Enhancing Diabetes Education in the undergraduate-nursing curriculum

Enhancing Diabetes Education in the undergraduate-nursing curriculum J James and S Penfold Aims – Diabetes is a common medical condition and health care professionals should have an effective knowledge base on which to help patients manage their condition. Studies have indicated that the level of general diabetes knowledge amongst registered nurses is lacking. The aim of this project was to evaluate the effectiveness of an increased programme of diabetes education within the undergraduate-nursing curriculum. Methods – All teaching and clinical contacts related to diabetes have been mapped over the current three year undergraduate nursing curriculum. A significant proportion of the new teaching materials have been prepared and delivered by specialist nurses either currently working in or who have previously worked in the field of diabetes. One-week post an intensive day on diabetes, a sample of second year students were asked to complete a questionnaire focusing on specific aspects covered the previous week. Results – The direct teaching contact time related to diabetes in the first two years of the new curriculum for this undergraduate nursing degree has more than doubled. 76% of the student nurses agreed with a statement that generally registered nurses are lacking in their knowledge about diabetes. The vast majority (82%) expressed increased confidence in their own understanding of diabetes following the increased programme of education. The majority of students answered questions correctly about; the pathophysiology and function of insulin and were aware of the levels of hypoglycaemia and expected normal glucose levels. All students also were aware that different insulins have various durations of action. Conclusions – The benefit of an increased focus on Diabetes within the undergraduate nursing curriculum has improved the students understanding of the condition

A Large Cross-Sectional Community-Based Study of Newborn Care Practices in Southern Tanzania

Despite recent improvements in child survival in sub-Saharan Africa, neonatal mortality rates remain largely unchanged. This study aimed to determine the frequency of delivery and newborn-care practices in southern Tanzania, where neonatal mortality is higher than the national average. All households in five districts of Southern Tanzania were approached to participate. Of 213,220 female residents aged 13-49 years, 92% participated. Cross-sectional, retrospective data on childbirth and newborn care practices were collected from 22,243 female respondents who had delivered a live baby in the preceding year. Health facility deliveries accounted for 41% of births, with nearly all non-facility deliveries occurring at home (57% of deliveries). Skilled attendants assisted 40% of births. Over half of women reported drying the baby and over a third reported wrapping the baby within 5 minutes of delivery. The majority of mothers delivering at home reported that they had made preparations for delivery, including buying soap (84%) and preparing a cloth for drying the child (85%). Although 95% of these women reported that the cord was cut with a clean razor blade, only half reported that it was tied with a clean thread. Furthermore, out of all respondents 10% reported that their baby was dipped in cold water immediately after delivery, around two-thirds reported bathing their babies within 6 hours of delivery, and 28% reported putting something on the cord to help it dry. Skin-to-skin contact between mother and baby after delivery was rarely practiced. Although 83% of women breastfed within 24 hours of delivery, only 18% did so within an hour. Fewer than half of women exclusively breastfed in the three days after delivery. The findings suggest a need to promote and facilitate health facility deliveries, hygienic delivery practices for home births, delayed bathing and immediate and exclusive breastfeeding in Southern Tanzania to improve newborn health

Towards the accurate simulation of multi-resonance emitters using mixed-reference spin-flip time-dependent density functional theory

Multi-resonant Thermally Activated Delayed Fluorescent (MR-TADF) materials have received significant research interest owing to their potential use as emitters in high-performance Organic Light Emitting Diodes (OLEDs). Despite their advantages, including narrow emission spectra leading to high colour purity, several challenges remain in optimising the performance of these materials. One key issue is the typically long delayed fluorescence lifetime which arises from a large gap and weak coupling between the lowest lying singlet and triplet states. To develop high-performing materials, in silicodesign is an important step and consequently it is crucial to develop and deploy computational methods that accurately model their excited state properties. Previous studies have highlighted the importance of double excitations, which are not accounted for within the framework of Linear Response Time-Dependent Density Functional Theory (LR-TDDFT), contributing to the poor performance of this method for these materials. Consequently, in this work, we employ Mixed-Reference Spin-Flip Time-Dependent Density Functional Theory (MRSF-TDDFT) to calculate the properties of MR-TADF materials. Our findings indicate that this approach accurately predicts the excited state properties including the crucial E, the energy difference between the lowest singlet (S) and triplet (T) excited states. We further use this method to explore the excited state properties of systems designed to enhance the coupling between singlet and triplet states by increasing the density of states and enhancing spin–orbit coupling through metal perturbation. The results in this work sets the foundation for computationally efficient in silico development high-performing MR-TADF materials within the framework of MRSF-TDDFT

