The DiGEM trial protocol--a randomised controlled trial to determine the effect on glycaemic control of different strategies of blood glucose self-monitoring in people with type 2 diabetes [ISRCTN47464659].

BACKGROUND: We do not yet know how to use blood glucose self-monitoring (BGSM) most effectively in the self-management of type 2 diabetes treated with oral medication. Training in monitoring may be most effective in improving glycaemic control and well being when results are linked to behavioural change. METHODS/DESIGN: DiGEM is a three arm randomised parallel group trial set in UK general practices. A total of 450 patients with type 2 diabetes managed with lifestyle or oral glucose lowering medication are included. The trial compares effectiveness of three strategies for monitoring glycaemic control over 12 months (1) a control group with three monthly HbA1c measurements; interpreted with nurse-practitioner; (2) A self-testing of blood glucose group; interpreted with nurse- practitioner to inform adjustment of medication in addition to 1; (3) A self-monitoring of blood glucose group with personal use of results to interpret results in relation to lifestyle changes in addition to 1 and 2. The trial has an 80% power at a 5% level of significance to detect a difference in change in the primary outcome, HbA1c of 0.5% between groups, allowing for an attrition rate of 10%. Secondary outcome measures include health service costs, well-being, and the intervention effect in sub-groups defined by duration of diabetes, current management, health status at baseline and co-morbidity. A mediation analysis will explore the extent to which changes in beliefs about self-management of diabetes between experimental groups leads to changes in outcomes in accordance with the Common Sense Model of illness. The study is open and has recruited more than half the target sample. The trial is expected to report in 2007. DISCUSSION: The DiGEM intervention and trial design address weaknesses of previous research by use of a sample size with power to detect a clinically significant change in HbA1c, recruitment from a well-characterised primary care population, definition of feasible monitoring and behaviour change strategies based on psychological theory and evidence, and measures along the hypothesised causal path from cognitions to behaviours and disease and well being related outcomes. The trial will provide evidence to support, focus or discourage use of specific BGSM strategies.RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are

Species Diversity and Endemicity in the Angolan Leguminosae Flora

Angola has a great diversity of species and ecosystems and a high level of endemism. However, knowledge of the native flora remains very incomplete and outdated. Leguminosae is the largest family in the country, including many species which are of local or more regional economic importance. Based on an extensive review of bibliographic sources, natural history collections, and online databases, the checklist of Angolan Leguminosae plants was updated, including data on their native distribution, conservation status, and principal uses. The endemic taxa were the subject of additional investigation, including the main habitat, the number of collections preserved in herbaria, and the locality of the first collection. We identified 953 Leguminosae taxa occurring in Angola, of which 165 are endemic to the country. Among the 180 genera found, Crotalaria (136) and Indigofera (96) have the highest number of taxa. Almost half of the studied species have important applications, mainly in traditional medicine (385), forage (267), timber (188), and food (120). Nevertheless, only 27.7% have been assessed according to the IUCN Red List and 10 species are classified as threatened. Thirty-three endemics are known only from the type specimen, revealing the lack of knowledge on these species and the need for further field research. More than 30 type specimens were collected in the Serra da Chela, which highlights the importance of this region for biodiversity conservation.info:eu-repo/semantics/publishedVersio

New species of Asclepias (Apocynaceae), Baphia (Leguminosae), Cochlospermum (Bixaceae) and Endostemon (Lamiaceae) from the Kalahari sands of Angola and NW Zambia, with one new combination in Vangueria (Rubiaceae)

Four new species are described from central and eastern Angola and adjacent NW Zambia. All occur in Kalahari sand savannas rich in endemic and more widely distributed geoxylic suffrutices. Despite being known from very few collections, the conservation status of one of these new species is assessed as Least Concern, as these grasslands are nutrient-poor, are in remote sparsely populated areas, and are not threatened with conversion to agriculture. The remaining three are treated as Data Deficient. In addition, one new combination is provided for Ancylanthos rubiginosus Desf. under Vangueria as V. rubiginosa (Desf.) Lantz is an illegitimate later homonym. We also make orthographic corrections to specific epithets commemorating Ilse von Nolde, a collector who made important collections from Quela in Malange in the 1930s

