Type 2 diabetes in Tirana City, Albania: a rapid increase in a country in transition.

AIMS: To determine how the prevalence of Type 2 diabetes mellitus has changed in Tirana, the capital of Albania, over 20 years. METHODS: Cluster sampling was used to select 700 households including 1540 adults 25 years of age and over in Tirana City, Albania in 2001. RESULTS: Of 1540 potential subjects, 1120 participated (response rate 72.7%). Using the 1985 WHO criteria to provide comparability with earlier data, the overall prevalence of Type 2 diabetes mellitus in the age group 25+ was 6.3% (95% confidence interval 4.8-7.7); 6.9% (4.8-9.1%) male; 5.6% (3.8-7.5%) female. The age-adjusted prevalence in those aged 25+ was 5.4%. Of respondents, 3.4% were known to have diabetes, and 2.9% were newly identified through the survey. The prevalence of diabetes increased with age, although among men there was a slight decline after age 65. Impaired glucose tolerance was found in a further 2.9% of respondents, again increasing with age. The prevalence of diabetes has increased significantly since 1980, doubling in the age group 50+. Use of the 1999 WHO diagnostic criteria produces a higher unadjusted prevalence, at 9.7% (8-11.4%). In a logistic regression model, obesity and family history were independent determinants of the probability of having diabetes. Among those known to have diabetes, control was poor. CONCLUSIONS: The prevalence of diabetes in Albania has increased rapidly, consistent with what has been seen in other countries undergoing rapid modernization. It is likely to increase further in the future, with important implications for health policy

Improving continence services for older people from the service-providers' perspective: a qualitative interview study

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.Objective To examine in depth the views and experiences of continence service leads in England on key service and continence management characteristics in order to identify and to improve our understanding of barriers to a good-quality service and potential facilitators to develop and to improve services for older people with urinary incontinence (UI). Design Qualitative semistructured interviews using a purposive sample recruited across 16 continence services. Setting 3 acute and 13 primary care National Health Service Trusts in England. Participants 16 continence service leads in England actively treating and managing older people with UI. Results In terms of barriers to a good-quality service, participants highlighted a failure on the part of commissioners, managers and other health professionals in recognising the problem of UI and in acknowledging the importance of continence for older people and prevalent negative attitudes towards continence and older people. Patient assessment and continence promotion regardless of age, rather than pad provision, were identified as important steps for a good-quality service for older people with UI. More rapid and appropriate patient referral pathways, investment in service capacity, for example, more trained staff and strengthened interservice collaborations and a higher profile within medical and nurse training were specified as being important facilitators for delivering an equitable and high-quality continence service. There is a need, however, to consider the accounts given by our participants as perhaps serving the interests of their professional group within the context of interprofessional work. Conclusions Our data point to important barriers and facilitators of a good-quality service for older people with UI, from the perspective of continence service leads. Further research should address the views of other stakeholders, and explore options for the empirical evaluation of the effectiveness of identified service facilitators.Funding was received from the New Dynamics of Ageing Programme, led by the Economic & Social Research Council, UK (grantnumber RES-353-25-0010)

Inducing Private Wildfire Risk Mitigation: Experimental Investigation of Measures on Adjacent Public Lands

Increasing private wildfire risk mitigation is an important part of the larger forest restoration policy challenge. Data from an economic experiment are used to evaluate the effectiveness of providing fuel treatments on public land adjacent to private land to induce private wildfire risk mitigation. Results show evidence of “crowding out” where public spending can decrease the level of private risk mitigation. However, a policy prescription that ameliorates this crowding out is identified. Participants undertake more mitigation when fuel treatments on publicly owned lands are conditional on a threshold level of private mitigation effort and information describing each participant’s spending is provided. Key Words:

Using shared goal setting to improve access and equity: a mixed methods study of the Good Goals intervention

