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Aims: To investigate the effects of a curriculum that teaches medical decision making and interpersonal communication in the context of prediabetes (preDM) and type 2 diabetes (T2DM).Methods: This evaluation was an active-controlled trial of 56 patients, including patients who received their diagnosis from intervention-trained clinicians or a control group. Patients attended a research appointment for informed consent and collection of baseline measures. Over the following six months, both groups were mailed surveys and informational handouts monthly. Upon conclusion, we recorded the most recent A1c from the patient's record.Results: An analysis of covariance test revealed patients who received a T2DM diagnosis from an intervention-trained clinician reported higher reassurance from the diagnosing clinician and had a higher perception of threat. Although not statistically significant, patients with T2DM in the intervention group had a lower A1c at follow up and patients in the intervention group reported less poor eating and a higher degree of diet decision making.Conclusions: The curriculum itself does not influence glycemic control, but our results demonstrate the positive impact on patients of the curriculum to teach critical skills to clinicians delivering a diabetes diagnosis. [ABSTRACT FROM AUTHOR]

To investigate the effects of adding virtual activity groups to a multicomponent ambulatory activity monitoring intervention in managing chronic conditions such as obesity and type 2 diabetes. We randomized 120 subjects with type 2 diabetes to receive an activity monitor with or without placement into virtual activity groups. We monitored subjects over six months and collected HbA1c, weight, step count, blood pressure, and SF-36 questionnaire data. All subjects lost significant weight over the course of the study (p = 0.005); however, there was no statistically significant difference in mean weight loss between two groups (p = 0.520). HbA1c decreased in both groups, but was not statistically significant (p = 0.084). Daily step counts were similar between groups (p = 0.633), but both groups did decrease significantly over time (p = 0.004). There was no linear correlation between daily step count and HbA1c (p = 0.609), but there was between daily step count and weight (p = 0.016) although this only accounted for 5.6% of weight loss. There were no significant differences found for blood pressure and Rand SF36 measures between groups or times, or group-time interactions with two exceptions. The SF36 Role functioning/emotional measure showed an interaction between group and time (p = 0.039) and the SF36 Health Change measure had a significant difference due to time irrespective of group (p < 0.0001). Compliance remained high, with 93.8% of subjects actively participating at the conclusion of the study. Activity monitoring with in-person goal-setting and scripted feedback over six months was associated with significant weight loss with or without virtual support groups. [ABSTRACT FROM AUTHOR]

Background and Purpose: Postpartum pain affects quality of life. Clinicians are increasingly using acupuncture for management of pain. Evidence based strategies that incorporate acupuncture for postpartum pain are lacking.Methods: We performed an exploratory, randomized clinical trial of Battlefield Auricular Acupuncture (BFA) plus standard analgesia versus standard analgesia alone for reduction of pain in the immediate postpartum period.Results: The mean time to 50% sustained reduction of initial pain in the standard analgesia group (n = 33) was 6 days compared to 5 days in the standard analgesia plus BFA (n = 37) group (p = 0.35). The mean total morphine equivalent units (MEUs) in the standard group compared to standard plus BFA group were 88 mg and 82 mg respectively (p = 0.45).Conclusions: This exploratory comparison suggests that BFA may not provide additional benefit to standard analgesia for immediate postpartum pain; however, the trend toward faster reduction in pain indicates that a larger definitive study may be required. [ABSTRACT FROM AUTHOR]

Objective: To ensure that 16 weeks of methylsulfonylmethane (MSM) does not cause adverse effects in patients with the musculoskeletal disorders of osteoarthritis and back pain.Design: We carried out a subgroup analysis on data from a randomized, double-blind, placebo-controlled trial, "The use of Methylsulfonylmethane (MSM) in the treatment of low back pain," to determine the safety of taking 6 g daily of MSM (OptiMSM®, Bergstrom Nutrition). We monitored metabolic parameters to determine whether MSM altered hematologic, liver or kidney function. We also monitored physiologic parameters of blood pressure and weight.Setting: Family Medicine Residency, Mike O'Callaghan Military Medical Center.Main Outcome Measures: Metabolic parameters as measured by hematologic function - white blood cells (WBC), platelets, hemoglobin (Hb), glucose; liver function as measured by - total bilirubin, alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Physiologic parameters as measured by weight, diastolic (DBP) and systolic blood pressure (SBP); kidney function as measured by creatinine.Results: Analysis of outcome measures showed no significant difference between MSM and placebo (p < 0.05) safety values.Conclusion: MSM has no effects on WBC, platelets, Hb, total bilirubin, AST, ALT, creatinine weight, DBP, or SBP in this study. [ABSTRACT FROM AUTHOR]

Objective: To ensure that cinnamon extract does not cause electrocardiographic (ECG) effects in patients with prediabetes.Design: A subgroup analysis was carried out on data from 103 prediabetic patients participating in the "Effect of Lifestyle Intervention Plus Water-Soluble Cinnamon Extract on Lowering Blood Glucose in Prediabetics" trial. The trial was a randomized, double-blind, placebo-controlled trial comparing cinnamon extract versus placebo in prediabetic adults who committed to participate in a standard-of-care, aggressive lifestyle therapy program.Setting: Family Medicine Residency, Mike O'Callaghan Military Medical Center; Family Medicine Residency, David Grant Medical Center, Travis AFB; Wilford Hall Ambulatory Surgical Center, Family Medicine Residency; Eglin AFB, Family Medicine residency; Offutt AFB, Family Medicine Residency.Main Outcome Measures: QTc interval, QT interval, PR interval, QRS duration and heart rate from ECGs at baseline, 3 months, and 6 months.Results: Analysis of the ECGs showed no time-matched intra-group differences in any of the ECG parameters (QTc interval, QT interval, PR interval, QRS duration and heart rate; all p-values >0.05).Conclusions: Use of cinnamon extract in prediabetic patients does not affect electrocardiographic measures. [ABSTRACT FROM AUTHOR]

