Development of a complex intervention to test the effectiveness of peer support in type 2 diabetes

BACKGROUND: Diabetes is a chronic illness which requires the individual to assume responsibility for their own care with the aim of maintaining glucose and blood pressure levels as close to normal as possible. Traditionally self management training for diabetes has been delivered in a didactic setting. In recent times alternatives to the traditional delivery of diabetes care have been investigated, for example, the concept of peer support which emphasises patient rather than professional domination. The aim of this paper is to describe the development of a complex intervention of peer support in type 2 diabetes for a randomised control trial in a primary care setting. METHODS: The Medical Research Council (MRC) framework for the development and evaluation of complex interventions for randomised control trials (RCT) was used as a theoretical guide to designing the intervention. The first three phases (Preclinical Phase, Phase 1, Phase 2) of this framework were examined in depth. The Preclinical Phase included a review of the literature relating to type 2 diabetes and peer support. In Phase 1 the theoretical background and qualitative data from 4 focus groups were combined to define the main components of the intervention. The preliminary intervention was conducted in Phase 2. This was a pilot study conducted in two general practices and amongst 24 patients and 4 peer supporters. Focus groups and semi structured interviews were conducted to collect additional qualitative data to inform the development of the intervention. RESULTS: The four components of the intervention were identified from the Preclinical Phase and Phase 1. They are: 1. Peer supporters; 2. Peer supporter training; 3. Retention and support for peer supporters; 4. Peer support meetings. The preliminary intervention was implemented in the Phase 2. Findings from this phase allowed further modeling of the intervention, to produce the definitive intervention. CONCLUSION: The MRC framework was instrumental in the development of a robust intervention of peer support of type 2 diabetes in primary care. TRIAL REGISTRATION: Current Controlled Trials ISRCTN42541690

Effects of regular salt marsh haying on marsh plants, algae, invertebrates and birds at Plum Island Sound, Massachusetts

Author Posting. © The Author(s), 2009. This is the author's version of the work. It is posted here by permission of Springer for personal use, not for redistribution. The definitive version was published in Wetlands Ecology and Management 17 (2009): 469-487, doi: 10.1007/s11273-008-9125-3.The haying of salt marshes, a traditional activity since colonial times in New England, still occurs in about 400 ha of marsh in the Plum Island Sound estuary in northeastern Massachusetts. We took advantage of this haying activity to investigate how the periodic large-scale removal of aboveground biomass affects a number of marsh processes. Hayed marshes were no different from adjacent reference marshes in plant species density (species per area) and end-of-year aboveground biomass, but did differ in vegetation composition. Spartina patens was more abundant in hayed marshes than S. alterniflora, and the reverse was true in reference marshes. The differences in relative covers of these plant species were not associated with any differences between hayed and reference marshes in the elevations of the marsh platform. Instead it suggested that S. patens was more tolerant of haying than S. alterniflora. S. patens had higher stem densities in hayed marshes than it did in reference marshes, suggesting that periodic cutting stimulated tillering of this species. Although we predicted that haying would stimulate benthic chlorophyll production by opening up the canopy, we found differences to be inconsistent, possibly due to the relatively rapid regrowth of S. patens and to grazing by invertebrates on the algae. The pulmonate snail, Melampus bidendatus was depleted in its δ13C content in the hayed marsh compared to the reference, suggesting a diet shift to benthic algae in hayed marshes. The stable isotope ratios of a number of other consumer species were not affected by haying activity. Migratory shorebirds cue in to recently hayed marshes and may contribute to short term declines in some invertebrate species, however the number of taxa per unit area of marsh surface invertebrates and their overall abundances were unaffected by haying over the long term. Haying had no impact on nutrient concentrations in creeks just downstream from hayed plots, but the sediments of hayed marshes were lower in total N and P compared to references. In sum, haying appeared to affect plant species composition but had only short-term affects on consumer organisms. This contrasts with many grassland ecosystems, where an intermediate level of disturbance, such as by grazing, increases species diversity and may stimulate productivity. From a management perspective, periodic mowing could be a way to maintain S. patens habitats and the suite of species with which they are associated.This research was supported by the Plum Island Ecosystem Long Term Ecological Research program (OCE-972692 and OCE 0423565) of the National Science Foundation (NSF). J. Horowitz and J. Ludlam were supported by NSF Research Experience for Undergraduate (REU) grants when they were students at Hampshire College and Gordon College respectively

Focused Examination of the Intestinal lamina Propria Yields Greater Molecular Insight into Mechanisms Underlying SIV Induced Immune Dysfunction

