Self-Management among the Ethnic Groups with Type 2 Diabetes Mellitus in Thailand

The prevalence of diabetes mellitus has been rising all over the world. Self-management is required for diabetes mellitus patients. The objective of this study is to explore the self-management among the ethnic groups with type 2 diabetes mellitus in Thailand, an upper middle-income country which is located in South East Asia. The ethnic groups in Thailand are a minority group which has limited education and a different culture, language, costume and lifestyle from Thai people. The qualitative exploratory study was used in this study. In-depth interviews with semi-structured open questions were conducted by 20 participants from purposive sampling. These participants were the ethnic groups who have type 2 diabetes mellitus, received the services from a region hospital, understood Thai and were willing to participate. Content analysis was adopted for the study. The results showed that all of the participants controlled their diet before the appointment day and never miss their appointment. Only 3 participants did their exercise while 2 participants stated that they occasionally forgot to take medicine. 10 participants use the herbs for reducing the sugar level. 12 participants drank a lot of water after a lapse in the diet because they believed that water could dilute the sugar. The findings identified 5 themes; ‘controlling diet before appointment day’; ‘drinking water after a lapse in diet’; ‘medication being a vital importance’; ‘exercise is unimportant’; and ‘taking herbs for sugar reduction’. The results of this study are important to the health professionals to understand the self-management of Ethnic groups and use the data to create the appropriate intervention for promoting health among the ethnic groups with type 2 diabetes mellitus in Thailand. The findings will lead to the revision of health policy and the procedure for promoting health in this special ethnic groups

GenoType® MTBDRsl assay for resistance to second-line anti-tuberculosis drugs

Background Genotype® MTBDRsl (MTBDRsl) is a rapid DNA-based test for detecting specific mutations associated with resistance to fluoroquinolones and second-line injectable drugs (SLIDs) in Mycobacterium tuberculosis complex. MTBDRsl version 2.0 (released in 2015) identifies the mutations detected by version 1.0, as well as additional mutations. The test may be performed on a culture isolate or a patient specimen, which eliminates delays associated with culture. Version 1.0 requires a smear-positive specimen, while version 2.0 may use a smear-positive or -negative specimen. We performed this updated review as part of a World Health Organization process to develop updated guidelines for using MTBDRsl. Objectives To assess and compare the diagnostic accuracy of MTBDRsl for: 1. fluoroquinolone resistance, 2. SLID resistance, and 3. extensively drug-resistant tuberculosis, indirectly on a M. tuberculosis isolate grown from culture or directly on a patient specimen. Participants were people with rifampicin-resistant or multidrug-resistant tuberculosis. The role of MTBDRsl would be as the initial test, replacing culture-based drug susceptibility testing (DST), for detecting second-line drug resistance. Search methods We searched the following databases without language restrictions up to 21 September 2015: the Cochrane Infectious Diseases Group Specialized Register; MEDLINE; Embase OVID; Science Citation Index Expanded, Conference Proceedings Citation Index-Science, and BIOSIS Previews (all three from Web of Science); LILACS; and SCOPUS; registers for ongoing trials; and ProQuest Dissertations & Theses A&I. We reviewed references from included studies and contacted specialists in the field. Selection criteria We included cross-sectional and case-control studies that determined MTBDRsl accuracy against a defined reference standard (culture-based DST, genetic sequencing, or both). Data collection and analysis Two review authors independently extracted data and assessed quality using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. We synthesized data for versions 1.0 and 2.0 separately. We estimated MTBDRsl sensitivity and specificity for fluoroquinolone resistance, SLID resistance, and extensively drug-resistant tuberculosis when the test was performed indirectly or directly (smear-positive specimen for version 1.0, smear-positive or -negative specimen for version 2.0). We explored the influence on accuracy estimates of individual drugs within a drug class and of different reference standards. We performed most analyses using a bivariate random-effects model with culture-based DST as reference standard. Main results We included 27 studies. Twenty-six studies evaluated version 1.0, and one study version 2.0. Of 26 studies stating specimen country origin, 15 studies (58%) evaluated patients from low- or middle-income countries. Overall, we considered the studies to be of high methodological quality. However, only three studies (11%) had low risk of bias for the reference standard; these studies used World Health Organization (WHO)-recommended critical concentrations for all drugs in the culture-based DST reference standard. MTBDRsl version 1.0 Fluoroquinolone resistance: indirect testing, MTBDRsl pooled sensitivity and specificity (95% confidence interval (CI)) were 85.6% (79.2% to 90.4%) and 98.5% (95.7% to 99.5%), (19 studies, 2223 participants); direct testing (smear-positive specimen), pooled sensitivity and specificity were 86.2% (74.6% to 93.0%) and 98.6% (96.9% to 99.4%), (nine studies, 1771 participants, moderate quality evidence). SLID resistance: indirect testing, MTBDRsl pooled sensitivity and specificity were 76.5% (63.3% to 86.0%) and 99.1% (97.3% to 99.7%), (16 studies, 1921 participants); direct testing (smear-positive specimen), pooled sensitivity and specificity were 87.0% (38.1% to 98.6%) and 99.5% (93.6% to 100.0%), (eight studies, 1639 participants, low quality evidence). Extensively drug-resistant tuberculosis: indirect testing, MTBDRsl pooled sensitivity and specificity were 70.9% (42.9% to 88.8%) and 98.8% (96.1% to 99.6%), (eight studies, 880 participants); direct testing (smear-positive specimen), pooled sensitivity and specificity were 69.4% (38.8% to 89.0%) and 99.4% (95.0% to 99.3%), (six studies, 1420 participants, low quality evidence). Similar to the original Cochrane review, we found no evidence of a significant difference in MTBDRsl version 1.0 accuracy between indirect and direct testing for fluoroquinolone resistance, SLID resistance, and extensively drug-resistant tuberculosis. MTBDRsl version 2.0 Fluoroquinolone resistance: direct testing, MTBDRsl sensitivity and specificity were 97% (83% to 100%) and 98% (93% to 100%), smear-positive specimen; 80% (28% to 99%) and 100% (40% to 100%), smear-negative specimen. SLID resistance: direct testing, MTBDRsl sensitivity and specificity were 89% (72% to 98%) and 90% (84% to 95%), smear-positive specimen; 80% (28% to 99%) and 100% (40% to 100%), smear-negative specimen. Extensively drug-resistant tuberculosis: direct testing, MTBDRsl sensitivity and specificity were 79% (49% to 95%) and 97% (93% to 99%), smear-positive specimen; 50% (1% to 99%) and 100% (59% to 100%), smear-negative specimen. We had insufficient data to estimate summary sensitivity and specificity of version 2.0 (smear-positive and -negative specimens) or to compare accuracy of the two versions. A limitation was that most included studies did not consistently use the World Health Organization (WHO)-recommended concentrations for drugs in the culture-based DST reference standard. Authors' conclusions In people with rifampicin-resistant or multidrug-resistant tuberculosis, MTBDRsl performed on a culture isolate or smear-positive specimen may be useful in detecting second-line drug resistance. MTBDRsl (smear-positive specimen) correctly classified around six in seven people as having fluoroquinolone or SLID resistance, although the sensitivity estimates for SLID resistance varied. The test rarely gave a positive result for people without drug resistance. However, when second-line drug resistance is not detected (MTBDRsl result is negative), conventional DST can still be used to evaluate patients for resistance to the fluoroquinolones or SLIDs. We recommend that future work evaluate MTBDRsl version 2.0, in particular on smear-negative specimens and in different settings to account for different resistance-causing mutations that may vary by strain. Researchers should also consider incorporating WHO-recommended critical concentrations into their culture-based reference standards

