Smokers still underestimate the risks posed by secondhand smoke: a repeated cross-sectional study

BACKGROUND

Little is known about risk perception of secondhand smoke (SHS) and its changes over time. The aim of the study was to examine the role of smoking status and demographics on perceiving a range of health risks of SHS exposure and their trends over time among a representative sample of the Irish general population.

METHODS

This study included 2 repeated cross-sectional samples of Irish adults in 1999 (n = 1,240) and 2006 (n = 1,000), in addition to a representative sample of General Practitioners (2006: n = 248), sampled as a health care professional's view on SHS risk. Participants were asked to consider whether a nonsmoker, exposed to SHS, is at an increased risk of asthma, lung cancer, heart disease, bronchitis, diabetes, and ear infections in children.

RESULTS

There was a significant increase in the general population's risk perception of SHS for asthma, lung cancer, heart disease, and bronchitis from 1999 to 2006. Not even half of the general population in 1999 and in 2006 perceived a risk for the development of ear infections in children with SHS exposure (45% in 1999, 46% in 2006). With the exception of ear infections in children in 2006, the risk perception of all diseases differed significantly by smoking status; smokers' risk perception of SHS was significantly lower. Encouraging results suggest that the differences in risk perception between smokers and nonsmokers have decreased.

CONCLUSION

Risk perception of SHS exposure has improved as has the gap in perception between smokers and nonsmokers. This research points to a lack of awareness among the general population of the risk perception of SHS exposure to children.

An observational study of public and private general practitioner consultations in the Republic of Ireland

BACKGROUND

The reasons why patients visit their general practitioner (GP) is vital information for fund holders and policy makers. GP consultations in the Republic of Ireland are either paid by the patient on a fee-per-service basis (private patients) or by the state [general medical service (GMS) card holders], and information related to primary care consultations is limited.

OBJECTIVES

The aim of this study was to conduct an observational study of GMS and private consultations within general practice in Ireland.

DESIGN

This is a cross-sectional study of general practitioner consultations.

METHODS

GPs within existing Continued Medical Education (CME) groups were invited to participate. Participating GPs gathered data on 100 consecutive consultations between September 2008 and April 2010.

RESULTS

There were 16,899 consultations recorded; 53.8 % (9,095) were GMS patients. Patients ≥65 years accounted for 23.69 % of consultations (n = 3,822). Respiratory illnesses accounted for the highest proportion of consultations (3,886, 23.0 %), followed by routine check-ups (15.4 %). GMS patients were more likely to consult for a repeat prescription (OR = 4.04, 95 % CI 2.93-5.57) and were also more likely to consult to review their treatment (OR = 2.33, 95 % CI 1.68-3.22) compared to private patients.

CONCLUSION

This study displays the consultation behaviour of patients in Ireland. It suggests that inequalities may exist in access to primary care services in ROI; however, more research is required to examine this further. There is insufficient information available on primary healthcare utilisation. Key issues such as the lack of unique patient identifiers and the lack of extractable data from GP practices in ROI need to be addressed.

Static and predictive tomographic reconstruction for wide-field multi-object adaptive optics systems

Multi-object adaptive optics (MOAO) systems are still in their infancy: their complex optical designs for tomographic, wide-field wavefront sensing, coupled with open-loop (OL) correction, make their calibration a challenge. The correction of a discrete number of specific directions in the field allows for streamlined application of a general class of spatio-angular algorithms, initially proposed in Whiteley et al. [J. Opt. Soc. Am. A15, 2097 (1998)], which is compatible with partial on-line calibration. The recent Learn & Apply algorithm from Vidal et al. [J. Opt. Soc. Am. A27, A253 (2010)] can then be reinterpreted in a broader framework of tomographic algorithms and is shown to be a special case that exploits the particulars of OL and aperture-plane phase conjugation. An extension to embed a temporal prediction step to tackle sky-coverage limitations is discussed. The trade-off between lengthening the camera integration period, therefore increasing system lag error, and the resulting improvement in SNR can be shifted to higher guide-star magnitudes by introducing temporal prediction. The derivation of the optimal predictor and a comparison to suboptimal autoregressive models is provided using temporal structure functions. It is shown using end-to-end simulations of Raven, the MOAO science, and technology demonstrator for the 8 m Subaru telescope that prediction allows by itself the use of 1-magnitude-fainter guide stars.

