Telecare motivational interviewing for diabetes patient education and support : a randomised controlled trial based in primary care comparing nurse and peer supporter delivery

Background: There is increasing interest in developing peer-led and 'expert patient'-type interventions, particularly to meet the support and informational needs of those with long term conditions, leading to improved clinical outcomes, and pressure relief on mainstream health services. There is also increasing interest in telephone support, due to its greater accessibility and potential availability than face to face provided support. The evidence base for peer telephone interventions is relatively weak, although such services are widely available as support lines provided by user groups and other charitable services. Methods/Design: In a 3-arm RCT, participants are allocated to either an intervention group with Telecare service provided by a Diabetes Specialist Nurse (DSN), an intervention group with service provided by a peer supporter (also living with diabetes), or a control group receiving routine care only. All supporters underwent a 2-day training in motivational interviewing, empowerment and active listening skills to provide telephone support over a period of up to 6 months to adults with poorly controlled type 2 diabetes who had been recommended a change in diabetes management (i.e. medication and/or lifestyle changes) by their general practitioner (GP). The primary outcome is self-efficacy; secondary outcomes include HbA1c, total and HDL cholesterol, blood pressure, body mass index, and adherence to treatment. 375 participants (125 in each arm) were sought from GP practices across West Midlands, to detect a difference in self-efficacy scores with an effect size of 0.35, 80% power, and 5% significance level. Adults living with type 2 diabetes, with an HbA1c > 8% and not taking insulin were initially eligible. A protocol change 10 months into the recruitment resulted in a change of eligibility by reducing HbA1c to > 7.4%. Several qualitative studies are being conducted alongside the main RCT to describe patient, telecare supporter and practice nurse experience of the trial. Discussion and implications of the research: With its focus on self-management and telephone peer support, the intervention being trialled has the potential to support improved self-efficacy and patient experience, improved clinical outcomes and a reduction in diabetes-related complications

International feasibility study for the Women's Wellness with Type 2 Diabetes Programme (WWDP): An eHealth enabled 12-week intervention programme for midlife women with type 2 diabetes.

AimsThe current study aimed to examine feasibility of participant recruitment and retention rates for the Women's Wellness with Type 2 Diabetes program (WWDP), and to assess initial efficacy of the program in improving wellbeing outcomes.Methods70 midlife women with type 2 diabetes mellitus (T2DM) participated in a 12-week wellness-focused intervention, the WWDP. The WWDP involved a structured book (with participatory activities), an interactive website and nurse consultations. This study had an Australian and a UK arm. Analyses were conducted using chi-square, McNemar, paired t-test, and Wilcoxon signed-ranks tests.ResultsThe attrition rate for the sample was 22.2%. Overall, significant improvement was observed in diabetes distress (DD), diabetes self-efficacy, weight, BMI, menopausal symptoms and sleep symptoms from baseline to program completion at 12 weeks. Australian participants were also more likely to meet fruit recommendation guidelines and had significant waist- and hip-circumference reductions.ConclusionsGood retention rates and initial efficacy findings indicated feasibility of the WWDP as a promising 12-week health and wellness program for women with T2DM. They also suggest incorporating a focus on self-efficacy and gendered information may be important in improving wellness and health outcomes related to distress and menopause

Biofouling of the hydroid Ectopleura larynx on aquaculture nets in Ireland: implications for finfish health

Peer-reviewedThe potential direct health problems posed to marine-farmed salmonids by the biofouling hydroid Ectopleura larynx (Phylum Cnidaria, Class Hydrozoa) and in situ net washing processes to remove the fouling organisms have not yet been addressed. In an attempt to address the possible impacts, the rate of E. larynx growth on aquaculture nets over a net-cleaning cycle was assessed and Atlantic salmon (Salmo salar) smolts were exposed to hydroid-biofouled nets under experimental challenge. After only 1 week of immersion, there was a high settlement of E. larynx on net panels, with the maximum growth observed after 3 week of immersion. For the challenges trials, experimental treatment groups of S. salar were exposed to hydroid net panels or loose hydroid material for 11 hours under controlled conditions. Gills were examined for signs of gross damage and assigned a histopathological gill score. Prior to the experiment, the gills were healthy and did not show signs of damage from any insult. After exposure to E. larynx, focal areas of epithelial sloughing, necrosis and haemorrhage were visible on the gills under histopathology and a maximum gill score of 4 was observed. These results are the first in an investigation of this kind and suggest that E. larynx can damage the gills of S. salar. Further work on this area is vital to develop a better understanding of the pathogenesis of the damage caused by hydroids and their long-term effects on fish health, growth and survival

Reading, Trauma and Literary Caregiving 1914-1918: Helen Mary Gaskell and the War Library

This article is about the relationship between reading, trauma and responsive literary caregiving in Britain during the First World War. Its analysis of two little-known documents describing the history of the War Library, begun by Helen Mary Gaskell in 1914, exposes a gap in the scholarship of war-time reading; generates a new narrative of "how," "when," and "why" books went to war; and foregrounds gender in its analysis of the historiography. The Library of Congress's T. W. Koch discovered Gaskell's ground-breaking work in 1917 and reported its successes to the American Library Association. The British Times also covered Gaskell's library, yet researchers working on reading during the war have routinely neglected her distinct model and method, skewing the research base on war-time reading and its association with trauma and caregiving. In the article's second half, a literary case study of a popular war novel demonstrates the extent of the "bitter cry for books." The success of Gaskell's intervention is examined alongside H. G. Wells's representation of textual healing. Reading is shown to offer sick, traumatized and recovering combatants emotional and psychological caregiving in ways that she could not always have predicted and that are not visible in the literary/historical record