The rise of consumer health wearables: promises and barriers

Will consumer wearable technology ever be adopted or accepted by the medical community? Patients and practitioners regularly use digital technology (e.g., thermometers and glucose monitors) to identify and discuss symptoms. In addition, a third of general practitioners in the United Kingdom report that patients arrive with suggestions for treatment based on online search results. However, consumer health wearables are predicted to become the next “Dr Google.” One in six (15%) consumers in the United States currently uses wearable technology, including smartwatches or fitness bands. While 19 million fitness devices are likely to be sold this year, that number is predicted to grow to 110 million in 2018. As the line between consumer health wearables and medical devices begins to blur, it is now possible for a single wearable device to monitor a range of medical risk factors. Potentially, these devices could give patients direct access to personal analytics that can contribute to their health, facilitate preventive care, and aid in the management of ongoing illness. However, how this new wearable technology might best serve medicine remains unclea

Postcode Lotteries in Public Health - The NHS Health Checks Programme in North West London

<p>Abstract</p> <p>Background</p> <p>Postcode lotteries in health refer to differences in health care between different geographic areas. These have been previously associated with clinical services. However there has been little documentation of postcode lotteries relating to preventative health care services. This paper describes a postcode lottery effect in relation to the NHS Health Checks Programme (a national cardiovascular screening programme in England) in eight PCTs in the North West sector of London.</p> <p>Methods</p> <p>A descriptive cross-sectional analysis of the Health Checks Programme was carried out in eight PCTs in North West London using a structured data-collecting instrument.</p> <p>Results</p> <p>The analysis found variation in the implementation of the national Health Checks Programme in terms of: the screening approach taken; the allocated budget (which varied from £69,000 to £1.4 million per 100,000 eligible population); payment rates made to providers of Health Checks; tools used to identify and measure risk of cardiovascular disease and diabetes; monitoring and evaluation; and preventative services available following the health check.</p> <p>Conclusions</p> <p>This study identifies a postcode lottery effect related to a national public health programme. Although it is important to allow enough flexibility in the design of the Health Checks Programme so that it fits in with local factors, aspects of the programme may benefit from greater standardisation or stronger national guidance.</p

The diversity and evolution of pollination systems in large plant clades: Apocynaceae as a case study

Background and Aims Large clades of angiosperms are often characterized by diverse interactions with pollinators, but how these pollination systems are structured phylogenetically and biogeographically is still uncertain for most families. Apocynaceae is a clade of >5300 species with a worldwide distribution. A database representing >10 % of species in the family was used to explore the diversity of pollinators and evolutionary shifts in pollination systems across major clades and regions. Methods The database was compiled from published and unpublished reports. Plants were categorized into broad pollination systems and then subdivided to include bimodal systems. These were mapped against the five major divisions of the family, and against the smaller clades. Finally, pollination systems were mapped onto a phylogenetic reconstruction that included those species for which sequence data are available, and transition rates between pollination systems were calculated. Key Results Most Apocynaceae are insect pollinated with few records of bird pollination. Almost three-quarters of species are pollinated by a single higher taxon (e.g. flies or moths); 7 % have bimodal pollination systems, whilst the remaining approx. 20 % are insect generalists. The less phenotypically specialized flowers of the Rauvolfioids are pollinated by a more restricted set of pollinators than are more complex flowers within the Apocynoids + Periplocoideae + Secamonoideae + Asclepiadoideae (APSA) clade. Certain combinations of bimodal pollination systems are more common than others. Some pollination systems are missing from particular regions, whilst others are over-represented. Conclusions Within Apocynaceae, interactions with pollinators are highly structured both phylogenetically and biogeographically. Variation in transition rates between pollination systems suggest constraints on their evolution, whereas regional differences point to environmental effects such as filtering of certain pollinators from habitats. This is the most extensive analysis of its type so far attempted and gives important insights into the diversity and evolution of pollination systems in large clades

Chemical variation and insecticidal activity of Lippia javanica (Burm. F.) Spreng essential oil against Sitophilus zeamais Motschulsky