Differences in the structure of outpatient diabetes care between endocrinologist-led and general physician-led services

Background

Despite a shift in diabetes care internationally from secondary to primary care, diabetes care in the Republic of Ireland remains very hospital-based. Significant variation in the facilities and resources available to hospitals providing outpatient diabetes care have been reported in the UK. The aim of this study was to ascertain the structure of outpatient diabetes care in public hospitals in the Republic of Ireland and whether differences existed in services provided across hospitals.

Methods

We conducted a cross sectional observational study of the 36 public general hospitals providing adult outpatient diabetes care in the Republic of Ireland. Data relating to numbers of specialist medical, nursing and allied health professionals, waiting times for new and return patients, patterns of discharge back to primary care and engagement in quality improvement initiatives were recorded.

Results

Thirty-five of the 36 eligible hospitals participated in the study. Sixty percent of these had at least one consultant endocrinologist in post, otherwise care delivery was led by a general physician. Waiting times for newly diagnosed patients exceeded six months in 30% of hospitals and this was higher where an endocrinologist was in place (47% V 7%, p = 0.013). Endocrinologists were more likely to have developed subspecialty clinics, access to allied health professionals and engage more in quality improvement initiatives but less likely to discharge patients back to primary care than general physicians (76 v 29%, p = 0.005).

Conclusions

Variations exist in the structure and provision of diabetes care in Irish hospitals. Endocrinology-led services have more developed subspecialty structures and access to specialist allied health professionals and engage more in quality improvement initiatives. Nonetheless, waiting times are longer and discharge rates to primary care are lower than for non-specialty led services. Further studies to determine the extent to which case-mix variation accounts for these observations are warranted. Aspects of hospital-based outpatient care could be developed further to ensure equitable services are provided nationally. At a time when the delivery of diabetes services in primary care is being promoted, further research is warranted on the factors influencing the successful transition to primary care.

Guidance on the use of respiratory and facial protection equipment

Infectious micro-organisms may be transmitted by a variety of routes, and some may be spread by more than one route. Respiratory and facial protection is required for those organisms that are usually transmitted via the droplet/airborne route, or when airborne particles have been artificially created, such as during ‘aerosol-generating procedures’. A range of personal protective equipment that provides different degrees of facial and respiratory protection is available. It is apparent from the recent experiences with severe acute respiratory syndrome and pandemic (H1N1) 2009 influenza that healthcare workers may have difficulty in choosing the correct type of facial and respiratory protection in any given clinical situation. To address this issue, the Scientific Development Committee of the Healthcare Infection Society established a short-life working group to develop guidance. The guidance is based upon a review of the literature, which is published separately, and expert consensus.

GPs' perspectives on the management of patients with multimorbidity: systematic review and synthesis of qualitative research

OBJECTIVE

To synthesise the existing published literature on the perceptions of general practitioners (GPs) or their equivalent on the clinical management of multimorbidity and determine targets for future research that aims to improve clinical care in multimorbidity.

DESIGN

Systematic review and metaethnographic synthesis of primary studies that used qualitative methods to explore GPs' experiences of clinical management of multimorbidity or multiple chronic diseases.

DATA SOURCES

EMBASE, MEDLINE, CINAHL, PsycInfo, Academic Search Complete, SocIndex, Social Science Full Text and digital theses/online libraries (database inception to September 2012) to identify literature using qualitative methods (focus groups or interviews).

REVIEW METHODS

The 7-step metaethnographic approach described by Noblit and Hare, which involves cross-interpretation between studies while preserving the context of the primary data.

RESULTS

Of 1805 articles identified, 37 were reviewed in detail and 10 were included, using a total of 275 GPs in 7 different countries. Four areas of difficulty specific to the management of multimorbidity emerged from these papers: disorganisation and fragmentation of healthcare; the inadequacy of guidelines and evidence-based medicine; challenges in delivering patient-centred care; and barriers to shared decision-making. A 'line of argument' was drawn which described GPs' sense of isolation in decision-making for multimorbid patients.

CONCLUSIONS

This systematic review shows that the problem areas for GPs in the management of multimorbidity may be classified into four domains. There will be no 'one size fits all' intervention for multimorbidity but these domains may be useful targets to guide the development of interventions that will assist and improve the provision of care to multimorbid patients.

