Active participation of patients with type 2 diabetes in consultations with their primary care practice nurses - what helps and what hinders:a qualitative study

Background:Patients with type 2 diabetes mellitus (T2DM) receiving primary care regularly visit their practicenurses (PNs). By actively participating during medical consultations, patients can better manage their disease,improving clinical outcomes and their quality of life. However, many patients with T2DM do not activelyparticipate during medical consultations. To understand the factors affecting engagement of patients withT2DM, this study aimed to identify factors that help or hinder them from actively participating inconsultations with their primary care PNs.Methods:Two semi-structured focus groups and 12 semi-structured individual interviews were conductedwith patients with T2DM (n= 20) who were undergoing treatment byprimary care PNs. All interviews weretranscribed verbatim and analyzed using a two-step approach derived from the context-mapping framework.Results:Four factors were found to help encourage patients to actively participate in their consultation:developing trusting relationships with their PNs,having enough time in the appointment, deliberatelypreparing for consultations, and allowing for the presence of a spouse. Conversely, four factors were found tohinder patients from participating during consultations: lacking the need or motivation to participate,readjusting to a new PN, forgetting to ask questions, and ineffectively expressing their thoughts.Conclusion:Patients lacked the skills necessary to adequately prepare for a consultation and achieve anactive role. In addition, patients’keen involvement appeared to benefit from a trusting relationship with theirPNs. When active participation is impeded by barriers such as a lack of patient’s skills, facilitators should beintroduced at an early stage

Bacterial porin disrupts mitochondrial membrane potential and sensitizes host cells to apoptosis

The bacterial PorB porin, an ATP-binding beta-barrel protein of pathogenic Neisseria gonorrhoeae, triggers host cell apoptosis by an unknown mechanism. PorB is targeted to and imported by host cell mitochondria, causing the breakdown of the mitochondrial membrane potential (delta psi m). Here, we show that PorB induces the condensation of the mitochondrial matrix and the loss of cristae structures, sensitizing cells to the induction of apoptosis via signaling pathways activated by BH3-only proteins. PorB is imported into mitochondria through the general translocase TOM but, unexpectedly, is not recognized by the SAM sorting machinery, usually required for the assembly of beta-barrel proteins in the mitochondrial outer membrane. PorB integrates into the mitochondrial inner membrane, leading to the breakdown of delta psi m. The PorB channel is regulated by nucleotides and an isogenic PorB mutant defective in ATP-binding failed to induce delta psi m loss and apoptosis, demonstrating that dissipation of delta psi m is a requirement for cell death caused by neisserial infection

The spine of the swan: A Herschel study of the DR21 ridge and filaments in Cygnus X

In order to characterise the cloud structures responsible for the formation of high-mass stars, we present Herschel observations of the DR21 environment. Maps of the column density and dust temperature unveil the structure of the DR21 ridge and several connected filaments. The ridge has column densities larger than 1e23/cm^2 over a region of 2.3 pc^2. It shows substructured column density profiles and branching into two major filaments in the north. The masses in the studied filaments range between 130 and 1400 Msun whereas the mass in the ridge is 15000 Msun. The accretion of these filaments onto the DR21 ridge, suggested by a previous molecular line study, could provide a continuous mass inflow to the ridge. In contrast to the striations seen in e.g., the Taurus region, these filaments are gravitationally unstable and form cores and protostars. These cores formed in the filaments potentially fall into the ridge. Both inflow and collisions of cores could be important to drive the observed high-mass star formation. The evolutionary gradient of star formation running from DR21 in the south to the northern branching is traced by decreasing dust temperature. This evolution and the ridge structure can be explained by two main filamentary components of the ridge that merged first in the south.Comment: 8 pages, 5 figures, accepted for publication as a Letter in Astronomy and Astrophysic

Stock assessment of tunas from the Indian seas

The tuna catch in India in the small scale sector fluctuated between 23 170 tonnes and 35 610 tonnes during 1984-88, the average catch for the priod being 29 146 tonnes. In 1989, 45,240 tonnes of tunas were landed by the artisanal sector

Interstellar MHD Turbulence and Star Formation

This chapter reviews the nature of turbulence in the Galactic interstellar medium (ISM) and its connections to the star formation (SF) process. The ISM is turbulent, magnetized, self-gravitating, and is subject to heating and cooling processes that control its thermodynamic behavior. The turbulence in the warm and hot ionized components of the ISM appears to be trans- or subsonic, and thus to behave nearly incompressibly. However, the neutral warm and cold components are highly compressible, as a consequence of both thermal instability in the atomic gas and of moderately-to-strongly supersonic motions in the roughly isothermal cold atomic and molecular components. Within this context, we discuss: i) the production and statistical distribution of turbulent density fluctuations in both isothermal and polytropic media; ii) the nature of the clumps produced by thermal instability, noting that, contrary to classical ideas, they in general accrete mass from their environment; iii) the density-magnetic field correlation (or lack thereof) in turbulent density fluctuations, as a consequence of the superposition of the different wave modes in the turbulent flow; iv) the evolution of the mass-to-magnetic flux ratio (MFR) in density fluctuations as they are built up by dynamic compressions; v) the formation of cold, dense clouds aided by thermal instability; vi) the expectation that star-forming molecular clouds are likely to be undergoing global gravitational contraction, rather than being near equilibrium, and vii) the regulation of the star formation rate (SFR) in such gravitationally contracting clouds by stellar feedback which, rather than keeping the clouds from collapsing, evaporates and diperses them while they collapse.Comment: 43 pages. Invited chapter for the book "Magnetic Fields in Diffuse Media", edited by Elisabete de Gouveia dal Pino and Alex Lazarian. Revised as per referee's recommendation

The JCMT Gould Belt Survey: A First Look at IC 5146

We present 450 and 850 μm submillimeter continuum observations of the IC 5146 star-forming region taken as part of the James Clerk Maxwell Telescope Gould Belt Survey. We investigate the location of bright submillimeter (clumped) emission with the larger-scale molecular cloud through comparison with extinction maps, and find that these denser structures correlate with higher cloud column density. Ninety-six individual submillimeter clumps are identified using FellWalker, and their physical properties are examined. These clumps are found to be relatively massive, ranging from 0.5 M⊙ to 116 M⊙ with a mean mass of 8 M⊙ and a median mass of 3.7 M⊙. A stability analysis for the clumps suggests that the majority are (thermally) Jeans stable, with M/MJ < 1. We further compare the locations of known protostars with the observed submillimeter emission, finding that younger protostars, i.e., Class 0 and I sources, are strongly correlated with submillimeter peaks and that the clumps with protostars are among the most Jeans unstable. Finally, we contrast the evolutionary conditions in the two major star-forming regions within IC 5146: the young cluster associated with the Cocoon Nebula and the more distributed star formation associated with the Northern Streamer filaments. The Cocoon Nebula appears to have converted a higher fraction of its mass into dense clumps and protostars, the clumps are more likely to be Jeans unstable, and a larger fraction of these remaining clumps contain embedded protostars. The Northern Streamer, however, has a larger number of clumps in total and a larger fraction of the known protostars are still embedded within these clumps