Conformational Control of Donor–Acceptor Molecules Using Non-covalent Interactions

Controlling the architecture of organic molecules is an important aspect in tuning the functional properties of components in organic electronics. For purely organic thermally activated delayed fluorescence (TADF) molecules, design is focused upon orthogonality orientated donor and acceptor units. In these systems, the rotational dynamics around the donor and acceptor bond has been shown to be critical for activating TADF; however, too much conformational freedom can increase the non-radiative rate, leading to a large energy dispersion of the emitting states and conformers, which do not exhibit TADF. To date, control of the motion around the D–A bond has focused upon steric hindrance. In this work, we computationally investigate eight proposed donor–acceptor molecules, exhibiting a B–N bond between the donor and acceptor. We compare the effect of steric hindrance and noncovalent interactions, achieved using oxygen (sulfur) boron heteroatom interactions, in exerting fine conformational control of the excited state dynamics. This work reveals the potential for judiciously chosen noncovalent interactions to strongly influence the functional properties of TADF emitters, including the accessible conformers and the energy dispersion associated with the charge transfer states

Factors associated with Self-reported First Sexual Intercourse in Scottish Adolescents

Background: There is continuing concern about high pregnancy rates and increasing numbers of sexually transmitted infections being detected in Scottish adolescents. Consistent evidence about factors associated with risky sexual behaviours, including early first sexual intercourse, may help to identify adolescents at risk and help improve interventions. This study aimed to provide detailed analysis of the evidence of the associations between individual factors and early sexual intercourse using cross-sectional questionnaire data from 4,379 Scottish adolescents who participated in a sexual health intervention evaluation. Findings: Multivariate secondary analysis showed that aspects of family and school life such as decreasing parental monitoring (OR 1.45, 95% CI 1.24–1.70) and decreasing enjoyment of school (OR 2.55, 95% CI 2.15–3.03) were associated with reporting previous sexual intercourse. Furthermore, females were more likely to report previous sexual intercourse than males (OR 1.48, 95% CI 1.14–1.91). Several factors commonly used to inform sexual health intervention design, such as socioeconomic status, self-esteem and religion, were not independently associated. Conclusion: These results contribute to the evidence base for the association of several factors with early initiation of sexual activity. The findings suggest that interventions aiming to delay first intercourse may need to consider targeting aspects of individuals' connection to their school and family. Furthermore, the results do not support the need to consider socio-economic background, religion or self-esteem of the individuals in intervention design

Genetic variation in traits affecting the water relations of balsam poplar along a latitudinal transect in Northwestern Ontario

Genetic variation In traits potentially affecting the waterrelations of balsam poplar (PopuIus balsamifera L.) clones from four provenances along a transect from northern Wisconsin to Pickle Lake in northwestern Ontario was examined both in the field and In the greenhouse. Traits measured were transpiration rates, stomatal conductance, internode length, average single-leaf abaxial area and oven-dry weight, specific leaf weight, and stomatal density and length. Additional traits measured In the greenhouse provenance trial were shoot length, number of leaves per plant, total abaxial leaf area per plant, total oven-dry root, shoot and leaf weight, and oven-dry root/shoot weight ratio. Most of the observed variation in traits was attributable to clones within provenances and to ramets within clones. As much as eighty-five percent of the observed variation was attributable to variation among and within clones within provenances. The provenance effect had a significant Influence on leaf size and morphology traits, with an apparent north-south clinical trend. Leaves from northern sources were smaller In area, lighter In weight, and were thicker than leaves from southern sources. As expected stomatal conductance was positively correlated with measured transpiration rates. The only other trait significantly correlated with transpiration rates was stomatal length, and this only occurred in the greenhouse provenance trial. Larger stomata were associated with higher rates of transpiration

Effect of an electric field on a floating lipid bilayer: a neutron reflectivity study

We present here a neutron reflectivity study of the influence of an alternative electric field on a supported phospholipid double bilayer. We report for the first time a reproducible increase of the fluctuation amplitude leading to the complete unbinding of the floating bilayer. Results are in good agreement with a semi-quantitative interpretation in terms of negative electrostatic surface tension.Comment: 12 pages, 7 figures, 1 table accepted for publication in European Physical Journal E Replaced with with correct bibliograph