Development of large scale inland flood scenarios for disaster response planning based on spatial/temporal conditional probability analysis

Extreme event scenarios are useful for civil emergency services to help in developing contingency plans for responding effectively to major flooding incidents. In the UK, the official national risk register includes a scenario for inland flooding (from rivers and other sources), which is described in terms of a probability of occurrence over a five year period of between 1 in 200 and 1 in 20. This scenario was previously based on recent extreme floods, in conjunction with maps produced to aid in development planning on floodplains. At the time it was constructed, it was not feasible to assess scientifically the combined probability of a nationally-significant flood event of this type, therefore the scenario probability assessment was ambiguous. Recent developments in multivariate extreme value statistics now allow the probability of large scale flood events to be assessed with reference to hydrological summary statistics or impact metrics. Building on theory and pilot studies by Heffernan and Tawn [1], Lamb et al. [2] and Keef et al. [3], we describe the development of a set of national-scale scenarios based on a high-dimensional (ca. 1,100 locations) conditional probability analysis of extreme river flows and rainfall. The methodology provides a theoretically justified basis for extrapolation into the joint tail of the distribution of these variables, which is then used to simulate extreme events with associated probabilities. The probabilistic events are compared with current understanding of meteorological scenarios associated with significant, large-scale flooding in the UK, and with historical flooding, in order to identify plausible events that can inform national risk scenarios. Additionally, we combined scenarios of inland and coastal extremes that have been considered by linking the analysis discussed in this paper with methods presented in a companion paper by Wyncoll et al

Bovine tuberculosis in African buffaloes : observations regarding Mycobacterium bovis shedding into water and exposure to environmental mycobacteria