Electrochemical nanostructuring of n-GaAs photoelectrodes

Methods to simultaneously optimize carrier collection and light in-coupling in semiconductors are important for developing low-cost, high-efficiency photovoltaics and photoelectrodes. We anodically etched nanostructures into planar (100) n-GaAs wafers with different bulk minority carrier diffusion lengths L(D). The structures were varied by changing the anodization parameters. A ferrocene/ferrocenium electrolyte provided a conformal rectifying contact to the anodized n-GaAs and enabled the measurement of carrier generation and collection as a function of nanostructure geometry and L(D). Internal quantum efficiency Φ(int) of photoelectrodes varied with nanostructure geometry and L(D). External quantum efficiency Φ(ext) also depended on the reflectance of the nanostructured GaAs-electrolyte interface. Reflectance was minimized using anodization current densities of 100-150 mA cm(-2), which etched subwavelength trigonal prismatic nanostructures ~400 nm in width at their base. For Si-doped n-GaAs with L(D) = 170 nm, peak Φ(ext) of ~75% and Φ(int) of ~85% was achieved using J(anod) = 150 mA cm(-2). The control of both surface nanostructure (to minimize reflection) and pore depth and spacing (to optimize 3D carrier collection) via two-step anodization yielded photoelectrodes with peak Φ(ext) of ~85% and peak Φ(int) of ~95% for Te-doped n-GaAs with a bulk L(D) of only 420 nm. The measured short-circuit current densities for the nanostructured photoelectrodes were up to 2.5 times that of planar controls, demonstrating that appropriate nanostructuring significantly improves carrier collection even for direct bandgap materials with large absorption coefficients like GaAs.

Barriers to, and facilitators in, introducing integrated diabetes care in Ireland: a qualitative study of views in general practice

OBJECTIVE

To examine the barriers to, and facilitators in, improving diabetes management from the general practice perspective, in advance of the implementation of an integrated model of care in Ireland.

DESIGN

Qualitative using semistructured interviews.

SETTING

Primary care in the Republic of Ireland.

PARTICIPANTS

Purposive sample of 29 general practitioners (GPs) and two practice nurses.

METHODS

Data were analysed using a framework approach.

RESULTS

The main barriers and facilitators occurred at the level of the health system but had a ripple effect at an organisational, professional and patient level. The lack of targeted remuneration for diabetes management in the Irish health system created apathy in general practice and was perceived to be indicative of the lack of value placed on chronic disease management in the health system. There were 'pockets of interest' among GPs motivated by 'vocational' incentives such as a sense of professional duty; however, this was not sufficient to drive widespread improvement. The hospital service was seen as an essential support for primary care management, although some participants referred to emerging tension between settings. The lack of coordination at the primary-secondary interface resulted in avoidable duplication and an 'in the meantime' period of uncertainty around when patients would be called or recalled by specialist services. Facilitators included the availability of nursing support and serendipitous access to services. The lack of resources in the community was considered to be at odds with policy to shift routine management to general practice, which is fast reaching saturation.

CONCLUSIONS

At present, intrinsic motivation is driving the improvement of diabetes care in Ireland. This will not be sufficient to implement the proposed reform including a national model of integrated care. Policymakers need to assess and prepare for the disparate levels of interest and infrastructure in primary care in Ireland to support this change.

Determining in-patient diabetes treatment satisfaction in the UK--the DIPSat study

AIMS

To measure in-patient diabetes treatment satisfaction and its relationship to in-patient diabetes care.

METHODS

In a cross-sectional study, diabetes in-patient specialist nurses at 58 UK hospitals asked insulin-treated in-patients with diabetes to complete the recently updated Diabetes Treatment Satisfaction Questionnaire for In-patients and a general questionnaire; 1319 in-patients completed these questionnaires.

RESULTS

Satisfaction with the general diabetes treatment items in the Diabetes Treatment Satisfaction Questionnaire for In-patients was high, but there were high levels of extreme dissatisfaction with meal choices, meal quality and lack of similarity of hospital meals to normal domestic choices--23% would never or rarely have made similar meal choices at home. Hyperglycaemia or hypoglycaemia was reported for much of the in-patient stay (20% and 7%, respectively) and 26% reported at least one severe hypoglycaemic episode; these groups had lower satisfaction with the timing of medication in relation to meals (P < 0.003). More frequent in-patient hyperglycaemia or hypoglycaemia were associated with significantly poorer overall satisfaction scores and negative well-being scores (both P < 0.0001). Previous experience of a multiple daily insulin injection regimen was associated with more dissatisfaction than other regimens (P < 0.01). Multiple regression models explained 36% of variability in overall treatment satisfaction, with most (22.4%) accounted for by satisfaction with time spent with a diabetes in-patient specialist nurse (P < 0.0001). Self-administration of insulin was independently associated with higher treatment satisfaction (P < 0.006) in this model.

CONCLUSIONS

The DIPSat programme describes the complex relationships between diabetes in-patient treatment satisfaction and in-patient diabetes care.

