segram is comparable with state-of-the-art techniques but Segram requires less computational effort. We release our datasets and code. Thirdly, we study the prevalence of padding among privacy-focused DoT/DoH resolvers, finding that up to 81% of our sample fail to enable padding. Our results suggest that recommended padding approaches are less effective than expected and that resolver operators are not sufficiently aware about this feature.Comment: Accepted at The 16th International Conference on Availability, Reliability and Security (ARES 2021

Analysis of consumer information brochures on osteoporosis prevention and treatment

Purpose: Evidence-based consumer information is a prerequisite for informed decision making. So far, there are no reports on the quality of consumer information brochures on osteoporosis. In the present study we analysed brochures on osteoporosis available in Germany

Selective information seeking: can consumers' avoidance of evidence-based information on colorectal cancer screening be explained by the theory of cognitive dissonance?

Background: Evidence-based patient information (EBPI) is a prerequisite for informed decision-making. However, presentation of EBPI may lead to irrational reactions causing avoidance, minimisation and devaluation of the information

Development of a patient decision aid for prevention of myocardial infarction in type 2 diabetes – rationale, design and pilot testing

Aims: Development and testing of a decision aid about prevention of myocardial infarction for persons with type 2 diabetes

Graphzerlegungstechniken für Quantenspinsysteme mit Multi-Spin Wechselwirkungen

This thesis, titled “Graph decomposition techniques for quantum spin systems with multi-spin interactions”, introduces an approach to formulate perturbative linked-cluster expansions via full hypergraph decompositions for quantum spin systems at zero temperature where the unperturbed part of the problem is local and the elementary perturbations couple more than two sites. The approach is then employed to investigate ground-state and excitation energies of several physical models, most of them featuring some kind of topological order. With the presented approach the established method of linked-cluster expansions via a full graph decomposition is extended to problems with perturbations which couple multiple sites. The first step is to find all subclusters of the system which are relevant for the calculation of the desired quantity. In the next step the subclusters are sorted into equivalence classes, such that two subclusters in the same equivalence class, have the same reduced contribution to the desired quantity. It is actually this step where the presented method differs from conventional graph decompositions. For problems with a local unperturbed part and a perturbation consisting of two-spin couplings a graph representation of the subclusters appears natural: The vertices represent the sites and the edges represent the couplings between the sites. Finally, the equivalence of subclusters relates to isomorphism of the representing graphs. For perturbations with multi-spin couplings, such a graph representation is not as obvious, whereas a representation in terms of hypergraphs appears natural. In the end, we use a graph representation of these hypergraphs, the König representation, to distinguish equivalence classes of subclusters. As for conventional graph decompositions, this allows to calculate the reduced contribution to the desired quantity once for each class, instead of once for each subcluster. Considering highly symmetric lattice models, this typically reduces the calculational effort significantly. It is the main focus of this thesis to explain hypergraph decompositions in a rather general way considering also minor complications like non-symmetric interactions or the presence of several different types of couplings. We encounter these aspects in the treatment of the various physical problems within this thesis. Importantly, we also use hypergraph decompositions to calculate series expansions in the topological phase of the toric code in a magnetic field. While we only slightly extend the previously known series, we explain how to systematically include the non-local effects of the anyonic statistics into a full hypergraph decomposition. Further considered models include the X-Cube model in a parallel magnetic field and a model which puts the X-Cube model and the 3D toric code into competition.Diese Arbeit, mit dem Titel „Graphzerlegungstechniken für Quantenspinsysteme mit Multi-Spin Wechselwirkungen“, beschreibt ein Verfahren perturbative Linked-Cluster Entwicklungen für Quantenspinsysteme am Temperaturnullpunkt mithilfe vollständiger Hypergraphzerlegungen zu formulieren, wobei der ungestörte Teil des Problems lokal ist und die elementare Störung mehr als zwei Plätze koppelt. Der Ansatz wird schließlich verwendet um Grundzustands- und Anregungsenergien verschiedener physikalischer Modelle zu berechnen, von denen die meisten eine Art topologischer Ordnung aufweisen. Mithilfe des vorgestellten Verfahrens wird die etablierte Methode von Linked-Cluster Entwicklungen mittels vollständiger Graphzerlegung auf Probleme erweitert, bei denen Störterme mehrere Plätze koppeln. Der erste Schritt ist es alle Untercluster des Systems zu finden, die für die Berechnung der zu bestimmenden Größe relevant sind. Im nächsten Schritt werden die Untercluster in Äquivalenzklassen eingeteilt, so dass zwei Untercluster aus der selben Äquivalenzklasse den gleichen reduzierten Beitrag zu der zu bestimmenden Größe liefern. Tatsächlich, ist es dieser Schritt, wo sich die Methode von konventionellen Graphzerlegungen unterscheidet. Für Probleme mit einem lokalen ungestörten Teil und einer Störung die aus Zwei-Spin-Kopplungen besteht, ist eine Graphdarstellung der Untercluster offensichtlich: Die Vertices stellen die Plätze und die Kanten die Kopplungen zwischen den Plätzen dar. Die Äquivalenz von Unterclustern steht in enger Beziehung zur Isomorphie der entsprechenden Graphen. Für Störungen mit Multi-Spin-Kopplungen ist eine solche Graphdarstellung nicht mehr so offensichtlich, wohingegen eine Darstellung mithilfe von Hypergraphen naheliegend erscheint. Letztlich, nutzen wir eine Graphdarstellung dieser Hypergraphen, die Königdarstellung, um Äquivalenzklassen von Unterclustern zu unterscheiden. Wie bei herkömmlichen Graphzerlegungen, erlaubt dies den reduzierten Beitrag zur zu berechnenden Größe nur einmal für jede Äquivalenzklasse zu berechnen, anstatt einmal für jeden Untercluster. Im Bereich hochsymmetrischer Gittermodelle reduziert dies den Rechenaufwand typischerweise erheblich. Es ist der Hauptfokus dieser Arbeit Hypergraphzerlegungen in einer relativ allgemeinen Weise zu erklären, und dabei auch kleinere Schwierigkeiten, wie nicht symmetrische Wechselwirkungen oder die Existenz mehrerer verschiedener Kopplungstypen miteinzubeziehen. Wir stoßen bei der Behandlung der verschiedenen physikalischen Modelle innerhalb dieser Arbeit auf diese Aspekte. Ein wichtiger Punkt ist die Verwendung von Hypergraphzerlegungen, um Reihenenwicklungen für den Toric Code im Magnetfeld innerhalb der topologischen Phase zu berechnen. Insbesondere erklären wir, wie man die nicht-lokalen Effekte der anyonischen Statistik in eine volle Hypergraphzerlegung einbezieht. Weitere Modelle, die in dieser Arbeit behandelt werden, beinhalten das X-Cube Modell in einem parallelen magnetischen Feld, sowie ein Modell, welches das X-Cube Modell und den 3D Toric Code in einem Hamiltonoperator kombiniert