Background: The Gastrointestinal (GI) tract is critical to AIDS pathogenesis as it is the primary site for viral transmission and a major site of viral replication and CD4 + T cell destruction. Consequently GI disease, a major complication of HIV/SIV infection can facilitate translocation of lumenal bacterial products causing localized/systemic immune activation leading to AIDS progression. Methodology/Principal Findings: To better understand the molecular mechanisms underlying GI disease we analyzed global gene expression profiles sequentially in the intestine of the same animals prior to and at 21 and 90d post SIV infection (PI). More importantly we maximized information gathering by examining distinct mucosal components (intraepithelial lymphocytes, lamina propria leukocytes [LPL], epithelium and fibrovascular stroma) separately. The use of sequential intestinal resections combined with focused examination of distinct mucosal compartments represents novel approaches not previously attempted. Here we report data pertaining to the LPL. A significant increase (61.7-fold) in immune defense/inflammation, cell adhesion/migration, cell signaling, transcription and cell division/differentiation genes were observed at 21 and 90d PI. Genes associated with the JAK-STAT pathway (IL21, IL12R, STAT5A, IL10, SOCS1) and T-cell activation (NFATc1, CDK6, Gelsolin, Moesin) were notably upregulated at 21d PI. Markedly downregulated genes at 21d PI included IL17D/IL27 and IL28B/IFNc3 (anti-HIV/viral), activation induced cytidine deaminase (B-cell function) an

Wave Vector Difference of Magnetic Bragg Reflections and Low Energy Magnetic Excitations in Charge-stripe Ordered La2NiO4.11

We report on the magnetism of charge-stripe ordered La2NiO4.11±0.01 by neutron scattering and μSR. On going towards zero energy transfer there is an observed wave vector offset in the centring of the magnetic excitations and magnetic Bragg reflections, meaning the excitations cannot be described as Goldstone modes of the magnetic order. Weak transverse field μSR measurements determine the magnetically order volume fraction is 87% from the two stripe twins, and the temperature evolution of the magnetic excitations is consistent with the low energy excitations coming from the magnetically ordered volume of the material. We will discuss how these results contrast with the proposed origin of a similar wave vector offset recently observed in a La-based cuprate, and possible origins of this effect in La2NiO4.11

Multi-messenger observations of a binary neutron star merger

On 2017 August 17 a binary neutron star coalescence candidate (later designated GW170817) with merger time 12:41:04 UTC was observed through gravitational waves by the Advanced LIGO and Advanced Virgo detectors. The Fermi Gamma-ray Burst Monitor independently detected a gamma-ray burst (GRB 170817A) with a time delay of ~1.7 s with respect to the merger time. From the gravitational-wave signal, the source was initially localized to a sky region of 31 deg2 at a luminosity distance of 40+8-8 Mpc and with component masses consistent with neutron stars. The component masses were later measured to be in the range 0.86 to 2.26 Mo. An extensive observing campaign was launched across the electromagnetic spectrum leading to the discovery of a bright optical transient (SSS17a, now with the IAU identification of AT 2017gfo) in NGC 4993 (at ~40 Mpc) less than 11 hours after the merger by the One- Meter, Two Hemisphere (1M2H) team using the 1 m Swope Telescope. The optical transient was independently detected by multiple teams within an hour. Subsequent observations targeted the object and its environment. Early ultraviolet observations revealed a blue transient that faded within 48 hours. Optical and infrared observations showed a redward evolution over ~10 days. Following early non-detections, X-ray and radio emission were discovered at the transient’s position ~9 and ~16 days, respectively, after the merger. Both the X-ray and radio emission likely arise from a physical process that is distinct from the one that generates the UV/optical/near-infrared emission. No ultra-high-energy gamma-rays and no neutrino candidates consistent with the source were found in follow-up searches. These observations support the hypothesis that GW170817 was produced by the merger of two neutron stars in NGC4993 followed by a short gamma-ray burst (GRB 170817A) and a kilonova/macronova powered by the radioactive decay of r-process nuclei synthesized in the ejecta

Galaxy And Mass Assembly (GAMA): Data Release 4 and the z < 0.1 total and z < 0.08 morphological galaxy stellar mass functions

In Galaxy And Mass Assembly Data Release 4 (GAMA DR4), we make available our full spectroscopic redshift sample. This includes 248 682 galaxy spectra, and, in combination with earlier surveys, results in 330 542 redshifts across five sky regions covering similar to 250 deg(2). The redshift density, is the highest available over such a sustained area, has exceptionally high completeness (95 per cent to r(KiDS) = 19.65 mag), and is well-suited for the study of galaxy mergers, galaxy groups, and the low redshift (z < 0.25) galaxy population. DR4 includes 32 value-added tables or Data Management Units (DMUs) that provide a number of measured and derived data products including GALEX, ESO KiDS, ESO VIKING, WISE, and HerschelSpace Observatory imaging. Within this release, we provide visual morphologies for 15 330 galaxies to z < 0.08, photometric redshift estimates for all 18 million objects to r(KiDS) similar to 25 mag, and stellar velocity dispersions for 111 830 galaxies. We conclude by deriving the total galaxy stellar mass function (GSMF) and its sub-division by morphological class (elliptical, compact-bulge and disc, diffuse-bulge and disc, and disc only). This extends our previous measurement of the total GSMF down to 10(6.75) M-circle dot h(70)(-2) and we find a total stellar mass density of rho(*) = (2.97 +/- 0.04) x 10(8) M-circle dot h(70) Mpc(-3) or Omega(*)=(2.17 +/- 0.03) x 10(-3) h(70)(-1). We conclude that at z < 0.1, the Universe has converted 4.9 +/- 0.1 per cent of the baryonic mass implied by big bang Nucleosynthesis into stars that are gravitationally bound within the galaxy population