Lippia javanica (Burm. f.) Spreng is used commercially as an herbal tea and medicinal plant in sub-Saharan Africa. Here we investigated the chemical variation and pesticidal potential of L. javanica essential oils against a major stored product pest, Sitophilus zeamais Motschulsky. We identified two morphologically distinct varieties of L. javanica growing at different locations in Malawi. Perillaldehyde was the major constituent in oil of L. javanica var. javanica while myrcenone (ipsdienone) was the major compound in oils of L. javanica var. whytei. Myrcene, linalool, carvone, β-caryophyllene and germacrene D were identified as the other most significant components in oils from both varieties. The yields of oil and the chemical composition also varied significantly with time of harvest during the season in both cases. In contact toxicity tests against S. zeamais, oils from both varieties were active. However, whereas perillaldehyde, linalool and carvone, components of the oil of L. javanica var. javanica, were all toxic against adult S. zeamais, myrcenone, the main component of oil from L. javanica var. whytei, was not. The oil from L. javanica var. javanica also showed some fumigant toxicity against S. zeamais. The high efficacy of L. javanica oil against S. zeamais suggests it is suitable to be used as a botanical insecticide to control S. zeamais in stored maize. However, further research is required to optimise and standardise the variety and harvest time to be recommended and to evaluate its activity against S. zeamais and other storage insect pests under farm conditions before it can be adopted by farmers more widely

Sixty-seven species newly recorded for the flora of Angola: recent findings from vegetation surveys and herbarium collections

Angola is a tropical country with many biogeographical units and, therefore, has a high floristic diversity. Although an increasing number of floristic studies has been carried out in Angola in recent years, the country is still considered to be underinvestigated as many species being collected were previously unknown there. Several scientific groups working in different parts of Angola contributed to this paper their data from biodiversity assessments. With this we can add 67 species newly recorded for Angola, including two new generic records and five alien species, to the almost 7,300 vascular plant taxa known so far for Angola. Most of the new records for Angola are also present in different neighbouring countries, but they are little known, and their IUCN threat status has not been assessed yet. However, ongoing fieldwork and exploration are needed to complete the floristic knowledge of the understudied country

Fire facilitates ground layer plant diversity in a Miombo ecosystem

SUPPLEMENTARY DATA: LIST S1: list of ground layer species. LIST S2: list of tree species. TABLE S1: results of the over dispersion test in GLM analyses. TABLE S2: output summaries of GLM analyses of ground layer richness. FIGURE S1: histograms of GLM residuals. FIGURE S2: sensitivity test for the model of total richness. FIGURE S3: sample-size-based rarefaction/extrapolation curves.BACKGROUND AND AIMS: Little is known about the response of ground layer plant communities to fire in Miombo ecosystems, which is a global blind spot of ecological understanding. We aimed: (1) to assess the impact of three experimentally imposed fire treatments on ground layer species composition and compare it with patterns observed for trees; and (2) to analyse the effect of fire treatments on species richness to assess how responses differ among plant functional groups. METHODS: At a 60-year-long fire experiment in Zambia, we quantified the richness and diversity of ground layer plants in terms of taxa and functional groups across three experimental fire treatments of late dry-season fire, early dry-season fire and fire exclusion. Data were collected in five repeat surveys from the onset of the wet season to the early dry season. KEY RESULTS: Of the 140 ground layer species recorded across the three treatments, fire-maintained treatments contributed most of the richness and diversity, with the least number of unique species found in the no-fire treatment. The early-fire treatment was more similar in composition to the no-fire treatment than to the late-fire treatment. C4 grass and geoxyle richness were highest in the late-fire treatment, and there were no shared sedge species between the late-fire and other treatments. At a plot level, the average richness in the late-fire treatment was twice that of the fire exclusion treatment. CONCLUSIONS: Heterogeneity in fire seasonality and intensity supports diversity of a unique flora by providing a diversity of local environments. African ecosystems face rapid expansion of land- and fire-management schemes for carbon offsetting and sequestration. We demonstrate that analyses of the impacts of such schemes predicated on the tree flora alone are highly likely to underestimate impacts on biodiversity. A research priority must be a new understanding of the Miombo ground layer flora integrated into policy and land management.The Natural Environment Research Council, International Development Research Centre, Canada and National Research Foundation, and Department of Science and Innovation.https://academic.oup.com/aobPlant Production and Soil SciencePlant ScienceSDG-15:Life on lan