General practitioners' and nurses' experiences of using computerised decision support in screening for diabetic foot disease:implementing Scottish Clinical Information - Diabetes Care in routine clinical practice

<strong>Objective</strong> The Scottish Care Information - Diabetes Collaboration (SCI-DC) developed a computer- based information system to create a shared electronic record for use by all involved in the care of patients with diabetes mellitus. The objectives of this study were to understand primary care practitioners' views towards screening for diabetic foot disease and their experience of the SCI-DC system. <strong>Method</strong> We conducted an exploratory study using qualitativemethods. Semi-structured interviews were audiotape-recorded, transcribed and subjected to thematic analysis. Seven practice nurses and six general practitioners (GPs) with special responsibility for diabetes care inNHS Lothian participated. <strong>Results</strong> Primary care clinicians reported good systems in place to screen for diabetes-related complications and to refer their patients to specialist care. Foot ulceration was rarely observed; other diabetesrelated conditions were seen as a higher priority. Most had heard of the SCI-DC foot assessment tool, but its failure to integrate with other primary care information technology (IT) systems meant it was not used in these general practices. <strong>Conclusions</strong> Adoption of the SCI-DC foot assessment tool in primary care is not perceived as clinically necessary. Although information recorded by specialist services on SCI-DC is helpful, important structural barriers to its implementation mean the potential benefits associated with its use are unlikely to be realised; greater engagement with primary care priorities for diabetes management is needed to assist its successful implementation and adoption

On the Solution of the Number-Projected Hartree-Fock-Bogoliubov Equations

The numerical solution of the recently formulated number-projected Hartree-Fock-Bogoliubov equations is studied in an exactly soluble cranked-deformed shell model Hamiltonian. It is found that the solution of these number-projected equations involve similar numerical effort as that of bare HFB. We consider that this is a significant progress in the mean-field studies of the quantum many-body systems. The results of the projected calculations are shown to be in almost complete agreement with the exact solutions of the model Hamiltonian. The phase transition obtained in the HFB theory as a function of the rotational frequency is shown to be smeared out with the projection.Comment: RevTeX, 11 pages, 3 figures. To be published in a special edition of Physics of Atomic Nuclei (former Sov. J. Nucl. Phys.) dedicated to the 90th birthday of A.B. Migda

Noncommutative SO(n) and Sp(n) Gauge Theories

We study the generalization of noncommutative gauge theories to the case of orthogonal and symplectic groups. We find out that this is possible, since we are allowed to define orthogonal and symplectic subgroups of noncommutative unitary gauge transformations even though the gauge potentials and gauge transformations are not valued in the orthogonal and symplectic subalgebras of the Lie algebra of antihermitean matrices. Our construction relies on an antiautomorphism of the basic noncommutative algebra of functions which generalizes the charge conjugation operator of ordinary field theory. We show that the corresponding noncommutative picture from low energy string theory is obtained via orientifold projection in the presence of a non-trivial NSNS B-field.Comment: 17 pages; considerations about fermions added and some minor change

Telehealthcare for chronic obstructive pulmonary disease

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a disease of irreversible airways obstruction in which patients often suffer exacerbations. Sometimes these exacerbations need hospital care: telehealthcare has the potential to reduce admission to hospital when used to administer care to the pateint from within their own home. OBJECTIVES: To review the effectiveness of telehealthcare for COPD compared with usual face‐to‐face care. SEARCH METHODS: We searched the Cochrane Airways Group Specialised Register, which is derived from systematic searches of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, AMED, and PsycINFO; last searched January 2010. SELECTION CRITERIA: We selected randomised controlled trials which assessed telehealthcare, defined as follows: healthcare at a distance, involving the communication of data from the patient to the health carer, usually a doctor or nurse, who then processes the information and responds with feedback regarding the management of the illness. The primary outcomes considered were: number of exacerbations, quality of life as recorded by the St George's Respiratory Questionnaire, hospitalisations, emergency department visits and deaths. DATA COLLECTION AND ANALYSIS: Two authors independently selected trials for inclusion and extracted data. We combined data into forest plots using fixed‐effects modelling as heterogeneity was low (I(2) < 40%). MAIN RESULTS: Ten trials met the inclusion criteria. Telehealthcare was assessed as part of a complex intervention, including nurse case management and other interventions. Telehealthcare was associated with a clinically significant increase in quality of life in two trials with 253 participants (mean difference ‐6.57 (95% confidence interval (CI) ‐13.62 to 0.48); minimum clinically significant difference is a change of ‐4.0), but the confidence interval was wide. Telehealthcare showed a significant reduction in the number of patients with one or more emergency department attendances over 12 months; odds ratio (OR) 0.27 (95% CI 0.11 to 0.66) in three trials with 449 participants, and the OR of having one or more admissions to hospital over 12 months was 0.46 (95% CI 0.33 to 0.65) in six trials with 604 participants. There was no significant difference in the OR for deaths over 12 months for the telehealthcare group as compared to the usual care group in three trials with 503 participants; OR 1.05 (95% CI 0.63 to 1.75). AUTHORS' CONCLUSIONS: Telehealthcare in COPD appears to have a possible impact on the quality of life of patients and the number of times patients attend the emergency department and the hospital. However, further research is needed to clarify precisely its role since the trials included telehealthcare as part of more complex packages

