Quality of life in people with Type 2 diabetes in relation to deprivation, gender, and age in a new community-based model of care

Objectives. To evaluate changes in health related quality of life (HRQL) for individuals with Type 2 diabetes following the introduction of a new community-based model of care. Methods. A survey method was used in which HRQL, Problems Areas In Diabetes (PAID) and demographics were assessed before and 18 months after introducing the new service. Results. Overall HRQL and PAID scores were lower than published levels in individuals with diabetes but remained stable during the transition to the new model of care except for the bodily pain domain and deteriorating PAID scores for older patients. Four domains of SF36 health showed deterioration in the highest socio-economic groups. Deterioration was also observed in males, most notably mental health, in patients aged 54 years or less, 75 years or more and patients from socio-economic groups 1 and 2. HRQL was lowest at baseline and follow-up in socio-economic groups 6 and 7. Low levels of distress in patients across all deprivation categories was observed but remained stable over the transition. Conclusions. HRQL and distress associated with diabetes remained stable following the introduction of the new community-based model of care except for deterioration in the bodily pain domain and deteriorating PAID scores for older patients. Relevance for Practice. (i) Health related quality of life assessment is practical and acceptable to patients. (ii) In clinical governance terms it is good practice to monitor the impact of change in service delivery on the health of the patients in your care. (iii) Screening with health related quality of life tools such as generic and disease specific tools could help identify health problems otherwise undetected within current clinical care. Systematic identification of the most vulnerable groups with Type 2 diabetes should allow care to be better targeted

Perceptions of a service redesign by adults living with type 2 diabetes

<b>Aim:</b> This article is a report of a study conducted to explore the perceptions of adults with type 2 diabetes towards the service redesign. <b>Background:</b> Diabetes is reaching epidemic proportions and the management of this chronic illness is changing in response to this challenge. In the United Kingdom, there is ongoing restructuring of healthcare services for people with chronic illnesses to ensure that their general health and clinical needs are met predominantly in primary care. <b>Method:</b> An explorative qualitative approach was used. Eight focus groups were conducted with 35 people with type 2 diabetes in one urban location between 2003 and 2004. Five focus groups were conducted with people who had recently experienced the restructured service and three groups with people who had up to 2 years' experience of the new service. Concurrent data collection and thematic analysis were conducted by three researchers and credibility and verification sought by feedback to participants. <b>Findings:</b> Five main themes were identified: impact of living with diabetes; understanding diabetes; drivers for organizational change; care in context and individual concerns. Participants identified issues for ongoing development of the service. <b>Conclusion:</b> People with type 2 diabetes appreciate their care management within the primary care setting where there has been investment in staff to deliver this care. Healthcare resources are required to support the development of staff and the necessary infrastructure to undertake management in primary care. Policy makers need to address the balance of resources between primary and secondary care

The X-ray binary population in M33: II. X-ray spectra and variability

In this paper we investigate the X-ray spectra and X-ray spectral variability of compact X-ray sources for 3 Chandra observations of the Local Group galaxy M33. The observations are centered on the nucleus and the star forming region NGC 604. In the observations 261 sources have been detected. For a total of 43 sources the number of net counts is above 100, sufficient for a more detailed spectral fitting. Of these sources, 25 have been observed in more than one observation, allowing the study of spectral variability on ~months timescales. A quarter of the sources are found to be variable between observations. However, except for two foreground sources, no source is variable within any observation above the 99% confidence level. Only six sources show significant spectral variability between observations. A comparison of N_H values with HI observations shows that X-ray absorption values are consistent with Galactic X-ray binaries and most sources in M33 are intrinsically absorbed. The pattern of variability and the spectral parameters of these sources are consistent with the M33 X-ray source population being dominated by X-ray binaries: Two thirds of the 43 bright sources have spectral and timing properties consistent with X-ray binaries; we also find two candidates for super-soft sources and two candidates for quasi-soft sources.Comment: 25 pages, ApJ accepte

