Diabetes Ther

INTRODUCTION: Type 2 diabetes represents a significant public health issue, with increasing prevalence in developing countries while adherence to insulin treatment remains a challenge. No studies have evaluated the relationship between adherence to insulin, diabetes-related distress, and trust in physician among persons with diabetes. Our objectives were to evaluate treatment adherence to insulin, emotional distress (using the Problem Areas in Diabetes Questionnaire, PAID), trust in physician, and to examine associations between them among Lebanese patients with diabetes. METHODS: This cross-sectional study, conducted in all districts of Lebanon between August 2016 and April 2017, enrolled 135 adult patients. RESULTS: The mean percentage score of adherence to insulin was 79.7 +/- 19.94. A significantly higher mean adherence score was found in non-sedentary (81.96) compared to sedentary patients (67.41) (p = 0.017), with no difference between gender, employment, rural vs non-rural residence, or familial history of diabetes. In addition, no significant relationship was seen between adherence score and education level, smoking, or alcohol intake. A significant positive association was found between trust in physician and adherence scores, whereas a significant but negative one was found between PAID and adherence scores. The results of linear regressions showed that a secondary level of education (beta = - 13.48) significantly decreased the trust in physician score, whereas the total number of oral antidiabetics (beta = 0.93) increased it. Having a sedentary lifestyle (beta = - 12.73) and smoking < 3 waterpipes/week compared to no smoking (beta = - 16.82) significantly decreased the adherence score. Female gender (beta = 10.46), smoking < 3 waterpipes (beta = 27.42) and 3 + waterpipes/week (beta = 17.95) significantly increased the PAID score. CONCLUSION: Trust in physician is associated with an increased adherence and with decreased diabetes-related distress. This distress was also associated with poor adherence in our study

What works for whom in the management of diabetes in people living with dementia: a realist review

Background Dementia and diabetes mellitus are common long-term conditions and co-exist in a large number of older people. People living with dementia (PLWD) may be less able to manage their diabetes, putting them at increased risk of complications such as hypoglycaemia. The aim of this review was to identify key mechanisms within different interventions that are likely to improve diabetes outcomes in PLWD. Methods This is a realist review involving scoping of the literature and stakeholder interviews to develop theoretical explanations of how interventions might work, systematic searches of the evidence to test and develop the theories and their validation with a purposive sample of stakeholders. Twenty-six stakeholders — user/patient representatives, dementia care providers, clinicians specialising in diabetes or dementia and researchers — took part in interviews, and 24 participated in a consensus conference. Results We included 89 papers. Ten focused on PLWD and diabetes, and the remainder related to people with either dementia, diabetes or other long-term conditions. We identified six context-mechanism-outcome configurations which provide an explanatory account of how interventions might work to improve the management of diabetes in PLWD. This includes embedding positive attitudes towards PLWD, person-centred approaches to care planning, developing skills to provide tailored and flexible care, regular contact, family engagement and usability of assistive devices. An overarching contingency emerged concerning the synergy between an intervention strategy, the dementia trajectory and social and environmental factors, especially family involvement. Conclusions Evidence highlighted the need for personalised care, continuity and family-centred approaches, although there was limited evidence that this happens routinely. This review suggests there is a need for a flexible service model that prioritises quality of life, independence and patient and carer priorities. Future research on the management of diabetes in older people with complex health needs, including those with dementia, needs to look at how organisational structures and workforce development can be better aligned to their needs. Trial registration PROSPERO, CRD42015020625. Registered on 18 May 2015

Common Mental Disorders: socio-demographic and pharmacotherapy profile

OBJECTIVE: this study reports an association between Common Mental Disorders and the socio-demographic and pharmacotherapy profiles of 106 patients cared for by a Primary Health Care unit in the interior of São Paulo, Brazil. METHOD: this is a cross-sectional descriptive exploratory study with a quantitative approach. Structured interviews and validated instruments were used to collect data. The Statistical Package for Social Science was used for analysis. RESULTS: The prevalence of Common Mental Disorders was 50%. An association was found between Common Mental Disorders and the variables occupation, family income, number of prescribed medications and number of pills taken a day. Greater therapy non-adherence was observed among those who tested positive for Common Mental Disorders. CONCLUSION: this study's results show the importance of health professionals working in PHC to be able to detect needs of a psychological nature among their patients and to support the implementation of actions to prevent the worsening of Common Mental Disorders

