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

Analysing assessment practice: how useful is the summative/formative divide as a tool?

A view of assessment as 'naturally' divided into the categories of formative and summative has become a taken-for-granted way of thinking about, talking about and organising assessment in universities, at least in the UK where the division is inscribed in national, institutional and departmental policy and guidance (eg. Quality Assurance Agency, http://www.qaa.ac.uk). In these documents summative and formative assessment tend to be understood as serving separate purposes with summative assessment understood as summing up the level of performance and formative assessment as feeding into future learning. We question the utility of the division in terms of better understanding assessment practices on the basis of an empirical study undertaken in a higher education institution in the UK. The aim of the Assessment Environments & Cultures project is to gain a better understanding of how academics assess and why they assess in the ways that they do. Interview and observational data have been collected from academics working in three subject areas: Design, Business and Applied Sciences. Initial analysis has focussed on the discourses in use and the subject positions taken up by academics when they talk about and undertake assessment. Analysis of our data suggests that, whilst academics used the categories of formative and summative to talk about their assessment practices, the distinction between assessment purposes may be 'messier' than the separate categories imply. Various examples from the project will be introduced to illustrate this point. This raises a number of questions in terms of researching assessment practices that will be raised for discussion at the roundtable. For example:Might it be useful to understand formative and summative assessment as occupying a shared and contested space rather than as distinct categories

Perceptions of a service redesign by adults living with type 2 diabetes

<b>Aim:</b> This article is a report of a study conducted to explore the perceptions of adults with type 2 diabetes towards the service redesign. <b>Background:</b> Diabetes is reaching epidemic proportions and the management of this chronic illness is changing in response to this challenge. In the United Kingdom, there is ongoing restructuring of healthcare services for people with chronic illnesses to ensure that their general health and clinical needs are met predominantly in primary care. <b>Method:</b> An explorative qualitative approach was used. Eight focus groups were conducted with 35 people with type 2 diabetes in one urban location between 2003 and 2004. Five focus groups were conducted with people who had recently experienced the restructured service and three groups with people who had up to 2 years' experience of the new service. Concurrent data collection and thematic analysis were conducted by three researchers and credibility and verification sought by feedback to participants. <b>Findings:</b> Five main themes were identified: impact of living with diabetes; understanding diabetes; drivers for organizational change; care in context and individual concerns. Participants identified issues for ongoing development of the service. <b>Conclusion:</b> People with type 2 diabetes appreciate their care management within the primary care setting where there has been investment in staff to deliver this care. Healthcare resources are required to support the development of staff and the necessary infrastructure to undertake management in primary care. Policy makers need to address the balance of resources between primary and secondary care

Transforming Graph Representations for Statistical Relational Learning

Relational data representations have become an increasingly important topic due to the recent proliferation of network datasets (e.g., social, biological, information networks) and a corresponding increase in the application of statistical relational learning (SRL) algorithms to these domains. In this article, we examine a range of representation issues for graph-based relational data. Since the choice of relational data representation for the nodes, links, and features can dramatically affect the capabilities of SRL algorithms, we survey approaches and opportunities for relational representation transformation designed to improve the performance of these algorithms. This leads us to introduce an intuitive taxonomy for data representation transformations in relational domains that incorporates link transformation and node transformation as symmetric representation tasks. In particular, the transformation tasks for both nodes and links include (i) predicting their existence, (ii) predicting their label or type, (iii) estimating their weight or importance, and (iv) systematically constructing their relevant features. We motivate our taxonomy through detailed examples and use it to survey and compare competing approaches for each of these tasks. We also discuss general conditions for transforming links, nodes, and features. Finally, we highlight challenges that remain to be addressed

Toward identification of larval sailfish (Istiophorus platypterus), white marlin (Tetrapturus albidus), and blue marlin (Makaira nigricans) in the western North Atlantic Ocean*