The effect of copayments for prescriptions on adherence to prescription medicines in publicly insured populations; a systematic review and meta-analysis

Introduction

Copayments are intended to decrease third party expenditure on pharmaceuticals, particularly those regarded as less essential. However, copayments are associated with decreased use of all medicines. Publicly insured populations encompass some vulnerable patient groups such as older individuals and low income groups, who may be especially susceptible to medication non-adherence when required to pay. Non-adherence has potential consequences of increased morbidity and costs elsewhere in the system.

Objective

To quantify the risk of non-adherence to prescribed medicines in publicly insured populations exposed to copayments.

Methods

The population of interest consisted of cohorts who received public health insurance. The intervention was the introduction of, or an increase, in copayment. The outcome was non-adherence to medications, evaluated using objective measures. Eight electronic databases and the grey literature were systematically searched for relevant articles, along with hand searches of references in review articles and the included studies. Studies were quality appraised using modified EPOC and EHPPH checklists. A random effects model was used to generate the meta-analysis in RevMan v5.1. Statistical heterogeneity was assessed using the I² test; p>0.1 indicated a lack of heterogeneity.

Results

Seven out of 41 studies met the inclusion criteria. Five studies contributed more than 1 result to the meta-analysis. The meta-analysis included 199, 996 people overall; 74, 236 people in the copayment group and 125,760 people in the non-copayment group. Average age was 71.75years. In the copayment group, (verses the non-copayment group), the odds ratio for non-adherence was 1.11 (95% CI 1.09–1.14; P = <0.00001). An acceptable level of heterogeneity at I² = 7%, (p = 0.37) was observed.

Conclusion

This meta-analysis showed an 11% increased odds of non-adherence to medicines in publicly insured populations where copayments for medicines are necessary. Policy-makers should be wary of potential negative clinical outcomes resulting from non-adherence, and also possible knock-on economic repercussions.

Assessing the impact of diabetes on the quality of life of older adults living in a care home: validation of the ADDQoL Senior

AIMS

Around a quarter of UK care-home residents have diabetes. Diabetes is known to impact quality of life but existing diabetes-specific quality of life measures are unsuitable for elderly care-home residents. We aimed to develop and evaluate a new measure for use with older adults, to be particularly suitable for use with care-home residents: the Audit of Diabetes-Dependent Quality of Life (ADDQoL) Senior*.

METHODS

Content and format changes were made to the 19-domain ADDQoL, informed by related measures for people with visual impairments (12 domain-specific items were retained, four items were revised/added and three items were removed). This revision was modified further following cognitive debriefing interviews with three older adults living in a care home. Psychometric evaluation of the newly developed 17-domain ADDQoL Senior was conducted using data from 90 care-home residents with diabetes who took part in a broader intervention study.

RESULTS

The life domains most impacted by diabetes were 'independence' and 'freedom to eat as I wish'. The ADDQoL Senior demonstrated good factor structure and internal consistency (Cronbach's alpha = 0.924). Domain scores were, as expected, significantly intercorrelated.

CONCLUSIONS

The ADDQoL Senior measures the perceived impact of diabetes on quality of life in older adults, and has been found to be suitable for those living in care homes if administered by interview. The scale has demonstrated acceptability and excellent psychometric properties. It is anticipated that the number of items may be reduced in the future if our current findings can be replicated.

Guidelines for transoesophageal echocardiographic probe cleaning and disinfection from the British Society of Echocardiography

The clinical utility of transoesophageal echocardiography (TOE) is well established. Being a semi-invasive procedure, however, the potential for transmission of infection between sequential patients exists. This has implications for the protection of both patients and medical staff. Guidelines for disinfection during gastrointestinal endoscopy (GIE) have been in place for many years.(1,2) Unfortunately, similar guidance is lacking with respect to TOE. Although traversing the same body cavities and sharing many similarities with upper GIE, there are fundamental structural and procedural differences with TOE which merit special consideration in establishing a decontamination protocol. This document provides recommendations for TOE probe decontamination based on the available evidence, expert opinion, and modification of the current British Society of Gastroenterology guidelines.

