Improving outcomes in patients with coexisting multimorbid conditions-the development and evaluation of the combined diabetes and renal control trial (C-DIRECT): study protocol.

Diabetes mellitus (DM) is the most common cause of end-stage renal disease (ESRD). Patients with diabetes on dialysis have worse clinical outcomes and increased psychological burden. The need to manage the combined treatment demands for both conditions is particularly challenging yet there is paucity of data of the barriers preventing optimal management to combined therapy for diabetes and kidney failure. The study aims to explore needs of patients and develop an intervention to enable people with diabetes and ESRD to better manage both their conditions

Complex reconstructions in head and neck cancer surgery: decision making

Defects in head and neck after tumor resection often provide significant functional and cosmetic deformity. The challenge for reconstruction is not only the aesthetic result, but the functional repair. Cancer may involve composite elements and the in sano resection may lead to an extensive tissue defect. No prospective randomized controlled studies for comparison of different free flaps are available. There are many options to cover defects and restore function in the head and neck area, however we conclude from experience that nearly all defects in head and neck can be closed by 5 different free flaps: radial forearm flap, free fibula flap, anterior lateral thigh flap, lateral arm flap and parascapular flap

A review of diagnostic and functional imaging in headache

The neuroimaging of headache patients has revolutionised our understanding of the pathophysiology of primary headaches and provided unique insights into these syndromes. Modern imaging studies point, together with the clinical picture, towards a central triggering cause. The early functional imaging work using positron emission tomography shed light on the genesis of some syndromes, and has recently been refined, implying that the observed activation in migraine (brainstem) and in several trigeminal-autonomic headaches (hypothalamic grey) is involved in the pain process in either a permissive or triggering manner rather than simply as a response to first-division nociception per se. Using the advanced method of voxel-based morphometry, it has been suggested that there is a correlation between the brain area activated specifically in acute cluster headache — the posterior hypothalamic grey matter — and an increase in grey matter in the same region. No structural changes have been found for migraine and medication overuse headache, whereas patients with chronic tension-type headache demonstrated a significant grey matter decrease in regions known to be involved in pain processing. Modern neuroimaging thus clearly suggests that most primary headache syndromes are predominantly driven from the brain, activating the trigeminovascular reflex and needing therapeutics that act on both sides: centrally and peripherally

Commercial relationships between intermediaries and harvesters of the mangrove crab Ucides cordatus (Linnaeus, 1763) in the Mamanguape River estuary, Brazil, and their socio-ecological implications

The large mangrove crab Ucides cordatus (“caranguejo-uçá”) is a key fisheries resource in Brazil, critical for the sustenance of livelihoods of thousands of people in coastal rural areas. Today's crab populations suffer from habitat degradation, disease, and increasing fishing pressure. Crabs are sold alive on local and regional markets, or traded as processed meat and the market chains typically involve intermediaries (i.e. traders). The present study examined the relationship between crab harvesters and the intermediaries, and the socio-ecological implications thereof. The research was performed between September 2013 and October 2014 in the Mamanguape River estuary, northeastern Brazil. Socioeconomic information and data regarding the catch (sex and carapace width of the crabs), the processing of U. cordatus meat and the commercial relationship between harvesters and intermediaries were obtained through structured (questionnaires) and semi-structured interviews and direct observations. The crab harvesters exist under precarious socioeconomic conditions that place them at the edge of society and therefore often seek loans offered by the intermediaries, generating loyalty and dependence that guarantees the intermediaries a stable supply of crabs needed to supply an avid market.Within this relationship, the intermediaries create pressure on natural crab populations by stimulating non-selective captures, as they buy specimens below the legal size limit (6 cm wide carapace) for meat processing. During crab meat processing, the intermediaries themselves report that the meat is often mixed with cooked and shredded of other marine vertebrates, such as spotted eagle ray (Aetobatus narinari) and nurse shark (Ginglymostoma cirratum), to increase the weight of the final product. As with the crab harvesters, the women involved in processing the crabmeat often accept loans, resulting in the same type of dependence and loyalty to the intermediaries. The intermediaries, with their strong influence on the crab harvesting, are directly linked to the commercial, social and ecological implications of these harvesting activities, together with the crab harvesters themselves. Hence, to ensure sustainability of the U. cordatus fishery and maintain (better improve) dependant livelihoods, all actors involved in the production chain of U. cordatus must be considered when developing management strategies, rather than the current approach of considering the crab harvesters only. We advise the development and implementation of fisheries associations to give the crab harvesters (and regulating bodies) greater control over and capital gains from their catches

Mitochondrial physiology

As the knowledge base and importance of mitochondrial physiology to evolution, health and disease expands, the necessity for harmonizing the terminology concerning mitochondrial respiratory states and rates has become increasingly apparent. The chemiosmotic theory establishes the mechanism of energy transformation and coupling in oxidative phosphorylation. The unifying concept of the protonmotive force provides the framework for developing a consistent theoretical foundation of mitochondrial physiology and bioenergetics. We follow the latest SI guidelines and those of the International Union of Pure and Applied Chemistry (IUPAC) on terminology in physical chemistry, extended by considerations of open systems and thermodynamics of irreversible processes. The concept-driven constructive terminology incorporates the meaning of each quantity and aligns concepts and symbols with the nomenclature of classical bioenergetics. We endeavour to provide a balanced view of mitochondrial respiratory control and a critical discussion on reporting data of mitochondrial respiration in terms of metabolic flows and fluxes. Uniform standards for evaluation of respiratory states and rates will ultimately contribute to reproducibility between laboratories and thus support the development of data repositories of mitochondrial respiratory function in species, tissues, and cells. Clarity of concept and consistency of nomenclature facilitate effective transdisciplinary communication, education, and ultimately further discovery

Between Governance-Driven Democratisation and Democracy-Driven Governance: explaining changes in Participatory Governance in the Case of Barcelona

Scholars of participatory democracy have long noted dynamic interactions and transformations within and between political spaces that can foster (de)democratisation. At the heart of this dynamism lie (a) the processes through which top‐down “closed” spaces can create opportunities for rupture and democratic challenges and (b) vice‐versa, the mechanisms through which bottom‐up, open spaces can be co‐opted through institutionalisation. This paper seeks to unpick dynamic interactions between different spaces of participation by looking specifically at two forms of participatory governance, or participatory forms of political decision making used to improve the quality of democracy. First, Mark Warren's concept of ‘governance‐driven democratization’ describes top‐down and technocratic participatory governance aiming to produce better policies in response to bureaucratic rationales. Second, we introduce a new concept, democracy‐driven governance, to refer to efforts by social movements to invent new, and reclaim and transform existing, spaces of participatory governance and shape them to respond to citizens’ demands. The paper defines these concepts and argues that they co‐exist and interact in dynamic fashion; it draws on an analysis of case study literature on participatory governance in Barcelona to illuminate this relationship. Finally, the paper relates the theoretical framework to the case study by making propositions as to the structural and agential drivers of shifts in participatory governance