Includes bibliographyBackground: African buffaloes are the maintenance host for Mycobacterium bovis in the endemically infected Kruger National Park (KNP). The infection is primarily spread between buffaloes via the respiratory route, but it is not known whether shedding of M. bovis in nasal and oral excretions may lead to contamination of ground and surface water and facilitate the transmission to other animal species. A study to investigate the possibility of water contamination with M. bovis was conducted in association with a BCG vaccination trial in African buffalo. Groups of vaccinated and nonvaccinated buffaloes were kept together with known infected in-contact buffalo cows to allow natural M. bovis transmission under semi-free ranging conditions. In the absence of horizontal transmission vaccinated and control buffaloes were experimentally challenged with M. bovis. Hence, all study buffaloes in the vaccination trial could be considered potential shedders and provided a suitable setting for investigating questions relating to the tenacity of M. bovis shed in water. Results: Serial water samples were collected from the drinking troughs of the buffaloes once per season over an eleven-month period and cultured for presence of mycobacteria. All water samples were found to be negative for M. bovis, but 16 non-tuberculous Mycobacterium spp. isolates were cultured. The non-tuberculous Mycobacterium species were further characterised using 5'-16S rDNA PCR-sequencing, resulting in the identification of M. terrae, M. vaccae (or vanbaalenii), M. engbaekii, M. thermoresistibile as well as at least two species which have not yet been classified. Conclusion: The absence of detectable levels of Mycobacterium bovis in the trough water suggests that diseased buffalo do not commonly shed the organism in high quantities in nasal and oral discharges. Surface water may therefore not be likely to play an important role in the transmission of bovine tuberculosis from buffalo living in free-ranging ecosystems. The study buffalo were, however, frequently exposed to different species of non-tuberculous, environmental mycobacteria, with an unknown effect on the buffaloes' immune response to mycobacteria.Peer Reviewe

Radio imaging of the Subaru/XMM-Newton Deep Field - III. Evolution of the radio luminosity function beyond z=1

We present spectroscopic and eleven-band photometric redshifts for galaxies in the 100-uJy Subaru/XMM-Newton Deep Field radio source sample. We find good agreement between our redshift distribution and that predicted by the SKA Simulated Skies project. We find no correlation between K-band magnitude and radio flux, but show that sources with 1.4-GHz flux densities below ~1mJy are fainter in the near-infrared than brighter radio sources at the same redshift, and we discuss the implications of this result for spectroscopically-incomplete samples where the K-z relation has been used to estimate redshifts. We use the infrared--radio correlation to separate our sample into radio-loud and radio-quiet objects and show that only radio-loud hosts have spectral energy distributions consistent with predominantly old stellar populations, although the fraction of objects displaying such properties is a decreasing function of radio luminosity. We calculate the 1.4-GHz radio luminosity function (RLF) in redshift bins to z=4 and find that the space density of radio sources increases with lookback time to z~2, with a more rapid increase for more powerful sources. We demonstrate that radio-loud and radio-quiet sources of the same radio luminosity evolve very differently. Radio-quiet sources display strong evolution to z~2 while radio-loud AGNs below the break in the radio luminosity function evolve more modestly and show hints of a decline in their space density at z>1, with this decline occurring later for lower-luminosity objects. If the radio luminosities of these sources are a function of their black hole spins then slowly-rotating black holes must have a plentiful fuel supply for longer, perhaps because they have yet to encounter the major merger that will spin them up and use the remaining gas in a major burst of star formation.Comment: Accepted for publication in MNRAS: 36 pages, including 13 pages of figures to appear online only. In memory of Stev

Public perceptions of deer management in Scotland : the impact of place of residence, knowledge and demographic factors

Deer have a prominent public and political profile in Scotland because of their iconic status, environmental and socio-economic impacts, and the long-running controversies surrounding their management. However, few studies have examined public perceptions of deer management. This article investigates whether rural and urban place of residence and other demographic factors are significant influences on public perceptions of deer management. A survey (n = 184) in rural and urban locations in Scotland explored public perceptions of deer management in contrasting localities. Place of residence, demographic information and self-reported knowledge levels were analysed to examine their impact on perceptions. Respondents generally agreed that deer management is necessary, with fencing and culling the first and second most preferred management options. Rural or urban place of residence had a limited influence on opinions of deer management, with engagement in land-based employment playing a more important role. Self-reported understanding of deer management was the most important factor in shaping opinions; those with greater knowledge were more likely to support deer culling. The findings suggest that improved public education concerning the need for deer management would be beneficial, increasing public understanding of management practices.PostprintPeer reviewe

Historical flash floods in England:new regional chronologies and database

There is increasing interest in past occurrences of flooding from intense rainfall, commonly referred to as “flash flooding,” and the associated socioeconomic consequences. Historical information can help us to place recent events in context and to understand the effect of low frequency climate variability on changing flash flood frequencies. Previous studies have focussed on fluvial flooding to reconstruct the temporal and spatial patterns of past events. Here, we provide an online flood chronology for the north and south‐west of England for flash floods, including both surface water and fluvial flooding, with coverage from ~1700 to ~2013 (http://ceg-fepsys.ncl.ac.uk/fc). The primary source of documentary material is local newspaper reports, which often give detailed descriptions of impacts. This provides a new resource to inform communities and first responders of flood risks, especially those from rapid rise in water level whose severity may be greater than those of accompanying peak flow. Examples are provided of historical flash floods that exemplify how the chronologies can help to place recent floods in the context of the preinstrumental record for: (a) more robust estimates of event return period, (b) identification of catchment or settlement susceptibility to flash flood events, and (c) characterisation of events in ungauged catchments