LABORATORY AND FIELD EVALUATIONS OF BEAUVERIA BASSIANA (BALSAMO) VUILLEMIN AGAINST GRASSHOPPERS AND LOCUSTS IN AFRICA

Two isolates of the fungus Beauveria bassiana (Balsamo) Vuillemin, GHA and BF, were evaluated in Cape Verde in 1991 and 1992 for infectivity to the Senegalese grasshopper, Oedaleus senegalensis (Krauss), and the migratory locust, Locusta migratoria migratorioides (Reiche and Fairmaire). Evaluations included laboratory bioassays and small-scale field trials. Laboratory bioassays evaluated five different formulations. Four of the formulations tested showed strong dose–response patterns and significantly higher mortality than the untreated control or carriers minus spores. All four formulations achieved high mortality levels when applied at economically feasible dose rates. The GHA and BF isolates, formulated in an oil carrier with an emulsifier, were equally infectious to migratory locust nymphs. Six different formulations of GHA were evaluated in field trials. Field trials evaluated both direct effects (treatment of field plots infested with O. senegalensis) and indirect effects (treatment of plots without grasshoppers, after which grasshoppers were introduced). In both cases, all six formulations showed good biocontrol potential. Grasshoppers exposed to treated plots up to 72 h after application exhibited comparatively high mortality levels, indicating that large numbers of spores remained viable in the field for at least 3 days. This was confirmed by analysis of the viability of conidia from vegetation samples obtained in the field following treatment. In open-plot, small-scale field trials, two different formulations (oil and clay-based) of GHA resulted in high rates of infection and approximately 45% reductions in grasshopper densities in the treated plots 7 days after application, even though density-reduction results were "diluted" by grasshopper migration into and out of the test plots. Results of the Cape Verde evaluations demonstrate that biopesticides developed from B. bassiana represent a promising alternative to chemical pesticides for grasshopper and locust control.

A computer based, automated analysis of process and outcomes of diabetic care in 23 GP practices

The predicted prevalence of diabetes in Ireland by 2015 is 190,000. Structured diabetes care in general practice has outcomes equivalent to secondary care and good diabetes care has been shown to be associated with the use of electronic healthcare records (EHRs). This automated analysis of EHRs in 23 practices took 10 minutes per practice compared with 15 hours per practice for manual searches. Data was extracted for 1901 type II diabetics. There was valid data for >80% of patients for 6 of the 9 key indicators in the previous year. 543 (34%) had a Hba1c > 7.5%, 142 (9%) had a total cholesterol >6 mmol/l, 83 (6%) had an LDL cholesterol >4 mmol/l, 367 (22%) had Triglycerides > 2.2 mmol/l and 162 (10%) had Blood Pressure > 160/100 mmHg. Data quality and key indicators of care compare well with manual audits in Ireland and the U.K. electronic healthcare records and automated audits should be a feature of all chronic disease management programs.

Fast iterative algorithm (FIA) for controlling MEMS deformable mirrors: principle and laboratory demonstration

We present a fast and high accuracy iterative algorithm to control Micro-Electro-Mechanical-System (MEMS) deformable mirrors (DMs) for open-loop (OL) adaptive optics (AO) applications. Our approach relies on a simple physical model for the forces applied on DM actuators and membrane, defined by a small number of parameters that we measure in an experimental setup. The algorithm iteratively applies forces and updates actuator displacements, allowing real-time utilization in an Extreme-AO system (control rate ≥ Khz). Our measurements show that it reproduces Kolmogorov type phase screens with an error equal to 7.3% of the rms of the desired phase (1.6% of the peak-to-valley of the desired phase). This performance corresponds to an improvement of a factor three compared to the standard quadratic model (common relation between voltage and actuator displacement). Originally developed for the DM control of the Subaru Coronagraphic Extreme-AO (SCExAO) project, the algorithm is also suitable for Multi-Object AO systems.

Interfacial morphology and photoelectrochemistry of conjugated polyelectrolytes adsorbed on single crystal TiO2

The nanoscale morphology and photoactivity of conjugated polyelectrolytes (CPEs) deposited from different solvents onto single crystal TiO(2) were investigated with atomic force microscopy (AFM) and photocurrent spectroscopy. CPE surface coverages on TiO(2) could be incremenentally increased by adsorbing the CPEs from static solutions. The solvents used for polymer adsorption influenced the surface morpohology of the CPEs on the TiO(2) surface. Photocurrent spectroscopy measurements in aqueous electrolytes, using iodide as a hole scavenger, revealed that the magnitude of the sensitized photocurrents was related to the surface coverages and the degree of aggregation of the CPEs as determined by AFM imaging. Absorbed photon-to-current efficiencies approaching 50% were measured for CPE layers as thick as 4 nm on TiO(2). These results suggest that precise control of CPE morphology at the TiO(2) interface can be achieved through optimization of the deposition conditions to improve the power conversion efficiencies of polymer-sensitized solar cells.