The identification of larval istiophorid billfishes from the western North Atlantic Ocean has long been problematic. In the present study, a molecular technique was used to positively identify 27 larval white marlin (Tetrapturus albidus), 96 larval blue marlin (Makaira nigricans), and 591 larval sailfish (Istiophorus platypterus) from the Straits of Florida and the Bahamas. Nine morphometric measurements were taken for a subset of larvae (species known), and lower jaw pigment patterns were recorded on a grid. Canonical variates analysis (CVA) was used to reveal the extent to which the combination of morphometric, pigment pattern, and month of capture information was diagnostic to species level. Linear regression revealed species-specific relationships between the ratio of snout length to eye orbit diameter and standard length (SL). Confidence limits about these relationships served as defining characters for sailfish >10 mm SL and for blue and white marlin >17 mm SL. Pigment pattern analysis indicated that 40% of the preflexion blue marlin examined possessed a characteristic lower jaw pigment pattern and that 62% of sailfish larvae were identifiable by lower jaw pigments alone. An identification key was constructed based on pigment patterns, month of capture, and relationships between SL and the ratio of snout length to eye orbit diameter. The key yielded identifications for 69.4% of 304 (blind sample) larvae used to test it; only one of these identifications was incorrect. Of the 93 larvae that could not be identified by the key, 71 (76.3%) were correctly identified with CVA. Although identif ication of certain larval specimens may always require molecular techniques, it is encouraging that the majority (92.4%) of istiophorid larvae examined were ultimately identifiable from external characteristics alone

Using Moored Arrays and Hyperspectral Aerial Imagery to Develop Nutrient Criteria for New Hampshire\u27s Estuaries

Increasing nitrogen concentrations and declining eelgrass beds in Great Bay, NH are clear indicators of impending problems for the state’s estuaries. A workgroup established in 2005 by the NH Department of Environmental Services and the NH Estuaries Project (NHEP) adopted eelgrass survival as the water quality target for nutrient criteria development for NH’s estuaries. In 2007, the NHEP received a grant from the U.S. Environmental Protection Agency to collect water quality information including that from moored sensors and hyper-spectral imagery data of the Great Bay Estuary. Data from the Great Bay Coastal Buoy, part of the regional Integrated Ocean Observing System (IOOS), were used to derive a multivariate model of water clarity with phytoplankton, Colored Dissolved Organic Matter (CDOM), and non-algal particles. Non-algal particles include both inorganic and organic matter. Most of the temporal variability in the diffuse attenuation coefficient of Photosynthetically Available Radiation (PAR) was associated with non-algal particles. However, on a mean daily basis non-algal particles and CDOM contributed a similar fraction (~30 %) to the attenuation of light. The contribution of phytoplankton was about a third of the other two optically important constituents. CDOM concentrations varied with salinity and magnitude of riverine inputs demonstrating its terrestrial origin. Non-algal particle concentration also varied with river flow but also wind driven resuspension. Twelve of the NHEP estuarine assessment zones were observed with the hyperspectral aerial imagery on August 29 and October 17. A concurrent in situ effort included buoy measurements, continuous along-track sampling, discrete water grab samples, and vertical profiles of light attenuation. PAR effective attenuation coefficients retrieved from deep water regions in the imagery agreed well with in-situ observations. Water clarity was lower and optically important constituent concentrations were higher in the tributaries. Eelgrass survival depth, estimated as the depth at which 22% of surface light was available, ranged from less than half a meter to over two meters. The best water clarity was found in the Great Bay (GB), Little Bay (LB), and Lower Piscataqua River (LPR) assessment zones. Absence of eelgrass from these zones would indicate controlling factors other than water clarity

Learning to assess in higher education: exploring the interplay of ‘formal’ and ‘informal’ learning in the academic workplace.

