Quality of life in people with Type 2 diabetes in relation to deprivation, gender, and age in a new community-based model of care

Objectives. To evaluate changes in health related quality of life (HRQL) for individuals with Type 2 diabetes following the introduction of a new community-based model of care. Methods. A survey method was used in which HRQL, Problems Areas In Diabetes (PAID) and demographics were assessed before and 18 months after introducing the new service. Results. Overall HRQL and PAID scores were lower than published levels in individuals with diabetes but remained stable during the transition to the new model of care except for the bodily pain domain and deteriorating PAID scores for older patients. Four domains of SF36 health showed deterioration in the highest socio-economic groups. Deterioration was also observed in males, most notably mental health, in patients aged 54 years or less, 75 years or more and patients from socio-economic groups 1 and 2. HRQL was lowest at baseline and follow-up in socio-economic groups 6 and 7. Low levels of distress in patients across all deprivation categories was observed but remained stable over the transition. Conclusions. HRQL and distress associated with diabetes remained stable following the introduction of the new community-based model of care except for deterioration in the bodily pain domain and deteriorating PAID scores for older patients. Relevance for Practice. (i) Health related quality of life assessment is practical and acceptable to patients. (ii) In clinical governance terms it is good practice to monitor the impact of change in service delivery on the health of the patients in your care. (iii) Screening with health related quality of life tools such as generic and disease specific tools could help identify health problems otherwise undetected within current clinical care. Systematic identification of the most vulnerable groups with Type 2 diabetes should allow care to be better targeted

Is null-point reconnection important for solar flux emergence?

The role of null-point reconnection in a 3D numerical MHD model of solar emerging flux is investigated. The model consists of a twisted magnetic flux tube rising through a stratified convection zone and atmosphere to interact and reconnect with a horizontal overlying magnetic field in the atmosphere. Null points appear as the reconnection begins and persist throughout the rest of the emergence, where they can be found mostly in the model photosphere and transition region, forming two loose clusters on either side of the emerging flux tube. Up to 26 nulls are present at any one time, and tracking in time shows that there is a total of 305 overall, despite the initial simplicity of the magnetic field configuration. We find evidence for the reality of the nulls in terms of their methods of creation and destruction, their balance of signs, their long lifetimes, and their geometrical stability. We then show that due to the low parallel electric fields associated with the nulls, null-point reconnection is not the main type of magnetic reconnection involved in the interaction of the newly emerged flux with the overlying field. However, the large number of nulls implies that the topological structure of the magnetic field must be very complex and the importance of reconnection along separators or separatrix surfaces for flux emergence cannot be ruled out.Comment: 26 pages, 12 figures. Added one referenc

Staphylococcus aureus endocarditis associated with injecting new psychoactive substances

Background Staphylococcus aureus infective endocarditis (IE) associated with injection of new psychoactive substances (NPS) in Edinburgh from 2014 to 2016 was observed. We compared these infections with a series of S. aureus IE cases in a non-injecting population within Edinburgh. Methods NPS-associated S. aureus IE diagnosed between 1 January 2014 and 31 May 2016 in persons who inject drugs (PWID) were compared with a series of S. aureus IE cases from non-PWID. Results There was a fourfold increase in the annual incidence of S. aureus IE, mainly due to NPS use in PWID. A larger vegetation diameter was seen on echocardiogram in PWID vs non-PWID (median 1.7 cm vs 0.65 cm; p = 0.009) with more embolic complications in PWID (15 PWID vs 1 non-PWID; p = 2.1 x 10-7) but no difference in 90-day mortality (2 PWID vs 4 non-PWID; p = 0.39). Conclusions NPS-associated S. aureus IE correlated with complications, such as deep organ embolic abscesses, that were different from non-PWID S. aureus IE. The alarming increase in incidence resolved with targeted public health and legislative measures

On Solving the Coronal Heating Problem

This article assesses the current state of understanding of coronal heating, outlines the key elements of a comprehensive strategy for solving the problem, and warns of obstacles that must be overcome along the way.Comment: Accepted by Solar Physics; Published by Solar Physic

Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine

[This corrects the article DOI: 10.1186/s13054-016-1208-6.]

