Effectiveness of a structured educational intervention using psychological delivery methods in children and adolescents with poorly controlled type 1 diabetes: a cluster randomised controlled trial of the CASCADE intervention

Introduction: Type 1 diabetes in children and adolescents is increasing worldwide with a particular increase in children < 5 years. Fewer than one in six children and adolescents achieve recommended HbA1c values. Methods: A pragmatic, cluster randomised control trial assessed the efficacy of a clinic-based structured educational group incorporating psychological approaches to improve long-term glycaemic control, quality of life and psychosocial functioning in children and adolescents with T1D. 28 paediatric diabetes services were randomised to deliver the intervention or standard care. 362 children (8-16 years) HbA1c ≥ 8.5% were recruited. Outcomes were HbA1c at 12 and 24 months, hypoglycaemia, admissions, self-management skills, intervention compliance, emotional and behavioural adjustment and quality of life. A process evaluation collected data from key stakeholder groups in order to evaluate the feasibility of delivering the intervention. Results: 298/362 patients (82.3%) provided HbA1c at 12 months and 284/362 (78.5%) at 24 months. The intervention did not improve HbA1c at 12 months (intervention effect 0.11, 95% CI −0.28 to 0.50, P=0.584), or 24 months (intervention effect 0.03, 95% CI -0.36 to 0.41, P=0.891). There were no significant changes in remaining outcomes. 96/180 (53%) families in the intervention arm attended at least one module. The number of modules attended did not affect outcome. Reasons for low uptake included difficulties organising groups and work and school commitments. Those with highest HbA1cs were less likely to attend. Mean cost of the intervention was £683 per child. Conclusions: Significant challenges in the delivery of a structured education intervention using psychological techniques to enhance engagement and behaviour change delivered by diabetes nurses and dietitians in routine clinical practice were found. The intervention did not improve HbA1c in children and adolescents with poor control

Preparation of Large Monodisperse Vesicles

Preparation of monodisperse vesicles is important both for research purposes and for practical applications. While the extrusion of vesicles through small pores (∼100 nm in diameter) results in relatively uniform populations of vesicles, extrusion to larger sizes results in very heterogeneous populations of vesicles. Here we report a simple method for preparing large monodisperse multilamellar vesicles through a combination of extrusion and large-pore dialysis. For example, extrusion of polydisperse vesicles through 5-µm-diameter pores eliminates vesicles larger than 5 µm in diameter. Dialysis of extruded vesicles against 3-µm-pore-size polycarbonate membranes eliminates vesicles smaller than 3 µm in diameter, leaving behind a population of monodisperse vesicles with a mean diameter of ∼4 µm. The simplicity of this method makes it an effective tool for laboratory vesicle preparation with potential applications in preparing large monodisperse liposomes for drug delivery

Bringing CASE in from the cold: the teaching and learning of thinking

Thinking Science is a two-year program of professional development for teachers and thinking lessons for students in junior high school science classes. This paper presents research on the effects of Thinking Science on students’ levels of cognition in Australia. The research is timely with a general capability focused on critical thinking in the newly implemented F-10 curriculum in Australia. The design of the research was a quasi-experiment with pre and post-intervention cognitive tests conducted with participating students (n = 655) from nine cohorts in seven high schools. Findings showed significant cognitive gains compared with an age matched control group over the length of the program. Noteworthy, is a correlation between baseline cognitive score and school Index of Community Socio-Educational Advantage (ICSEA). We argue that the teaching of thinking be brought into the mainstream arena of educational discourse and the principles from evidence-based programs such as Thinking Science be universally adopted

Reference evapotranspiration in the irrigated perimeters of the state of Sergipe

O conhecimento da evapotranspiração de referência (ETo) é essencial no manejo de irrigação de culturas agrícolas em todo o mundo. Neste trabalho se utilizaram dados meteorológicos diários de evaporação do tanque "Classe A", temperaturas máximas e mínimas, insolação, velocidade do vento a 2 m de altura e umidade relativa do ar, referentes ao período de 1989 a 1993, coletados em quatro perímetros irrigados do Estado de Sergipe, para estimativa da ETo com base nos métodos do Tanque Classe "A", Radiação Solar, Hargreaves & Samani, Linacre e Penman-Monteith (FAO/56). Comparam-se os valores diários da ETo para a região estudada, através dos quais, quando comparados com o modelo de Penman-Monteith (FAO/56) se obtiveram os melhores desempenhos com os métodos que utilizam a radiação solar como dado de entrada no modelo. O método do Tanque Classe "A" não apresentou desempenho satisfatório em nenhum perímetro irrigado estudado. _________________________________________________________________________________________ ABSTRACT: The knowledge of reference evapotranspiration (ETo) is essential for the irrigation scheduling of crops throughout the world. This work used daily meteorological data of Class A pan evaporation, maximum and minimum air temperatures, insolation, wind speed at 2 m above surface and relative humidity from 1989 to 1993 for four irrigated perimeters of Sergipe. These data were used for estimating ETo based on the following methods: Class A pan evaporation, Solar Radiation, Hargreaves & Samani, Linacre and Penman-Monteith (FAO/56). The daily values of ETo were compared to those obtained by FAO Penman-Monteith method in order to choose the best method of estimating ETo for the region. The best performance was obtained for those models which used the solar radiation as the data input. The Class A pan evaporation method did not show favorable performance in any irrigated perimeter