Lawson criterion for ignition exceeded in an inertial fusion experiment

For more than half a century, researchers around the world have been engaged in attempts to achieve fusion ignition as a proof of principle of various fusion concepts. Following the Lawson criterion, an ignited plasma is one where the fusion heating power is high enough to overcome all the physical processes that cool the fusion plasma, creating a positive thermodynamic feedback loop with rapidly increasing temperature. In inertially confined fusion, ignition is a state where the fusion plasma can begin "burn propagation" into surrounding cold fuel, enabling the possibility of high energy gain. While "scientific breakeven" (i.e., unity target gain) has not yet been achieved (here target gain is 0.72, 1.37 MJ of fusion for 1.92 MJ of laser energy), this Letter reports the first controlled fusion experiment, using laser indirect drive, on the National Ignition Facility to produce capsule gain (here 5.8) and reach ignition by nine different formulations of the Lawson criterion

The effects of disturbance intensity on temporal and spatial patterns of herb colonization in a southern New England mixed-oak forest

As managing forests for biodiversity becomes more common, it is important to understand how understory species respond to disturbance. We monitored changes in species’ dominance, calculated as importance values, over a 4-year period in order to determine how species’ dominance varied with disturbance intensity and gap position. An experimental linear canopy opening was created in a southern New England mixed-oak forest, and plots were established on the south side, center, and north side of the opening. All vegetation was removed in half of the plots, simulating a lethal disturbance. In the other half of the plots, only the overstory was removed, simulating minimal disturbance (release plot). Before the disturbance, Dennstaedtia punctilobula dominated the plots, but typical forest understory species such as Kalmia latifolia, Trientalis borealis, Maianthemum canadense, and Mitchella repens were very common. After the disturbance, D. punctilobula expanded and continued to remain dominant in all types of plots. Early successional species, such as Carex pensylvanica, Poaceae species, Rubus ideaus, and Rubus allegheniensis dominated the lethal and center plots; late successional forest understory species experienced a reduction in frequency and cover in these plots. However, in release and edge plots, late successional species maintained relatively similar frequencies and covers to pre-disturbance values. The ability of early successional species to seed into lethal plots and grow rapidly in the high light environment of the center plots allowed them to dominate in these plots. Late successional species were able to remain relatively dominant in release plots through clonal expansion and in edge plots through exclusion of early successional species from low light levels. Three years after the disturbance, most of the residual forest understory species had attained similar frequencies and covers to pre-disturbance values in all types of plots. Thus, although there is some initial loss of residual species in highly disturbed areas and in the center of the opening, most of these species are able to recover in a relatively short time period. However, locally uncommon species may be vulnerable to permanent loss. In order to minimize loss of species from the understory, forest managers should attempt to keep groundstory disturbance as minimal as possible where desirable late-successional species exist and create edge-partial shade effects with the remaining canopy for regeneration treatments

Location Software and Interface with GIS and Supply Chain Management

The objective of this paper is to bridge the gap between location theory and practice. To meet this objective focus is given to the development of software capable of addressing the different needs of a wide group of users. There is a very active community on location theory encompassing many research fields such as operations research, computer science, mathematics, engineering, geography, economics and marketing. As a result, people working on facility location problems have a very diverse background and also different needs regarding the software to solve these problems. For those interested in non-commercial applications (e. g. students and researchers), the library of location algorithms (LoLA can be of considerable assistance. LoLA contains a collection of efficient algorithms for solving planar, network and discrete facility location problems. In this paper, a detailed description of the functionality of LoLA is presented. In the fields of geography and marketing, for instance, solving facility location problems requires using large amounts of demographic data. Hence, members of these groups (e. g. urban planners and sales managers) often work with geographical information too s. To address the specific needs of these users, LoLA was inked to a geographical information system (GIS) and the details of the combined functionality are described in the paper. Finally, there is a wide group of practitioners who need to solve large problems and require special purpose software with a good data interface. Many of such users can be found, for example, in the area of supply chain management (SCM). Logistics activities involved in strategic SCM include, among others, facility location planning. In this paper, the development of a commercial location software tool is also described. The too is embedded in the Advanced Planner and Optimizer SCM software developed by SAP AG, Walldorf, Germany. The paper ends with some conclusions and an outlook to future activities