Pneumocystis jirovecii pneumonia in tropical and low and middle income countries: a systematic review and meta-regression

Objective: Pneumocystis jirovecii pneumonia (PCP), the commonest opportunistic infection in HIV-infected patients in the developed world, is less commonly described in tropical and low and middle income countries (LMIC). We sought to investigate predictors of PCP in these settings. Design Systematic review and meta-regression. METHODS: Meta-regression of predictors of PCP diagnosis (33 studies). Qualitative and quantitative assessment of recorded CD4 counts, receipt of prophylaxis and antiretrovirals, sensitivity and specificity of clinical signs and symptoms for PCP, co-infection with other pathogens, and case fatality (117 studies). RESULTS: The most significant predictor of PCP was per capita Gross Domestic Product, which showed strong linear association with odds of PCP diagnosis (p30%; treatment was largely appropriate. Prophylaxis appeared to reduce the risk for development of PCP, however 24% of children with PCP were receiving prophylaxis. CD4 counts at presentation with PCP were usually <200×10 3/ ml. CONCLUSIONS: There is a positive relationship between GDP and risk of PCP diagnosis. Although failure to diagnose infection in poorer countries may contribute to this, we also hypothesise that poverty exposes at-risk patients to a wide range of infections and that the relatively non-pathogenic P. jirovecii is therefore under-represented. As LMIC develop economically they eliminate the conditions underlying transmission of virulent infection: P. jirovecii , ubiquitous in all settings, then becomes a greater relative threat

Groundwater flow underneath mound spring tufas from geophysical surveys in the southwestern Great Artesian Basin, Australia

Artesian springs, which form carbonate mounds at the surface, occur in groups along the southwestern edge of the Great Artesian Basin (GAB), in northern South Australia. Their underground structure and relationship to faulting are not well understood. This study investigated four mound spring groups (Beresford Spring, Warburton Spring, the Bubbler Spring group, and Freeling Springs), which have different geological settings, using a range of geophysical techniques: self-potential (SP), magnetotellurics (MT) and time-domain electromagnetics (TEM). The results confirmed that despite generally similar mound morphologies at the surface, spring vents in different groups have different mechanisms for sourcing water from the GAB aquifer. SP measurements effectively showed where most of the vertical flow occurs at all groups, while MT and TEM models identified the location of faults, other geological structures and the thickness of the Bulldog Shale aquitard. Beresford and Warburton springs are similar in that the spring locations at both are directly related to points on a regional-scale fault, which appears to provide a low permeability pathway to the surface. At the Bubbler Springs group, a regionally aligned fault identified in MT data seems to be bounding an area where the aquifer is much closer to the surface (and the overlying aquitard has been thinned) where the spring abundance is highest. SP responses indicate that shallow flow paths feeding individual vents are unrelated to the fault. At Freeling Springs, the SP suggests that groundwater is flowing up within shallow aquifers, and that spring location is offset from this upward flow, instead located on range-front faults that provide the final conduit to the surface.K. Inverarity, G. Heinson and M. Hatc

Professionals' perceptions of type 2 diabetes in primary care during a service redesign

&lt;p&gt;The purpose of this study was to survey primary health care professionals' perceptions of type 2 diabetes, an evaluation during a service redesign. Management of people with type 2 diabetes has been led by hospital based secondary care. The objective of the service redesign was to transfer the management of the majority of people with type 2 diabetes from secondary care to general practitioner (GP) led, multidisciplinary primary care (comprising the GP, practice nurses, dietitians and podiatrists) delivered closer to the patients. Prior to implementation, all primary health care professionals undertook accredited educational preparation and there was infrastructure development by the creation of new posts and streamlining of IT systems to support the planned change.&lt;/p&gt; &lt;p&gt;The study aim was to examine health care professionals' perspectives of diabetes, its management, the value of clinical guidelines and the impact of practice organisation. &lt;/p&gt; &lt;p&gt;A cross-sectional survey design was used. Primary health care professionals in one geographical area were sent the validated Perceptions of Diabetes Questionnaire (n=112).&lt;/p&gt; &lt;p&gt;The response rate was 34% (n=38). Professionals attached great importance to ongoing education of people with type 2 diabetes in essential areas of care. Type 2 diabetes was perceived as more difficult to treat than other chronic conditions. There was a high level of satisfaction with the workload associated with the service redesign and a team approach is valued. There is an association between diabetes-specific education and confidence in diabetes management. Professionals identified some barriers to using clinical guidelines.&lt;/p&gt; &lt;p&gt;Overall, professionals were satisfied with the new model of multidisciplinary, GP led care management and their workload with the support of additional education in diabetes.&lt;/p&gt