Does low-energy sweetener consumption affect energy intake and body weight? A systematic review, including meta-analyses, of the evidence from human and animal studies

By reducing energy density, low-energy sweeteners (LES) might be expected to reduce energy intake (EI) and body weight (BW). To assess the totality of the evidence testing the null hypothesis that LES exposure (versus sugars or unsweetened alternatives) has no effect on EI or BW, we conducted a systematic review of relevant studies in animals and humans consuming LES with ad libitum access to food energy. In 62 of 90 animal studies exposure to LES did not affect or decreased BW. Of 28 reporting increased BW, 19 compared LES with glucose exposure using a specific ‘learning’ paradigm. Twelve prospective cohort studies in humans reported inconsistent associations between LES use and Body Mass Index (-0.002 kg/m2/year, 95%CI -0.009 to 0.005). Meta-analysis of short- term randomized controlled trials (RCTs, 129 comparisons) showed reduced total EI for LES- versus sugar-sweetened food or beverage consumption before an ad libitum meal (-94 kcal, 95%CI -122 to -66), with no difference versus water (-2 kcal, 95%CI -30 to 26). This was consistent with EI results from sustained intervention RCTs (10 comparisons). Meta-analysis of sustained intervention RCTs (4 weeks to 40 months) showed that consumption of LES versus sugar led to relatively reduced BW (nine comparisons; -1.35 kg, 95%CI –2.28 to - 0.42), and a similar relative reduction in BW versus water (three comparisons; -1.24 kg, 95%CI –2.22 to -0.26). Most animal studies did not mimic LES consumption by humans, and reverse causation may influence the results of prospective cohort studies. The preponderance of evidence from all human RCTs indicates that LES do not increase EI or BW, whether compared with caloric or non-caloric (e.g., water) control conditions. Overall, the balance of evidence indicates that use of LES in place of sugar, in children and adults, leads to reduced EI and BW, and possibly also when compared with water

Working practices and incomes of health workers : evidence from an evaluation of a delivery fee exemption scheme in Ghana

Background: This article describes a survey of health workers and traditional birth attendants (TBAs) which was carried out in 2005 in two regions of Ghana. The objective of the survey was to ascertain the impact of the introduction of a delivery fee exemption scheme on both health workers and those providers who were excluded from the scheme (TBAs). This formed part of an overall evaluation of the delivery fee exemption scheme. The results shed light not only on the scheme itself but also on the general productivity of a range of health workers in Ghana. Methods: A structured questionnaire was developed, covering individual and household characteristics, working hours and practices, sources of income, and views of the exemptions scheme and general motivation. After field testing, this was administered to 374 respondents in 12 districts of Central and Volta regions. The respondents included doctors, medical assistants (MAs), public and private midwives, nurses, community health nurses (CHNs), and traditional birth attendants, both trained and untrained. Results: Health workers were well informed about the delivery fee exemptions scheme and their responses on its impact suggest a realistic view that it was a good scheme, but one that faces serious challenges regarding financial sustainability. Concerning its impact on their morale and working conditions, the responses were broadly neutral. Most public sector workers have seen an increased workload, but counterbalanced by increased pay. TBAs have suffered, in terms of client numbers and income, while the picture for private midwives is mixed. The survey also sheds light on pay and productivity. The respondents report long working hours, with a mean of 54 hours per week for community nurses and up to 129 hours per week for MAs. Weekly reported client loads in the public sector range from a mean of 86 for nurses to 269 for doctors. Over the past two years, reported working hours have been increasing, but so have pay and allowances (for doctors, allowances now make up 66% of their total pay). The lowest paid public health worker now earns almost ten times the average gross national income (GNI) per capita, while the doctors earn 38.5 times GNI per capita. This compares well with average government pay of four times GNI per capita. Comparing pay with outputs, the relatively high number of clients reported by doctors reduces their pay differential, so that the cost per client – $1.09 – is similar to a nurse's (and lower than a private midwife's). Conclusion: These findings show that a scheme which increases demand for public health services while also sustaining health worker income and morale, is workable, if well managed, even within the relatively constrained human resources environment of countries like Ghana. This may be linked to the fact that internal comparisons reveal Ghana's health workers to be well paid from public sector sources.This work was undertaken as part of an international research programme – IMMPACT (Initiative for Maternal Mortality Programme Assessment) – funded by the Bill & Melinda Gates Foundation, the Department for International Development, the European Commission and USAID