International challenges without borders: a descriptive study of family physicians' educational needs in the field of diabetes

<p>Abstract</p> <p>Background</p> <p>The optimal care of persons with diabetes by general practitioners and family physicians (GP/FP) is complex and requires multiple competencies. This is a fairly unrecognized key challenge in the healthcare systems. In some cases, local and national Continuous Professional Development (CPD) initiatives target these challenges; however there have been few international initiatives, possibly because challenges emerging from different studies have not been linked across national boundaries. In this context, the authors have compiled data about gaps and/or barriers inherent to GP/FP care of persons with type 2 diabetes from Austria, Canada, Germany and the United Kingdom.</p> <p>Methods</p> <p>Secondary analyzes of pre-existing studies were conducted to identify challenges in the care of patients with type 2 diabetes as faced by GPs/FPs. Two sources of data were reviewed: unpublished research data from collaborating organizations and articles from a literature search (in English and German). Articles retrieved were scanned by the research team for relevance to the study objectives and to extract existing gaps and barriers. The identified challenges were then categorized along three major axes: (1) phase of the continuum of care {from screening to management}; (2) learning domain {knowledge, skills, attitudes, behavior, context}; and (3) by country/region. Compilation and categorization were performed by qualitative researchers and discrepancies were resolved through discussion until concordance was achieved.</p> <p>Results and discussion</p> <p>Thirteen challenges faced by GPs/FPs in the care for patients with type 2 diabetes were common in at least 3 of the 4 targeted countries/regions. These issues were found across the entire continuum of care and included: pathophysiology of diabetes, diagnostic criteria, treatment targets assessment, drugs' modes of action, decision-making in therapies, treatment guidelines, insulin therapy, adherence, management of complications, lifestyle changes, team integration, bureaucracy and third-party payers. The issues reported were not restricted to the physicians' knowledge, but also related to their skills, attitudes, behaviours and context.</p> <p>Conclusions</p> <p>This study revealed challenges faced by GPs/FPs when caring for patients with diabetes, which were similar across international and health system borders. Common issues might be addressed more efficiently through international educational designs, adapted to each country's healthcare system, helping develop and maintain physicians' competencies.</p

Therapeutic inertia amongst general practitioners with interest in diabetes

Introduction As the therapeutic options in the management of type 2 diabetes increase, there is an increase confusion among health care professionals, thus leading to the phenomenon of therapeutic inertia. This is the failure to escalate or de-escalate treatment when the clinical need for this is required. It has been studied extensively in various settings, however, it has never been reported in any studies focusing solely on primary care physicians with an interest in diabetes. This group is increasingly becoming the focus of managing complex diabetes care in the community, albeit with the support from specialists. Methods In this retrospective audit, we assessed the prevalence of the phenomenon of therapeutic inertia amongst primary care physicians with an interest in diabetes in UK. We also assessed the predictive abilities of various patient level characteristics on therapeutic inertia amongst this group of clinicians. Results Out of the 240 patients reported on, therapeutic inertia was judged to have occurred in 53 (22.1%) of patients. The full model containing all the selected variables was not statistically significant, p = 0.59. So the model was not able to distinguish between situations in which therapeutic inertia occurred and when it did not occur. None of the patient level characteristics on its own was predictive of therapeutic inertia. Conclusion Therapeutic inertia was present only in about a fifth of patient patients with diabetes being managed by primary care physicians with an interest in diabetes