Background: Access and equity in children’s therapy services may be improved by directing clinicians’ use of resources toward specific goals that are important to patients. A practice-change intervention (titled ‘Good Goals’) was designed to achieve this. This study investigated uptake, adoption, and possible effects of that intervention in children’s occupational therapy services. Methods: Mixed methods case studies (n = 3 services, including 46 therapists and 558 children) were conducted. The intervention was delivered over 25 weeks through face-to-face training, team workbooks, and ‘tools for change’. Data were collected before, during, and after the intervention on a range of factors using interviews, a focus group, case note analysis, routine data, document analysis, and researchers’ observations. Results: Factors related to uptake and adoptions were: mode of intervention delivery, competing demands on therapists’ time, and leadership by service manager. Service managers and therapists reported that the intervention: helped therapists establish a shared rationale for clinical decisions; increased clarity in service provision; and improved interactions with families and schools. During the study period, therapists’ behaviours changed: identifying goals, odds ratio 2.4 (95% CI 1.5 to 3.8); agreeing goals, 3.5 (2.4 to 5.1); evaluating progress, 2.0 (1.1 to 3.5). Children’s LoT decreased by two months [95% CI −8 to +4 months] across the services. Cost per therapist trained ranged from £1,003 to £1,277, depending upon service size and therapists’ salary bands. Conclusions: Good Goals is a promising quality improvement intervention that can be delivered and adopted in practice and may have benefits. Further research is required to evaluate its: (i) impact on patient outcomes, effectiveness, cost-effectiveness, and (ii) transferability to other clinical contexts

ECLSS advanced automation preliminary requirements

A description of the total Environmental Control and Life Support System (ECLSS) is presented. The description of the hardware is given in a top down format, the lowest level of which is a functional description of each candidate implementation. For each candidate implementation, both its advantages and disadvantages are presented. From this knowledge, it was suggested where expert systems could be used in the diagnosis and control of specific portions of the ECLSS. A process to determine if expert systems are applicable and how to select the expert system is also presented. The consideration of possible problems or inconsistencies in the knowledge or workings in the subsystems is described

A diagnostic prototype of the potable water subsystem of the Space Station Freedom ECLSS

In analyzing the baseline Environmental Control and Life Support System (ECLSS) command and control architecture, various processes are found which would be enhanced by the use of knowledge based system methods of implementation. The most suitable process for prototyping using rule based methods are documented, while domain knowledge resources and other practical considerations are examined. Requirements for a prototype rule based software system are documented. These requirements reflect Space Station Freedom ECLSS software and hardware development efforts, and knowledge based system requirements. A quick prototype knowledge based system environment is researched and developed

Radiation-Hydrodynamic Simulations of Collapse and Fragmentation in Massive Protostellar Cores

We simulate the early stages of the evolution of turbulent, virialized, high-mass protostellar cores, with primary attention to how cores fragment, and whether they form a small or large number of protostars. Our simulations use the Orion adaptive mesh refinement code to follow the collapse from ~0.1 pc scales to ~10 AU scales, for durations that cover the main fragmentation phase, using three-dimensional gravito-radiation hydrodynamics. We find that for a wide range of initial conditions radiation feedback from accreting protostars inhibits the formation of fragments, so that the vast majority of the collapsed mass accretes onto one or a few objects. Most of the fragmentation that does occur takes place in massive, self-shielding disks. These are driven to gravitational instability by rapid accretion, producing rapid mass and angular momentum transport that allows most of the gas to accrete onto the central star rather than forming fragments. In contrast, a control run using the same initial conditions but an isothermal equation of state produces much more fragmentation, both in and out of the disk. We conclude that massive cores with observed properties are not likely to fragment into many stars, so that, at least at high masses, the core mass function probably determines the stellar initial mass function. Our results also demonstrate that simulations of massive star forming regions that do not include radiative transfer, and instead rely on a barotropic equation of state or optically thin heating and cooling curves, are likely to produce misleading results.Comment: 23 pages, 18 figures, emulateapj format. Accepted to ApJ. This version has minor typo fixes and small additions, no significant changes. Resolution of images severely degraded to fit within size limit. Download the full paper from http://www.astro.princeton.edu/~krumholz/recent.htm