Assisted admissions? A national survey of general practitioner experience of involuntary admissions

The 2001 Mental Health Act introduced in 2006, changed how a patient is admitted involuntarily to a psychiatric unit. This paper reports on a national survey of general practitioners' experience implementing the Act. Five hundred and sixty eight (568) GPs completed the survey. Twenty five percent (25%) of respondants had not used it. When used, twenty four percent (24%) report that it takes seven hours or more to complete an admission. Fifty percent (50%) of respondents are confident to complete the necessary paperwork. Overall GPs are dissatisfied with arrangements for transport of patients (mean Likert score 3.5), primarily due to the time delay. GPs believe this places risk on the patient, family and GP. Only thirty-three percent (33%) of respondents feel that the Mental Health Act has improved the patient, GP and family experience of involuntary admission.

A review of self-medication in physicians and medical students

BACKGROUND

There is a culture within medicine that doctors do not expect themselves or their colleagues to be sick. Thus, the associated complexities of self-diagnosis, self-referral and self-treatment among physicians are significant and may have repercussions for both their own health and, by implication, for the quality of care delivered to patients.

AIMS

To collate what is known about the self-treatment behaviour of physicians and medical students.

METHODS

The following databases were searched: PubMed, PsychInfo, EBSCO, Medline, BioMed central and Science Direct. Inclusion criteria specified research assessing self-treatment and self-medicating of prescription drugs among physicians and/or medical students. Only peer-reviewed English language empirical studies published between 1990 and 2009 were included.

RESULTS

Twenty-seven studies were identified that fitted the inclusion criteria. Self-treatment and self-medicating was found to be a significant issue for both physicians and medical students. In 76% of studies, reported self-treatment was >50% (range: 12-99%). Overall, only one of two respondents was registered with a general practitioner or primary care physician (mean = 56%, range = 21-96). Deeper analysis of studies revealed that physicians believed it was appropriate to self-treat both acute and chronic conditions and that informal care paths were common within the medical profession.

CONCLUSIONS

Self-treatment is strongly embedded within the culture of both physicians and medical students as an accepted way to enhance/buffer work performance. The authors believe that these complex self-directed care behaviours could be regarded as an occupational hazard for the medical profession.

Closed-loop control of a woofer-tweeter adaptive optics system using wavelet-based phase reconstruction

A novel closed-loop control technique for adaptive optics (AO) systems based on a wavelet-based phase reconstruction technique and a woofer-tweeter controller is presented. The wavelet-based reconstruction technique is based on obtaining a Haar decomposition of the phase screen directly from gradient measurements and has been extended here with the use of a Poisson solver to improve performance. This method is O(N) (i.e., a linear computation cost as number of actuators increases) and is the fastest of the known O(N) reconstruction techniques. The controller configuration is based on the woofer-tweeter controller to control low- and high-spatial-frequency aberrations, respectively. The separation of the woofer and tweeter signals is done using a computationally efficient method that is based on the availability of a low-spatial-resolution reconstruction during the wavelet synthesis process. The performance of the proposed technique is evaluated using a simulated AO system and phase screens generated to reflect atmospheric turbulence with various dynamic characteristics. Results indicate that the combination of the wavelet-based phase reconstruction and woofer-tweeter controller leads to very good results with respect to speed and accuracy.

Long-term biomedical and psychosocial outcomes following DAFNE (Dose Adjustment For Normal Eating) structured education to promote intensive insulin therapy in adults with sub-optimally controlled Type 1 diabetes

AIMS

To explore long-term outcomes of participation in a Dose Adjustment For Normal Eating (DAFNE) training course, which provided one-off exposure to structured education in intensive insulin therapy to people with established Type 1 diabetes.

METHODS

A cohort design follow-up of original trial participants at a mean of 44 months (range: 37-51 months) in hospital diabetes clinics in three English health districts. 104 (74%) original participants provided biomedical data; 88 (63%) completed questionnaires including the ADDQoL, measuring impact of diabetes on quality of life (QoL).

RESULTS

At 44 months, mean improvement in HbA(1c) from baseline was 0.36% (9.32+/-1.1% to 8.96+/-1.2%, p<0.01) remaining significant but deteriorated from 12 months (p<0.05). Improvements in QoL seen at 12 months were sustained at 44 (e.g. impact of diabetes on dietary freedom: -1.78+/-2.33 at 44 months versus -4.27+/-2.94, baseline, p<0.0001; versus 1.80+/-2.32 at 12 months, ns). Similar results were obtained using last observation carried forward for patients not supplying follow-up data.

