Self-Management among the Ethnic Groups with Type 2 Diabetes Mellitus in Thailand

The prevalence of diabetes mellitus has been rising all over the world. Self-management is required for diabetes mellitus patients. The objective of this study is to explore the self-management among the ethnic groups with type 2 diabetes mellitus in Thailand, an upper middle-income country which is located in South East Asia. The ethnic groups in Thailand are a minority group which has limited education and a different culture, language, costume and lifestyle from Thai people. The qualitative exploratory study was used in this study. In-depth interviews with semi-structured open questions were conducted by 20 participants from purposive sampling. These participants were the ethnic groups who have type 2 diabetes mellitus, received the services from a region hospital, understood Thai and were willing to participate. Content analysis was adopted for the study. The results showed that all of the participants controlled their diet before the appointment day and never miss their appointment. Only 3 participants did their exercise while 2 participants stated that they occasionally forgot to take medicine. 10 participants use the herbs for reducing the sugar level. 12 participants drank a lot of water after a lapse in the diet because they believed that water could dilute the sugar. The findings identified 5 themes; ‘controlling diet before appointment day’; ‘drinking water after a lapse in diet’; ‘medication being a vital importance’; ‘exercise is unimportant’; and ‘taking herbs for sugar reduction’. The results of this study are important to the health professionals to understand the self-management of Ethnic groups and use the data to create the appropriate intervention for promoting health among the ethnic groups with type 2 diabetes mellitus in Thailand. The findings will lead to the revision of health policy and the procedure for promoting health in this special ethnic groups

The public image of the social worker.

Thesis (M.S.)--Boston Universit

Implications of using whole genome sequencing to test unselected populations for high risk breast cancer genes: a modelling study.

BACKGROUND: The decision to test for high risk breast cancer gene mutations is traditionally based on risk scores derived from age, family and personal cancer history. Next generation sequencing technologies such as whole genome sequencing (WGS) make wider population testing more feasible. In the UK's 100,000 Genomes Project, mutations in 16 genes including BRCA1 and BRCA2 are to be actively sought regardless of clinical presentation. The implications of deploying this approach at scale for patients and clinical services are unclear. In this study we aimed to model the effect of using WGS to test an unselected UK population for high risk BRCA1 and BRCA2 gene variants to inform the debate around approaches to secondary genomic findings. METHODS: We modelled the test performance of WGS for identifying pathogenic BRCA1 and BRCA2 mutations in an unselected hypothetical population of 100,000 UK women, using published literature to derive model input parameters. We calculated analytic and clinical validity, described potential health outcomes and highlighted current areas of uncertainty. We also performed a sensitivity analysis in which we re-ran the model 100,000 times to investigate the effect of varying input parameters. RESULTS: In our models WGS was predicted to identify correctly 93 pathogenic BRCA1 mutations and 151 BRCA2 mutations in 120 and 200 women respectively, resulting in an analytic sensitivity of 75.5-77.5 %. Of 244 women with identified pathogenic mutations, we estimated that 132 (range 121-198) would develop breast cancer, so could potentially be helped by intervention. We also predicted that breast cancer would occur in 41 women (range 36-62) incorrectly identified with no pathogenic mutations and in 12,460 women without BRCA1 or BRCA2 mutations. There was considerable uncertainty about the penetrance of mutations in people without a family history of disease and the appropriate threshold of absolute disease risk for clinical action, which impacts on judgements about the clinical utility of intervention. CONCLUSIONS: This simple model demonstrates the need for robust processes to support the testing for secondary genomic findings in unselected populations that acknowledge levels of uncertainty about the clinical validity and clinical utility of testing positive for a cancer risk gene