Predictors of fecundability and conception waits among the Dogon of Mali

Surprisingly little is known about the mechanisms that underlie variation in female fertility in humans. Data on this topic are nonetheless vital to a number of pragmatic and theoretical enterprises, including population planning, infertility treatment and prevention, and evolutionary ecology. Here we study female fertility by focusing on one component of the interbirth interval: the waiting time to conception during menstrual cycling. Our study population is a Dogon village of 460 people in Mali, West Africa. This population is pronatalist and noncontracepting. In accordance with animist beliefs, the women spend five nights sleeping at a menstrual hut during menses. By censusing the women present at the menstrual huts in the study village on each of 736 consecutive nights, we were able to monitor women's conception waits prospectively. Hormonal profiles confirm the accuracy of the data on conception waits obtained from the menstrual hut census (Strassmann [1996], Behavioral Ecology 7: 304–315). Using survival analysis, we identified significant predictors of the waiting time to conception: wife's age (years), husband's age (49 years), marital duration (years), gravidity (number of prior pregnancies), and breast-feeding status. Additional variables were not significant, including duration of postpartum amenorrhea, sex of the last child, nutritional status, economic status, polygyny, and marital status (fiancÉe vs. married). We fit both continuous and discrete time survival models, but the former appeared to be a better choice for these data. Am J Phys Anthropol 105:167–184, 1998. © 1998 Wiley-Liss, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/37683/1/5_ftp.pd

Human gut Bacteroidetes can utilize yeast mannan through a selfish mechanism

Yeasts, which have been a component of the human diet for at least 7,000 years, possess an elaborate cell wall α-mannan. The influence of yeast mannan on the ecology of the human microbiota is unknown. Here we show that yeast α-mannan is a viable food source for the Gram-negative bacterium Bacteroides thetaiotaomicron, a dominant member of the microbiota. Detailed biochemical analysis and targeted gene disruption studies support a model whereby limited cleavage of α-mannan on the surface generates large oligosaccharides that are subsequently depolymerized to mannose by the action of periplasmic enzymes. Co-culturing studies showed that metabolism of yeast mannan by B. thetaiotaomicron presents a ‘selfish’ model for the catabolism of this difficult to breakdown polysaccharide. Genomic comparison with B. thetaiotaomicron in conjunction with cell culture studies show that a cohort of highly successful members of the microbiota has evolved to consume sterically-restricted yeast glycans, an adaptation that may reflect the incorporation of eukaryotic microorganisms into the human diet

Survey of Propulsion Technologies Applicable to Cubesats

At present, no Cubesat has flown in space featuring propulsion. This was acceptable as long as CubeSats were flown mostly as university experiments. As CubeSats become of interest to other users in the government and industry communities as well, a larger range of capabilities may be required than exhibited so far, while maintaining the uniqueness of the Cubesat platform. Propulsion capability is crucial in increasing mission capabilities of future CubeSats, such as orbit change and raising, formation flying, proximity operations, fine attitude control, or drag-make-up and de-orbit. While some of these tasks may be accomplished with propellantless devices, their applications are limited, applicable mostly to a single task, and bear their own risks. In this study, a survey was conducted of propulsion technologies applicable to CubeSats. Only few off-the-shelf design solutions exist today. The survey was thus expanded to such devices as well that are under significant development, and are approaching the required design envelope for CubeSats with respect to mass, volume, and power. In some cases, such as electric propulsion devices, CubeSat architectures themselves may need to be adapted, required to feature deployable solar arrays to increase power capabilities. Given the vast scope of this survey, only thruster technologies could be surveyed. However, valves and other feed system components, as well as their integration, are equally important, but have to be left to a future survey. Three major propulsion technology areas applicable to CubeSats emerged when conducting this review: (1) Existing technologies, such as butane systems, pulsed plasma thrusters, and vacuum arc thrusters are applicable to CubeSats today with no or only minor changes, (2) New thruster technologies under significant development, such as hydrazine monopropellant systems, ion engines, or colloid thrusters could be adapted to CubeSats with some further development, especially also in other subsystem areas such as feed systems and power processing units. They will also require increased power capabilities, and (3) emerging technologies, such as micro electrospray arrays and micro cavity discharge arrays that offer even higher flexibility due to scalability for CubeSats, and enable compact integration

Effects of a magnetic field on the hypervelocity flow about a blunt body /

"August 27, 1958.""Prepared for the Air Force Ballistic Missile Division, Headquarters Air Research and Development Command under Contract AF 04(647)--165, Magnetoaerodynamics Research.""GM-TR-0l65-00464."Includes bibliographical references (page 14).Mode of access: Internet