CONCLUSIONS

The impact of a single DAFNE course on glycaemic control remains apparent in the long term, although further interventions will be required to achieve recommended HbA(1c). In contrast, improvements in QoL and other patient-reported outcomes are well maintained over approximately 4 years.

Open-loop control demonstration of micro-electro-mechanical-system MEMS deformable mirror

New astronomical challenges revolve around the observation of faint galaxies, nearby star-forming regions and the direct imaging of exoplanets. The technologies required to progress in these fields of research rely on the development of custom Adaptive Optics (AO) instruments such as Multi-Object AO (MOAO) or Extreme AO (ExAO). Many obstacles remain in the development of these new technologies. A major barrier to the implementation of MOAO is the utilisation of deformable mirrors (DMs) in an open-loop control system. Micro-Electro-Mechanical-System (MEMS) DMs show promise for application in both MOAO and ExAO. Despite recent encouraging laboratory results, it remains an immature technology which has yet to be demonstrated on a fully operational on-sky AO system. Much of the research in this area focuses on the development of an accurate model of the MEMS DMs. In this paper, a thorough characterization process of a MEMS DM is performed, with the goal of developing an open-loop control strategy free of computationally heavy modelling (such as the use of plate equations). Instead, a simpler approach, based on the additivity of the influence functions, is chosen. The actuator stroke-voltage relationship and the actuator influence functions are carefully calibrated. For 100 initial phase screens with a mean rms of 97 nm (computer generated following a Von Karman statistic), the resulting mean residual open-loop rms error is 16.5 nm, the mean fitting error rms is 13.3 nm and the mean DM error rms is 10.8 nm (error reflecting the performances of the model under test in this paper). This corresponds to 11% of residual DM error.

Diabetes care in Ireland: a survey of general practitioners

AIM

To investigate the organisation of diabetes care in general practice in Ireland and identify areas for future development.

METHODS

Survey of a representative sample of 600 general practitioners (GPs). The questionnaire contained closed and open-ended questions addressing 4 topics; characteristics of the practice, diabetes care delivery, use of services and opportunities for developing diabetes care.

RESULTS

The response rate was 44% (n=262). There were an additional 86 responses to a follow-up shortened version of the survey resulting in a 58% response rate for 9 key questions. The majority of respondents were from an urban (43%, n=112) or a mixed area (39%, n=101) and 19% of practices were single-handed (n=66). The reported prevalence in participating practices was 0.7% for Type 1 diabetes and 2.8% for Type 2 diabetes. Forty-five percent of GPs maintained a diabetes register (n=157) while 53% reported using guidelines (n=140). A formal call recall system was reported by 30% (n=78) with a further 20% (n=54) reporting a regular if informal approach to calling patients for review. With regard to the use of diabetes related services 63% reported direct access to a dietician (n=165), 57% direct access to chiropody services (n=149) and 89% had direct access to retinopathy screening (n=234). There was a significant association between maintaining a diabetes register and other aspects of care delivery such as engaging in formal recall (p<0.001), using guidelines (p<0.001) and a declared special interest in diabetes (p=0.001). Of a number of choices 75% of GPs thought that training was the principal opportunity for improving diabetes care. In response to the open-ended questions GPs cited lack of resources, time constraints and workload as barriers to effective care delivery.

CONCLUSIONS

Delivery of diabetes care in Ireland remains largely unstructured. Key challenges to improving diabetes care appear to extend to the system and organisational level of care delivery.

Wavefront reconstruction over a circular aperture using gradient data extrapolated via the mirror equations

Methods for extrapolating gradient data outside a circular aperture from measurements obtained within a circular aperture are presented. The proposed methods are required to be computationally efficient and to avoid the excitation of additional waffle modes in Fried alignment. It is shown that, using an octagon as an intermediate step from the circle to the square in the extrapolation process, the computations or residual reconstruction error can be reduced. The resulting computational cost is as low as O(N(1/2)), where N is the number of measurement points. The performances of the extrapolation methods are studied in connection with a recently developed O(N) wavefront reconstruction algorithm based on wavelet filter banks [IEEE J. Sel. Top. Signal Process. 2, 781 (2008)] Experiments indicate that, as expected, there is a significant reconstruction error if no extrapolation is used. Further, the proposed extrapolation techniques lead to a reconstruction with data that are marginally different from a pupil masked reconstruction using data from a square aperture.

Psychometric validation and use of a novel diabetes in-patient treatment satisfaction questionnaire

AIMS

To develop the first psychometrically validated Diabetes Treatment Satisfaction Questionnaire for in-patients (DTSQ-IP) and examine determinants of in-patient diabetes treatment satisfaction.

