When is diabetes distress clinically meaningful?: establishing cut points for the Diabetes Distress Scale.

ObjectiveTo identify the pattern of relationships between the 17-item Diabetes Distress Scale (DDS17) and diabetes variables to establish scale cut points for high distress among patients with type 2 diabetes.Research design and methodsRecruited were 506 study 1 and 392 study 2 adults with type 2 diabetes from community medical groups. Multiple regression equations associated the DDS17, a 17-item scale that yields a mean-item score, with HbA(1c), diabetes self-efficacy, diet, and physical activity. Associations also were undertaken for the two-item DDS (DDS2) screener. Analyses included control variables, linear, and quadratic (curvilinear) DDS terms.ResultsSignificant quadratic effects occurred between the DDS17 and each diabetes variable, with increases in distress associated with poorer outcomes: study 1 HbA(1c) (P < 0.02), self-efficacy (P < 0.001), diet (P < 0.001), physical activity (P < 0.04); study 2 HbA(1c) (P < 0.03), self-efficacy (P < 0.004), diet (P < 0.04), physical activity (P = NS). Substantive curvilinear associations with all four variables in both studies began at unexpectedly low levels of DDS17: the slope increased linearly between scores 1 and 2, was more muted between 2 and 3, and reached a maximum between 3 and 4. This suggested three patient subgroups: little or no distress, <2.0; moderate distress, 2.0-2.9; high distress, ≥3.0. Parallel findings occurred for the DDS2.ConclusionsIn two samples of type 2 diabetic patients we found a consistent pattern of curvilinear relationships between the DDS and HbA(1c), diabetes self-efficacy, diet, and physical activity. The shape of these relationships suggests cut points for three patient groups: little or no, moderate, and high distress

Coronal heating by magnetohydrodynamic turbulence driven by reflected low-frequency waves

A candidate mechanism for the heating of the solar corona in open field line regions is described. The interaction of Alfvén waves, generated in the photosphere or chromosphere, with their reflections and the subsequent driving of quasi-two-dimensional MHD turbulence is considered. A nonlinear cascade drives fluctuations toward short wavelengths which are transverse to the mean field, thereby heating at rates insensitive to restrictive Alfvén timescales. A phenomenology is presented, providing estimates of achievable heating efficiency that are most favorable

MHD turbulence and heating of the open field-line solar corona

This paper discusses the possibility that heating of the solar corona in open field-line regions emanating from coronal holes is due to a nonlinear cascade, driven by low-frequency or quasi-static magnetohydrodynamic fluctuations. Reflection from coronal inhomogeneities plays an important role in sustaining the cascade. Physical and observational constraints are discussed. Kinetic processes that convert cascaded energy into heat must occur in regions of turbulent small-scale reconnection, and may be similar in some respects to ion heating due to intense electron beams observed in the aurora

Accounting for Housing in Poverty Analysis

The treatment of housing in the definition of income used to measure poverty makes a big difference to who is counted as poor. Both the Before Housing Costs (BHC) and After Housing Costs (AHC) measures in current use in the UK pose problems. BHC income does not capture the advantages of living in owner-occupied housing and AHC income might not account for the benefits of living in higher-quality accommodation. We explore the potential of including in income the difference between the estimated value of housing consumed and housing costs, which we refer to as net imputed rent. We investigate whether findings about child and pensioner poverty, and judgements about the effectiveness of poverty-reducing policies, are affected by accounting for housing in this way

Observations of the Ca II K line in Hel0830A dark points on August 3, 1985

Spectroheliograms taken in the light of He I 10830 A at the National Solar Observatory Vacuum Telescope on Kitt Peak were used to identify coronal holes and bright points (BPs). Target points were identified, coordinates calculated, and spectra recorded. For each spectrum, the difference in wavelength between the Ca II K minimum and the FeI reference line was calculated. It was noteworthy that the overall effect is a blueshift. It should be noted that if material of chromospheric density moves outward at this velocity, it could supply the mass flux of the solar wind if this chromospheric flow was concentrated in a few dozen sources, each of a diameter of a few arc seconds

A reduced magnetohydrodynamic model of coronal heating in open magnetic regions driven by reflected low-frequency waves

A reduced magnetohydrodynamic (RMHD) description is employed to examine a suggestion made by W. H. Matthaeus and colleagues in 1999 that coronal heating might be sustained by a cascade of low-frequency MHD turbulence. Here RMHD simulations show that the low-frequency cascade to high transverse wavenumbers can be driven by an externally maintained flux of low-frequency propagating Alfvén waves, in combination with reflection caused by an inhomogeneous background medium. The simulations show that the suggestions made previously on the basis of a phenomenology are indeed realizable. In addition, the effect is seen to sensitively depend on the presence of reflection, as the background turbulence level needed to maintain the cascade can be sustained only when reflection is imposed. The steady level of turbulence is insensitive to the initial seed turbulence level (provided it is nonzero). Consequences of this model for realistic models of coronal heating in open field-line regions are discussed

HUMAN SPINAL CORD IMPEDANCE: ITS APPLICATION IN NEUROSURGICAL STEREOTAXIC CORDOTOMY

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72600/1/j.1749-6632.1970.tb17740.x.pd

Current welfare problems facing horses in Great Britain as identified by equine stakeholders

This is the final version of the article. Available from the publisher via the DOI in this record.Despite growing concerns about the welfare of horses in Great Britain (GB) there has been little surveillance of the welfare status of the horse population. Consequently we have limited knowledge of the range of welfare problems experienced by horses in GB and the situations in which poor welfare occurs. Thirty-one in-depth interviews were conducted with a cross -section of equine stakeholders, in order to explore their perceptions of the welfare problems faced by horses in GB. Welfare problems relating to health, management and riding and training were identified, including horses being under or over weight, stabling 24 hours a day and the inappropriate use of training aids. The interviewees also discussed broader contexts in which they perceived that welfare was compromised. The most commonly discussed context was where horses are kept in unsuitable environments, for example environments with poor grazing. The racing industry and travellers horses were identified as areas of the industry where horse welfare was particularly vulnerable to compromise. Lack of knowledge and financial constraints were perceived to be the root cause of poor welfare by many interviewees. The findings give insight into the range of welfare problems that may be faced by horses in GB, the contexts in which these may occur and their possible causes. Many of the problems identified by the interviewees have undergone limited scientific investigation pointing to areas where further research is likely to be necessary for welfare improvement. The large number of issues identified suggests that some form of prioritisation may be necessary to target research and resources effectivelyThe research was funded by World Horse Welfare: http://www.worldhorsewelfare.org/Home Grant code: DFAS SJ1045