Galaxy And Mass Assembly (GAMA): Data Release 4 and the z < 0.1 total and z < 0.08 morphological galaxy stellar mass functions

In Galaxy And Mass Assembly Data Release 4 (GAMA DR4), we make available our full spectroscopic redshift sample. This includes 248 682 galaxy spectra, and, in combination with earlier surveys, results in 330 542 redshifts across five sky regions covering ∼250 deg2. The redshift density, is the highest available over such a sustained area, has exceptionally high completeness (95 per cent to rKiDS = 19.65 mag), and is well-suited for the study of galaxy mergers, galaxy groups, and the low redshift (z < 0.25) galaxy population. DR4 includes 32 value-added tables or Data Management Units (DMUs) that provide a number of measured and derived data products including GALEX, ESO KiDS, ESO VIKING, WISE, and HerschelSpace Observatory imaging. Within this release, we provide visual morphologies for 15 330 galaxies to z < 0.08, photometric redshift estimates for all 18 million objects to rKiDS ∼ 25 mag, and stellar velocity dispersions for 111 830 galaxies. We conclude by deriving the total galaxy stellar mass function (GSMF) and its sub-division by morphological class (elliptical, compact-bulge and disc, diffuse-bulge and disc, and disc only). This extends our previous measurement of the total GSMF down to 106.75 M⊙h−270 and we find a total stellar mass density of ρ* = (2.97 ± 0.04) × 108 M⊙h70 Mpc−3 or Ω∗=(2.17±0.03)×10−3h−170⁠. We conclude that at z < 0.1, the Universe has converted 4.9 ± 0.1 per cent of the baryonic mass implied by big bang Nucleosynthesis into stars that are gravitationally bound within the galaxy population

Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study

Purpose Delirium is a neuropsychiatric disorder delineated by an acute change in cognition, attention, and consciousness. It is common, particularly in older adults, but poorly recognised. Frailty is the accumulation of deficits conferring an increased risk of adverse outcomes. We set out to determine how severity of frailty, as measured using the CFS, affected delirium rates, and recognition in hospitalised older people in the United Kingdom. Methods Adults over 65 years were included in an observational multi-centre audit across UK hospitals, two prospective rounds, and one retrospective note review. Clinical Frailty Scale (CFS), delirium status, and 30-day outcomes were recorded. Results The overall prevalence of delirium was 16.3% (483). Patients with delirium were more frail than patients without delirium (median CFS 6 vs 4). The risk of delirium was greater with increasing frailty [OR 2.9 (1.8–4.6) in CFS 4 vs 1–3; OR 12.4 (6.2–24.5) in CFS 8 vs 1–3]. Higher CFS was associated with reduced recognition of delirium (OR of 0.7 (0.3–1.9) in CFS 4 compared to 0.2 (0.1–0.7) in CFS 8). These risks were both independent of age and dementia. Conclusion We have demonstrated an incremental increase in risk of delirium with increasing frailty. This has important clinical implications, suggesting that frailty may provide a more nuanced measure of vulnerability to delirium and poor outcomes. However, the most frail patients are least likely to have their delirium diagnosed and there is a significant lack of research into the underlying pathophysiology of both of these common geriatric syndromes

Competing interactions and magnetic frustration in Yb(4)LiGe(4)

We have studied polycrystalline Yb4LiGe4, a ternary variant of the R5T4 family of layered compounds characterized by a very strong coupling between the magnetic and crystallographic degrees of freedom. The system is mixed valent, with non-magnetic Yb2+ and magnetic Yb3+ present, and is characterized by coexisting ferromagnetic and antiferromagnetic correlations. We present measurements of resistivity, AC-susceptibility, specific heat, and muon spin relaxation (muSR), below 1 K. The low temperature measurements suggest a transition to a mesoscopically inhomogeneous magnetically ordered state below 2 K characterized by fluctuations well below the ordering temperature. This unusual state is believed to result from the enhanced two-dimensionality produced by Li substitution and frustration effects inherent in the Yb sub-lattice geometry.Comment: 29 pages, 11 figures, accepted for publication, Physical Review