System design for Dungeness crab processing

Dungeness crab is an important fishery on the Pacific Coast. The processing subsystem of the fishery is hampered by a variety of problems that have acted to impede technological innovations that could improve efficiency and sanitation in seafood plants. This paper provides background for problems encountered by the processors, discusses the existing plant operations, and points out problems inherent with the existing system. System. I presents solutions to identified problems, the principle ones being a crab butchering machine to replace the manual-operation; improved work design method for shucking crab meat; and a multi-purpose shaker table to combine the freshening, inspection, de-watering and can-filling operations. If all equipment and procedure changes recommended in System I are implemented, an estimated capital investment of $18, 350 will yield an annual savings of$13, 600. System II presents new concepts in crab processing. This system incorporates, a centrifuge to separate meat from the shell, a forming machine to make meat more consumer acceptable, cryogenic freezing to improve quality and improved packaging to increase sales. Finally, the following nine specific areas are identified for future studies: 1) cooking 4) crabmeat centrifuge 7) cryogenic freezing 2) cooling 5) formed body meat 8) packaging 3) shucking 6) crabmeat water content 9) Tanner crab Most of the above topics relate to the further design and refinement of System II, but probably the most important area for development lies in the Tanner crab fishery. Harvesting of this untapped species, in Oregon, will aid employment stabilization and increase effectiveness of people and plant facilities

Improvement of the Embarrassingly Parallel Search for Data Centers

International audienceWe propose an adaptation of the Embarrassingly Parallel Search (EPS) method for data centers. EPS is a simple but efficient method for parallel solving of CSPs. EPS decomposes the problem in many distinct subproblems which are then solved independently by workers. EPS performed well on multi-cores machines (40), but some issues arise when using more cores in a datacenter. Here, we identify the decomposition as the cause of the degradation and propose a parallel decomposition to address this issue. Thanks to it, EPS gives almost linear speedup and outperforms work stealing by orders of magnitude using the Gecode solver

Is small beautiful? A multicriteria assessment of small-scale energy technology applications in local governments

In its 2003 White Paper the UK government set ambitious renewable energy targets. Local governments and households have an increasing role in the overall energy system as consumers, suppliers of smaller-scale applications and citizens discussing energy projects. In this paper, we consider if small-scale or large-scale approaches to renewable energy provision can achieve energy targets in the most socially, economically and environmentally (SEE) effective way. We take a local case study of renewable energy provision in the Metropolitan Borough of Kirklees in Yorkshire, UK, and apply a multi-criteria decision analysis methodology to compare the small-scale schemes implemented in Kirklees with large-scale alternatives. The results indicate that small-scale schemes are the most SEE effective, despite large-scale schemes being more financially viable. The selection of the criteria on which the alternatives are assessed and the assigned weights for each criterion are of crucial importance. It is thus very important to include the relevant stakeholders to elicit this information

Management of work-relevant upper limb disorders: a review

Background Upper limb disorders (ULDs) are clinically challenging and responsible for considerable work loss. There is a need to determine effective approaches for their management. Aim To determine evidence-based management strategies for work-relevant ULDs and explore whether a biopsychosocial approach is appropriate. Methods Literature review using a best evidence synthesis. Data from articles identified through systematic searching of electronic databases and citation tracking were extracted into evidence tables. The information was synthesized into high-level evidence statements, which were ordered into themes covering classification/diagnosis, epidemiology, associations/risks and management/treatment, focusing on return to work or work retention and taking account of distinctions between non-specific complaints and specific diagnoses. Results Neither biomedical treatment nor ergonomic workplace interventions alone offer an optimal solution; rather, multimodal interventions show considerable promise, particularly for occupational outcomes. Early return to work, or work retention, is an important goal for most cases and may be facilitated, where necessary, by transitional work arrangements. The emergent evidence indicates that successful management strategies require all the players to be onside and acting in a coordinated fashion; this requires engaging employers and workers to participate. Conclusions The biopsychosocial model applies: biological considerations should not be ignored, but psychosocial factors are more influential for occupational outcomes. Implementation of interventions that address the full range of psychosocial issues will require a cultural shift in the way the relationship between upper limb complaints and work is conceived and handled. Dissemination of evidence-based messages can contribute to the needed cultural shift