Enhancing diabetes care for the most vulnerable in the 21st century::Interim findings of the National Advisory Panel on Care Home Diabetes (NAPCHD)

Older adults with diabetes may carry a substantial health burden in Western ageing societies, occupy more than one in four beds in care homes, and are a highly vulnerable group who often require complex nursing and medical care. The global pandemic (COVID-19) had its epicentre in care homes and revealed many shortfalls in diabetes care resulting in hospital admissions and considerable mortality and comorbid illness. The purpose of this work was to develop a national Strategic Document of Diabetes Care for Care Homes which would bring about worthwhile, sustainable and effective quality diabetes care improvements, and address the shortfalls in care provided. A large diverse and multidisciplinary group of stakeholders (NAPCHD) defined 11 areas of interest where recommendations were needed and using a subgroup allocation approach were set tasks to produce a set of primary recommendations. Each subgroup was given 5 starter questions to begin their work and a format to provide responses. During the initial phase, 16 key findings were identified. Overall, after a period of 18 months, 49 primary recommendations were made, and 7 major conclusions were drawn from these. A model of community and integrated diabetes care for care home residents with diabetes was proposed, and a series of 5 ‘quick-wins’ were created to begin implementation of some of the recommendations that would not require significant funding. The work of the NAPCHD is ongoing but we hope that this current resource will help leaders to make these required changes happen

Structures Related to the Emplacement of Shallow-Level Intrusions

A systematic view of the vast nomenclature used to describe the structures of shallow-level intrusions is presented here. Structures are organised in four main groups, according to logical breaks in the timing of magma emplacement, independent of the scales of features: (1) Intrusion-related structures, formed as the magma is making space and then develops into its intrusion shape; (2) Magmatic flow-related structures, developed as magma moves with suspended crystals that are free to rotate; (3) Solid-state, flow-related structures that formed in portions of the intrusions affected by continuing flow of nearby magma, therefore considered to have a syn-magmatic, non-tectonic origin; (4) Thermal and fragmental structures, related to creation of space and impact on host materials. This scheme appears as a rational organisation, helpful in describing and interpreting the large variety of structures observed in shallow-level intrusions

How Emission Certificate Allocations Distort Fossil Investments: The German Example

Despite political activities to foster a low-carbon energy transition, Germany currently sees a considerable number of new coal power plants being added to its power mix. There are several possible drivers for this dash for coal, but it is widely accepted that windfall profits gained through free allocation of ETS certificates play an important role. Yet the quantification of allocation-related investment distortions has been limited to back-of-the envelope calculations and stylized models so far. We close this gap with a numerical model integrating both Germany's particular allocation rules and its specific power generation structure. We find that technology specific new entrant provisions have substantially increased incentives to invest in hard coal plants compared to natural gas at the time of the ETS onset. Expected windfall profits compensated more than half the total capital costs of a hard coal plant. Moreover, a shorter period of free allocations would not have turned investors' favours towards the cleaner natural gas technology because of preexisting economic advantages for coal. In contrast, full auctioning of permits or a single best available technology benchmark would have made natural gas the predominant technology of choice

The efficacy of interventions to increase physical activity participation of children with cerebral palsy: A systematic review and meta-analysis

© 2017 Mac Keith Press.Aim: To determine efficacy of therapy and behaviour change interventions to increase the level of participation in leisure-time physical activities (LTPAs) and habitual physical activity in children and young people with cerebral palsy. Method: Five databases were systematically searched. Included studies were randomized or comparison designs. Methodological quality was assessed with a modified Downs and Black Scale. Quantitative analysis was performed using RevMan 5.3 (The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, Denmark). Intervention components and behaviour change constructs were mapped against (1) the International Classification of Functioning, Disability and Health (ICF) and (2) the Theoretical Domains Framework. Results: Searches yielded 2487 unique articles. Eight studies (nine articles) were included. Interventions included physical training, activity level training, combined physical training and behaviour change therapy, online behaviour change modules, and context-focused therapy. Study quality varied from moderate to high. There was a small, significant effect of physical activity intervention compared with passive usual care on level of habitual physical activity, of approximately 1000 additional steps per day (standardized mean difference 0.34, 95% confidence interval 0.03-0.66, p=0.030). There was no significant effect on LTPA participation (standardized mean difference 0.40, 95% confidence interval -0.40 to 1.19, p=0.330). Interpretation: Therapy and behaviour change interventions have the potential to increase LTPA participation of children and young people with cerebral palsy, although there is a need to depart from impairment-focused approaches. Inappropriate selection of outcomes and inadequate reporting of complex interventions are barriers to progress in this field

SOUTHERN AUSTRALIAN SPECIES OF CHAMPIA AND CHYLOCLADIA RHODYMENIALES RHODOPHYTA

Volume: 100Start Page: 75End Page: 10