Socioeconomic inequalities in mortality, morbidity and diabetes management for adults with type 1 diabetes: A systematic review.

AIMS: To systematically review the evidence of socioeconomic inequalities for adults with type 1 diabetes in relation to mortality, morbidity and diabetes management. METHODS: We carried out a systematic search across six relevant databases and included all studies reporting associations between socioeconomic indicators and mortality, morbidity, or diabetes management for adults with type 1 diabetes. Data extraction and quality assessment was undertaken for all included studies. A narrative synthesis was conducted. RESULTS: A total of 33 studies were identified. Twelve cohort, 19 cross sectional and 2 case control studies met the inclusion criteria. Regardless of healthcare system, low socioeconomic status was associated with poorer outcomes. Following adjustments for other risk factors, socioeconomic status was a statistically significant independent predictor of mortality in 9/10 studies and morbidity in 8/10 studies for adults with type 1 diabetes. There appeared to be an association between low socioeconomic status and some aspects of diabetes management. Although only 3 of 16 studies made adjustments for confounders and other risk factors, poor diabetes management was associated with lower socioeconomic status in 3/3 of these studies. CONCLUSIONS: Low socioeconomic status is associated with higher levels of mortality and morbidity for adults with type 1 diabetes even amongst those with access to a universal healthcare system. The association between low socioeconomic status and diabetes management requires further research given the paucity of evidence and the potential for diabetes management to mitigate the adverse effects of low socioeconomic status

Supporting self-management after attending a structured education programme: a qualitative longitudinal investigation of type 1 diabetes patients’ experiences and views

Background: Structured education programmes for patients with diabetes and other chronic conditions are being widely adopted. However, follow-up studies suggest that course graduates may struggle to sustain the self-care practices taught on their courses over time. This study explored the support needs of patients with type 1 diabetes after attending a structured education programme promoting an empowerment approach and training in use of flexible intensive insulin therapy, a regimen now widely advocated and used to manage this condition. The objective was to inform future support offered to course graduates. Methods: Repeat, in-depth interviews with 30 type 1 diabetes patients after attending Dose Adjustment for Normal Eating (DAFNE) courses in the UK, and six and 12 months later. Data were analysed using an inductive, thematic approach. Results: While the flexible intensive insulin treatment approach taught on DAFNE courses was seen as a logical and effective way of managing one’s diabetes, it was also considered more technically complex than other insulin regimens. To sustain effective disease self-management using flexible intensive insulin treatment over time, patients often expected, and needed, on-going input and support from health care professionals trained in the approach. This included: help determining insulin dose adjustments; reassurance; and, opportunities to trouble-shoot issues of concern. While some benefits were identified to receiving follow-up support in a group setting, most patients stated a preference or need for tailored and individualised support from appropriately-trained clinicians, accessible on an ‘as and when needed’ basis. Conclusions: Our findings highlight potential limitations to group-based forms of follow-up support for sustaining diabetes self-management. To maintain the clinical benefits of structured education for patients with type 1 diabetes over time, course graduates may benefit from and prefer ongoing, one-to-one support from health care professionals trained in the programme’s practices and principles. This support should be tailored and personalised to reflect patients’ specific and unique experiences of applying their education and training in the context of their everyday lives, and could be the subject of future research

Order-by-disorder and long-range interactions in the antiferromagnetic transverse-field Ising model on the triangular lattice -- A perturbative point of view

We study the low-field ground-state (GS) properties of the antiferromagnetic transverse-field Ising model with long-range interactions (afLRTFIM) on the triangular lattice. We use the method of perturbative continuous unitary transformations (pCUT) to derive an effective model for the degenerate GS space of the antiferromagnetic nearest-neighbour (NN) Ising model on a finite system, by treating the transverse-field (TF) and the long-range interactions (LRI) as a perturbation. We determine a level-crossing between the plain stripe phase at small TF and the clock-ordered phase at intermediate TF at $h\cong0.129$ for $\alpha=6$, $N=36$ spins in order three perturbation theory. We discuss the qualitative layout of the quantum phase diagram of the afLRTFIM on the triangular lattice.Comment: 3 pages, 1 figur