How Reasoning Aims at Truth

Many hold that theoretical reasoning aims at truth. In this paper, I ask what it is for reasoning to be thus aim-directed. Standard answers to this question explain reasoning’s aim-directedness in terms of intentions, dispositions, or rule-following. I argue that, while these views contain important insights, they are not satisfactory. As an alternative, I introduce and defend a novel account: reasoning aims at truth in virtue of being the exercise of a distinctive kind of cognitive power, one that, unlike ordinary dispositions, is capable of fully explaining its own exercises. I argue that this account is able to avoid the difficulties plaguing standard accounts of the relevant sort of mental teleology

Investigating the effects of particle shape on normal compression and overconsolidation using DEM

Discrete element modelling of normal compression has been simulated on a sample of breakable two-ball clumps and compared to that of spheres. In both cases the size effect on strength is assumed to be that of real silica sand. The slopes of the normal compression lines are compared and found to be consistent with the proposed equation of the normal compression line. The values of the coefficient of earth pressure at rest K0,nc are also compared and related to the critical state fiction angles for the two materials. The breakable samples have then been unloaded to establish the stress ratios on unloading. At low overconsolidation ratios the values of K0 follow a well-established empirical relationship and realistic Poisson ratios are observed. On progressive unloading both samples head towards passive failure, and the values of the critical state lines in extension in q–p' space are found to be consistent with the critical state angles deduced from the values of K0 during normal compression. The paper highlights the important role of particle shape in governing the stress ratio during both normal compression and subsequent overconsolidation

Thematic Report Three - Asylum, Security and Extremism

This is the final of three Thematic Reports published as part of a CREST-funded project carried out by a team of researchers at City, University of London, and Cranfield University at the Defence Academy of the United Kingdom. With the objective of better understanding Tamil diaspora communities’ attitudes and engagement in the Sri Lankan civil conflict (1983-2009) and its aftermath, the project explores diaspora and refugee communities’ relationship with the changing socio-political environment in the homeland, exploring what shapes and influences processes of radicalisation or moderation among these communities. It recognises that the socio-political circumstances in which these processes develop are often crucial to understanding why a community or individuals within that community abroad act in a certain way; this includes analysis of different scales and levels of engagement, both in home and host countries, as well as different ‘areas’ of engagement, which can include social, economic and political interactions. The three thematic reports produced as part of this project cumulatively build a comprehensive picture of the state of knowledge on political action among diaspora, refugee and asylum populations. The theoretically-informed, literature- and evidence-grounded conclusions arising from these three thematic reports are therefore of relevance beyond the case of Sri Lanka. Thematic Report One discussed how four analytical concepts, diaspora, transnationalism, cosmopolitanism, and translocalism, have come to frame the academic discussion of overseas politics and the potential of these concepts to shed light on the relationship between mobility and political action. Thematic Report Two complements the previous report’s broad conceptual discussion by specifically focusing on an analysis of the context and drivers of political action among diaspora and refugee populations, and engaging with the term ‘refugee politics’. The current paper – the final Thematic Report – analyses the growing ‘securitisation’ of refugees and other forcibly displaced populations and calls for greater consideration of structural vulnerabilities in the forced migration and displacement cycle that increase the risk of radicalisation, extremism and related political behaviours

Increasing impacts of extreme droughts on vegetation productivity under climate change

Terrestrial gross primary production (GPP) is the basis of vegetation growth and food production globally1 and plays a critical role in regulating atmospheric CO2 through its impact on ecosystem carbon balance. Even though higher CO2 concentrations in future decades can increase GPP2, low soil water availability, heat stress and disturbances associated with droughts could reduce the benefits of such CO2 fertilization. Here we analysed outputs of 13 Earth system models to show an increasingly stronger impact on GPP by extreme droughts than by mild and moderate droughts over the twenty-first century. Due to a dramatic increase in the frequency of extreme droughts, the magnitude of globally averaged reductions in GPP associated with extreme droughts was projected to be nearly tripled by the last quarter of this century (2075–2099) relative to that of the historical period (1850–1999) under both high and intermediate GHG emission scenarios. By contrast, the magnitude of GPP reductions associated with mild and moderate droughts was not projected to increase substantially. Our analysis indicates a high risk of extreme droughts to the global carbon cycle with atmospheric warming; however, this risk can be potentially mitigated by positive anomalies of GPP associated with favourable environmental conditions