An assessment of American Indian women's mammography experiences

<p>Abstract</p> <p>Background</p> <p>Mortality from breast cancer has increased among American Indian/Alaskan Native (AI/AN) women. Despite this alarming reality, AI/AN women have some of the lowest breast cancer screening rates. Only 37% of eligible AI/AN women report a mammogram within the last year and 52% report a mammogram within the last two years compared to 57% and 72% for White women. The experiences and satisfaction surrounding mammography for AI/AN women likely are different from that of women of other racial/ethnic groups, due to cultural differences and limited access to Indian Health Service sponsored mammography units. The overall goals of this study are to identify and understand the mammography experiences and experiential elements that relate to satisfaction or dissatisfaction with mammography services in an AI/AN population and to develop a culturally-tailored AI/AN mammography satisfaction survey.</p> <p>Methods and Design</p> <p>The three project aims that will be used to guide this work are: 1) To compare the mammography experiences and satisfaction with mammography services of Native American/Alaska Native women with that of Non-Hispanic White, Hispanic, and Black women, 2) To develop and validate the psychometric properties of an American Indian Mammography Survey, and 3) To assess variation among AI/AN women's assessments of their mammography experiences and mammography service satisfaction. Evaluations of racial/ethnic differences in mammography patient satisfaction have received little study, particularly among AI/AN women. As such, qualitative study is uniquely suited for an initial examination of their experiences because it will allow for a rich and in-depth identification and exploration of satisfaction elements.</p> <p>Discussion</p> <p>This formative research is an essential step in the development of a validated and culturally tailored AI/AN mammography satisfaction assessment. Results from this project will provide a springboard from which a maximally effective breast cancer screening program to benefit AI/AN population will be developed and tested in an effort to alter the current breast cancer-related morbidity and mortality trajectory among AI/AN women.</p

Whole-genome sequencing reveals host factors underlying critical COVID-19

Critical COVID-19 is caused by immune-mediated inflammatory lung injury. Host genetic variation influences the development of illness requiring critical care1 or hospitalization2–4 after infection with SARS-CoV-2. The GenOMICC (Genetics of Mortality in Critical Care) study enables the comparison of genomes from individuals who are critically ill with those of population controls to find underlying disease mechanisms. Here we use whole-genome sequencing in 7,491 critically ill individuals compared with 48,400 controls to discover and replicate 23 independent variants that significantly predispose to critical COVID-19. We identify 16 new independent associations, including variants within genes that are involved in interferon signalling (IL10RB and PLSCR1), leucocyte differentiation (BCL11A) and blood-type antigen secretor status (FUT2). Using transcriptome-wide association and colocalization to infer the effect of gene expression on disease severity, we find evidence that implicates multiple genes—including reduced expression of a membrane flippase (ATP11A), and increased expression of a mucin (MUC1)—in critical disease. Mendelian randomization provides evidence in support of causal roles for myeloid cell adhesion molecules (SELE, ICAM5 and CD209) and the coagulation factor F8, all of which are potentially druggable targets. Our results are broadly consistent with a multi-component model of COVID-19 pathophysiology, in which at least two distinct mechanisms can predispose to life-threatening disease: failure to control viral replication; or an enhanced tendency towards pulmonary inflammation and intravascular coagulation. We show that comparison between cases of critical illness and population controls is highly efficient for the detection of therapeutically relevant mechanisms of disease

Spatial access priority mapping (SAPM) with fishers : a quantitative GIS method for participatory planning

Spatial management tools, such as marine spatial planning and marine protected areas, are playing an increasingly important role in attempts to improve marine management and accommodate conflicting needs. Robust data are needed to inform decisions among different planning options, and early inclusion of stakeholder involvement is widely regarded as vital for success. One of the biggest stakeholder groups, and the most likely to be adversely impacted by spatial restrictions, is the fishing community. In order to take their priorities into account, planners need to understand spatial variation in their perceived value of the sea. Here a readily accessible, novel method for quantitatively mapping fishers’ spatial access priorities is presented. Spatial access priority mapping, or SAPM, uses only basic functions of standard spreadsheet and GIS software. Unlike the use of remote-sensing data, SAPM actively engages fishers in participatory mapping, documenting rather than inferring their priorities. By so doing, SAPM also facilitates the gathering of other useful data, such as local ecological knowledge. The method was tested and validated in Northern Ireland, where over 100 fishers participated in a semi-structured questionnaire and mapping exercise. The response rate was excellent, 97%, demonstrating fishers’ willingness to be involved. The resultant maps are easily accessible and instantly informative, providing a very clear visual indication of which areas are most important for the fishers. The maps also provide quantitative data, which can be used to analyse the relative impact of different management options on the fishing industry and can be incorporated into planning software, such as MARXAN, to ensure that conservation goals can be met at minimum negative impact to the industry. This research shows how spatial access priority mapping can facilitate the early engagement of fishers and the ready incorporation of their priorities into the decision-making process in a transparent, quantitative way

Beyond equilibrium climate sensitivity

ISSN:1752-0908ISSN:1752-089