IntCal09 and Marine09 radiocarbon age calibration curves, 0-50,000yeats cal BP

The IntCal04 and Marine04 radiocarbon calibration curves have been updated from 12 cal kBP (cal kBP is here defined as thousands of calibrated years before AD 1950), and extended to 50 cal kBP, utilizing newly available data sets that meet the IntCal Working Group criteria for pristine corals and other carbonates and for quantification of uncertainty in both the 14C and calendar timescales as established in 2002. No change was made to the curves from 0–12 cal kBP. The curves were constructed using a Markov chain Monte Carlo (MCMC) implementation of the random walk model used for IntCal04 and Marine04. The new curves were ratified at the 20th International Radiocarbon Conference in June 2009 and are available in the Supplemental Material at www.radiocarbon.org

Climate Change during and after the Roman Empire: Reconstructing the Past from Scientific and Historical Evidence

Growing scientific evidence from modern climate science is loaded with implications for the environmental history of the Roman Empire and its successor societies. The written and archaeological evidence, although richer than commonly realized, is unevenly distributed over time and space. A first synthesis of what the written records and multiple natural archives (multi-proxy data) indicate about climate change and variability across western Eurasia from c. 100 b.c. to 800 a.d. confirms that the Roman Empire rose during a period of stable and favorable climatic conditions, which deteriorated during the Empire's third-century crisis. A second, briefer period of favorable conditions coincided with the Empire's recovery in the fourth century; regional differences in climate conditions parallel the diverging fates of the eastern and western Empires in subsequent centuries. Climate conditions beyond the Empire's boundaries also played an important role by affecting food production in the Nile valley, and by encouraging two major migrations and invasions of pastoral peoples from Central Asia.Earth and Planetary SciencesHistor

Systematic review of communication technologies to promote access and engagement of young people with diabetes into healthcare

Background: Research has investigated whether communication technologies (e.g. mobile telephony, forums, email) can be used to transfer digital information between healthcare professionals and young people who live with diabetes. The systematic review evaluates the effectiveness and impact of these technologies on communication. Methods: Nine electronic databases were searched. Technologies were described and a narrative synthesis of all studies was undertaken. Results: Of 20,925 publications identified, 19 met the inclusion criteria, with 18 technologies assessed. Five categories of communication technologies were identified: video-and tele-conferencing (n = 2); mobile telephony (n = 3); telephone support (n = 3); novel electronic communication devices for transferring clinical information (n = 10); and web-based discussion boards (n = 1). Ten studies showed a positive improvement in HbA1c following the intervention with four studies reporting detrimental increases in HbA1c levels. In fifteen studies communication technologies increased the frequency of contact between patient and healthcare professional. Findings were inconsistent of an association between improvements in HbA1c and increased contact. Limited evidence was available concerning behavioural and care coordination outcomes, although improvement in quality of life, patientcaregiver interaction, self-care and metabolic transmission were reported for some communication technologies. Conclusions: The breadth of study design and types of technologies reported make the magnitude of benefit and their effects on health difficult to determine. While communication technologies may increase the frequency of contact between patient and health care professional, it remains unclear whether this results in improved outcomes and is often the basis of the intervention itself. Further research is needed to explore the effectiveness and cost effectiveness of increasing the use of communication technologies between young people and healthcare professionals

Teasing apart retrieval and encoding interference in the processing of anaphors

Two classes of account have been proposed to explain the memory processes subserving the processing of reflexive-antecedent dependencies. Structure-based accounts assume that the retrieval of the antecedent is guided by syntactic tree-configurational information without considering other kinds of information such as gender marking in the case of English reflexives. By contrast, unconstrained cue-based retrieval assumes that all available information is used for retrieving the antecedent. Similarity-based interference effects from structurally illicit distractors which match a non-structural retrieval cue have been interpreted as evidence favoring the unconstrained cue-based retrieval account since cue-based retrieval interference from structurally illicit distractors is incompatible with the structure-based account. However, it has been argued that the observed effects do not necessarily reflect interference occurring at the moment of retrieval but might equally well be accounted for by interference occurring already at the stage of encoding or maintaining the antecedent in memory, in which case they cannot be taken as evidence against the structure-based account. We present three experiments (self-paced reading and eye-tracking) on German reflexives and Swedish reflexive and pronominal possessives in which we pit the predictions of encoding interference and cue-based retrieval interference against each other. We could not find any indication that encoding interference affects the processing ease of the reflexive-antecedent dependency formation. Thus, there is no evidence that encoding interference might be the explanation for the interference effects observed in previous work. We therefore conclude that invoking encoding interference may not be a plausible way to reconcile interference effects with a structure-based account of reflexive processing

Enhancement and suppression effects resulting from information structuring in sentences

Information structuring through the use of cleft sentences increases the processing efficiency of references to elements within the scope of focus. Furthermore, there is evidence that putting certain types of emphasis on individual words not only enhances their subsequent processing, but also protects these words from becoming suppressed in the wake of subsequent information, suggesting mechanisms of enhancement and suppression. In Experiment 1, we showed that clefted constructions facilitate the integration of subsequent sentences that make reference to elements within the scope of focus, and that they decrease the efficiency with reference to elements outside of the scope of focus. In Experiment 2, using an auditory text-change-detection paradigm, we showed that focus has similar effects on the strength of memory representations. These results add to the evidence for enhancement and suppression as mechanisms of sentence processing and clarify that the effects occur within sentences having a marked focus structure