While there has been considerable research into HE teachers’ development and their conceptions of teaching more generally (see, for instance, Trigwell et al., 1994, Trigwell et al., 1999, Kane et al., 2002, Eley, 2006), the way in which HE staff become assessors and learn about assessment has not been widely researched. Researchers such as Knight et al. (2006) have highlighted the importance of non-/informal learning in the academic workplace, and there is conflicting evidence for the impact of more formal academic development. Research on workplace learning stresses that formal and informal dimensions of learning are intertwined, but also that formal learning opportunities have a role to play in the development of expertise (Tynjälä, 2008). This paper explores the ways in which academics learn to assess in HE. It draws on empirical data from two research projects undertaken at one UK university. The ‘assessment cultures’ project explores interrelationships between socio-cultural context and academic assessment practices. 37 interviews were conducted; 24 initial and 13 follow-up interviews. In the initial interviews lecturers described how they assess in specific modules they teach. In the follow-up interviews themes such as disciplinary and occupational background and the ways lecturers learned to assess were explored. The ‘staff learning’ project examines learning about assessment through different types of academic development: a compulsory course on assessment for new academics, a module on assessment for learning for experienced staff and a university assessment for learning network providing support and activities to its members. 31 semi-structured interviews were conducted: 17 with network members, 8 with participants of the course for new academics and 6 with participants of the course on assessment for learning. Interviewees were asked about the benefits or otherwise of the type of academic development experienced, changes in their understanding of assessment and changes in their assessment practices. Taken together, the data generated by the two projects provide insight into the complex process whereby formal and informal interact. Using data from the two projects has enabled us to extend the scope of each individual project in order to address questions which could otherwise not have been answered. It has also provided an opportunity to examine the data through the lenses of different theoretical frameworks, thus heightening our awareness for the ‘the theoretical frames of reference and methodological approaches which shape (…) [our] knowledge claims’ (Shay, p.1). The collaboration has increased our awareness for our own approaches and backgrounds and has required us to engage with each others’ theoretical and professional perspectives: that of Foucauldian post-structuralism and a focus on the discursive construction of identity with that of academic development and a focus on scholarship of teaching and learning and evaluation of academic development initiatives. It has also meant drawing on each others’ respective research backgrounds in student and teacher learning in higher education research on the one hand and workplace learning research on the other. In the critical review of student learning research which Shay refers to in her ‘think piece’, Haggis (2009) explicitly highlights the potential of the workplace learning literatures and debates for ‘thinking differently’ about higher education research. By challenging ways of knowing through collaboration, the paper intends to make a contribution to the ‘region’ (Shay, p.2). Our focus in the analysis is on the interrelationships between theoretical concepts and assessment practices. In some interviews encounters with a concept such as ‘assessment for learning’ were described as a lens which sheds light onto existing assessment practices as well as a tool which enables the development of practice. This draws attention to the importance of the discursive resources that are available to academics for talking about their practice. In addition, certain ways of learning appear to be significant both in everyday workplace practice and in academic development activities, for instance learning from and through others. Interaction with other members of staff, particularly from other disciplines, enables staff to question the taken for granted and re-think their assessment practices. The data suggest that the simple distinction between formal and informal learning in the academic workplace may be too crude and that it may therefore be difficult to evaluate or ‘prove’ the impact of formal learning opportunities. However, the findings have implications for academic development since they draws attention to the potential of specific types of ideas and learning activities to transform understandings of assessment and assessment practices. The paper will discuss the main findings as well as the benefits and challenges of working with data across two research projects with different theoretical underpinnings

Chandra Observations of Arp 220: The Nuclear Source

We present the first results from 60ks of observations of Arp 220 using the ACIS-S instrument on Chandra. We report the detection of several sources near the galaxy's nucleus, including a point source with a hard spectrum that is coincident with the western radio nucleus B. This point source is mildly absorbed (N_H ~ 3 x 10^22 cm^-2) and has an estimated luminosity of 4 x 10^40 erg/s. In addition, a fainter source may coincide with the eastern nucleus A. Extended hard X-ray emission in the vicinity raises the total estimated nuclear 2-10 keV X-ray luminosity to 1.2 x 10^41 erg/s, but we cannot rule out a hidden AGN behind columns exceeding 5 x 10^24 cm^-2. We also detect a peak of soft X-ray emission to the west of the nucleus, and a hard point source 2.5 kpc from the nucleus with a luminosity of 6 x 10^39 erg/s.Comment: Accepted for publication in Ap