METHODS

We studied 366 in-patients with insulin-treated diabetes at a single UK centre. We developed a 19-item DTSQ-IP to assess in-patient diabetes treatment satisfaction, and collected data on in-patient length of stay (LOS) and in-patient care at the same time.

RESULTS

Psychometric analyses including Principal Components Analysis and Cronbach's alpha reliability coefficient showed that a single satisfaction score (excluding two items scored individually) can be computed for the entire DTSQ-IP, indicating very good internal consistency reliability (0.92). The DTSQ-IP detected considerable dissatisfaction with meal choice and timing (13.7% of in-patients would never have chosen similar meals at home), and with in-patient hypoglycaemia (35.3% felt that their blood glucose was too low most of the time). In-patients on surgical wards, women, and those long established on insulin were significantly more dissatisfied, particularly with competence of hospital staff. Patients who administered their own insulin were not significantly less dissatisfied overall, but were so with the choice of meals (P = 0.005). Multiple regression analysis produced a model accounting for 8.2% of variability in DTSQ-IP (r = 0.29; P = 0.0058) and 21.7% of variability in LOS (r = 0.46; P = 0.0001).

CONCLUSIONS

The DTSQ-IP is a novel, psychometrically validated and sensitive tool that adds to the DTSQ portfolio. The DTSQ-IP facilitates efforts to assess and improve treatment satisfaction in in-patients with diabetes.

Efficacy of BSI-201, a poly (ADP-ribose) polymerase-1 (PARP1) inhibitor, in combination with gemcitabine/carboplatin (G/C) in patients with metastatic triple-negative breast cancer (TNBC): Results of a randomized phase II trial

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Background: TNBC is an aggressive breast cancer subtype that shares molecular and pathologic features with BRCA1-related breast cancers. BRCA-deficient cells are sensitive to inhibition of PARP1, a critical enzyme of cell proliferation and DNA repair, and thus represent a rational target of PARP inhibitor-based cancer therapy. The objectives of this study were to evaluate BSI-201, a potent PARP1 inhibitor, in combination with gemcitabine/carboplatin (G/C) in subjects with metastatic TNBC. Methods: Eligible subjects had measurable disease and had ≤2 prior cytotoxic regimens for ER-, PR-, and HER2-negative metastatic breast cancer. Patients were randomized (1:1) to G/C alone or G/C + BSI-201. Gemcitabine (1000 mg/m2) and carboplatin (AUC=2) were given on days 1 and 8, and BSI-201 (5.6 mg/kg; iv; biweekly) on days 1, 4, 8, and 11 every 21 days. Endpoints were clinical benefit rate (CBR = CR + PR + SD ≥6 months), progression-free survival (PFS) and overall survival (OS). Results: Analyses of the first 86 of a planned 120 patients showed that BSI-201 + G/C had improved CBR, median PFS, and median OS, compared with G/C alone. The frequency and nature of adverse events (AEs) did not differ between arms. Conclusions: This preliminary analysis demonstrates that BSI-201 + G/C significantly improves CBR, PFS, and OS, compared with G/C alone. BSI-201 + G/C was well tolerated, with BSI-201 adding no significant toxicity to G/C. Updated CBR, PFS, and OS for all 120 patients and exploratory correlative analyses of PARP expression and clinical response will be presented.

[Table: see text] [Table: see text]

Expanding the value of qualitative theories of illness experience in clinical practice: a grounded theory of secondary heart disease prevention

Qualitative theories of illness experience are about the individual interpretations of the psychosocial and cultural aspects of living with illness. Thus, they contribute to a better understanding of health and health care provision. In this paper, we examine how a grounded theory (GT) of heart disease experience can inform secondary prevention. In-depth interviews of individual experience of heart disease were conducted with 26 patients, using GT iterative data collection and analysis framework. A GT was compiled from data and examined within a sociocultural framework to ascertain how experience influenced health behaviour. Despite individual contextual variations, the theory of 'keeping it going' describes the study sample's common attitude to living with heart disease. The theory was adequate in explaining secondary cardiac behaviour, because it identified the aspects of patients' beliefs and attitudes which are key to effective secondary prevention. The assessment of the impact of illness experience on health behaviour within a sociocultural framework helped to articulate the strong influence of social and contextual factors. The study offers an appropriate explanatory framework for encouraging health behaviour change. It emphasizes the importance of interventions being relevant to individual perceptions and interpretations. It provides a framework for designing and evaluating cardiac interventions and the theoretical principles which underpin them.