Predictors of programme adherence and weight loss in women in an obesity programme using meal replacements

Objective: To explore predictors of programme adherence and weight loss in patients participating in a weight management programme using meal replacements (MR).Design: One hundred and fifty healthy obese women, age 48.5 years (s.d. = 8.3); weight, 97.6 kg (13.4); body mass index (BMI) 36.5 (3.7), participated in a longitudinal study with a 16-week acute weight loss phase (Phase 1) followed by 1 year of a trial of weight-loss maintenance (Phase 2). Energy intake during Phase 1 totaled 900 kcal (3.7 MJ) a day from a diet including two MR. Energy intake during Phase 2 consisted of either MR or a low-fat diet with a calculated energy deficit of 600 kcal/day (2.5 MJ).Methods: Weight, height and waist circumference were measured and body composition assessed by air plethysmography (Bodpod). Glucose and insulin were measured by standard immunoassays and insulin sensitivity assessed by homeostatic model assessment.Results: At the end of 16 weeks, 114 subjects (76%) completed Phase 1 and achieved a mean weight loss of 8.95 kg (3.38). Adherence to Phase 1 was predicted by weight loss over the first 2 weeks (p < 0.001). Weight loss during Phase 1 was predicted by initial weight and initial systolic blood pressure. Adherence to Phase 2 was not predicted by physiological measures. Weight loss maintenance in Phase 2 (not gaining more than 3% of the weight at start of phase 2) was predicted by cholesterol and triglyceride measured at the start of Phase 2 but otherwise was not predicted by the physiological measures. Initial insulin sensitivity did not predict weight loss in either phase.Conclusion: Participants whose weight loss over the first 2 weeks falls in the bottom third may need additional intervention if they are to continue in this type of programme. A battery of physiological measures at entry to a MR weight loss and maintenance programme explains only a very small proportion of the variation in weight loss

Nano-scale mechanical probing of supported lipid bilayers with atomic force microscopy

We present theory and experiments for the force-distance curve $F(z_0)$ of an atomic force microscope (AFM) tip (radius $R$) indenting a supported fluid bilayer (thickness $2d$). For realistic conditions the force is dominated by the area compressibility modulus $\kappa_A$ of the bilayer, and, to an excellent approximation, given by $F= \pi \kappa_A R z_0^2/(2d-z_0)^2$. The experimental AFM force curves from coexisting liquid ordered and liquid disordered domains in 3-component lipid bilayers are well-described by our model, and provides $\kappa_A$ in agreement with literature values. The liquid ordered phase has a yield like response that we model by hydrogen bond breaking.Comment: 6 pages, 6 figures, accepted for publication in Physical Review

Tensor model and dynamical generation of commutative nonassociative fuzzy spaces

Rank-three tensor model may be regarded as theory of dynamical fuzzy spaces, because a fuzzy space is defined by a three-index coefficient of the product between functions on it, f_a*f_b=C_ab^cf_c. In this paper, this previous proposal is applied to dynamical generation of commutative nonassociative fuzzy spaces. It is numerically shown that fuzzy flat torus and fuzzy spheres of various dimensions are classical solutions of the rank-three tensor model. Since these solutions are obtained for the same coupling constants of the tensor model, the cosmological constant and the dimensions are not fundamental but can be regarded as dynamical quantities. The symmetry of the model under the general linear transformation can be identified with a fuzzy analog of the general coordinate transformation symmetry in general relativity. This symmetry of the tensor model is broken at the classical solutions. This feature may make the model to be a concrete finite setting for applying the old idea of obtaining gravity as Nambu-Goldstone fields of the spontaneous breaking of the local translational symmetry.Comment: Adding discussions on effective geometry, a note added, four references added, other minor changes, 27 pages, 17 figure