Background and Purpose: Medical acupuncture is an additional treatment for pain management, in which physicians are increasingly being trained.Methods: We surveyed graduates of the Nellis Family Medicine Residency/Acus Foundation Acupuncture Training initiative. We asked them about their acupuncture practice patterns, satisfaction with their practice, and queried other aspects affecting their practice.Results: 85% (50/59) graduates responded. All graduates were still practicing acupuncture, and reported that the most common ailment treated was back pain. Respondents reported that they are happier and prescribe fewer opioids than they did before learning acupuncture.Conclusions: Medical acupuncture can be learned during Family Medicine Residency and results in more satisfied physicians who report prescribing fewer opioids. [ABSTRACT FROM AUTHOR]

Summary Background Graduate Entry Nursing programmes are pre-registration nursing curricula designed for candidates who already have a health related degree. The programmes aim to attract highly motivated individuals who have a commitment to nursing and hold the cognitive abilities associated with studying in higher education including critical thinking styles and capability to study independently. These attributes are termed within the literature as “graduateness”. They are viewed by some as advantages to nursing. In contrast, however, there remains widespread scepticism amongst the public and some professionals towards those who are academically educated entering nursing. Objectives To explore how GEN students anticipate, experience, explain and respond to attitudes which imply resistance to those who are academically educated. Design Longitudinal case study informed by the conventions advocated by Yin (2014) . Settings School of Health Sciences in a British University. Participants Eight GEN students participated over the two year duration of their programme. Twelve clinical assessors with a minimum of four months' experience of supporting GEN students in practice. Methods Students took part in individual interviews at six monthly periods which were informed by the content of diaries maintained throughout their clinical placements. Clinical assessors took part in focus group discussions. Practice documentation was accessed to identify the progression of clinical competency along with written feedback received by students from clinical assessors. Results Results demonstrate the ways in which GEN students position themselves performatively in order to pre-empt or challenge negative stereotypes relating to their competence, compassion and commitment. Conclusions Students employ a number of strategies to navigate the challenges of learning within an environment in which they are viewed with suspicion and distrust. [ABSTRACT FROM AUTHOR]

Abstract: Resource considerations have meant that brevity in health care interventions is a high priority, and have led to a constant striving after ever more impressive time efficiency. The UK''s National Health Service may be described as a kind of ‘fast healthcare’, where everyone is task busy, time is money, bed spaces are frenetically shuffled so as to accommodate the most needy and there appears to be ‘no time to talk’. Indeed, a great many health care encounters are taking place in short ‘blips’ often of 5min or less across a range of sites and involving a vast number of practitioners. In this paper we explore how brief communication can both alienate and be therapeutic for patients. We theorise brief interactions by considering a number of traditions of work in anthropology, linguistics and sociology and conclude that health care providers need to invest much more in the skills and strategies for how best to communicate briefly if it to retain its core tradition of caring for others. [Copyright &y& Elsevier]

Abstract: Reduced TiO2(110) surfaces usually have OH groups as a result of H2O dissociation at oxygen vacancy defects. Because of excess electrons due to OH adsorption, OH/TiO2 exhibit interesting properties favorable to further O2 or H2O adsorption. Both O2 and H2O can adsorb and easily diffuse on the OH/TiO2 surface; such behavior plays a significant role in photocatalysis, heterogeneous catalysis, electronic devices and sensors. Indeed, the processes of H2O dissociation, O2 and H2O diffusion on such TiO2 surfaces, in the presence of OH groups, are important issues in their own right. Herein, the most recent experimental and theoretical progresses in understanding the interactions between adsorbed OH groups and O2, or H2O, over TiO2(110) surfaces and their implications will be reviewed. [Copyright &y& Elsevier]

Summary: This article describes the implementation and evaluation of a novel form of assessment of communication skills and knowledge for all branches of nursing students in a multi-campus UK Midlands university. The assessment took the form of a recorded scenario which was presented on DVD and a series of assessment questions inviting students to consider communicative and care delivery aspects of the events depicted. This ‘DVD trigger’ assessment yielded theoretically informed, practically relevant answers from the students, over 80% of whom passed. Student reactions to the assessment were elicited via a specially designed questionnaire which indicated broad approval for the assessment and yielded a high degree of internal reliability, and suggested that attitudes to the assessment could be grouped into three major factors. The first factor comprised items relating to the practical aspects of the examination, the second to teaching, learning resources and exam support and the final factor represented the perceived relationship between the examination and the skills involved in care delivery and communication in professional practice. This highlights the value of evaluating students’ responses to assessment in developing new forms of examination and in harmonising assessments with learning resources, teaching and appropriate preparation for exams. Moreover, we argue that the face validity of assessments is important in ensuring students’ engagement with the learning tasks and assessment activities and may contribute to the broader validity of the assessment enterprise in predicting and enhancing skills in subsequent professional practice. [Copyright &y& Elsevier]

Depressive symptoms erode both physical and mental aspects of health-related quality of life (HRQoL). Social support (SS) may improve HRQoL through its direct effects or buffering effects. The association among depressive symptoms, SS, and HRQoL has been studied in specific groups, but research in the general adult population remains limited. This study examined the association among depressive symptoms, SS, and HRQoL, including exploring whether SS (including its three dimensions: subjective SS, objective SS and support utilization) mediated or moderated the relationship between depressive symptoms and HRQoL among community-based adults. We conducted a cross-sectional survey in six communities in Shanghai, China, and 1642 adult participants with complete information on depressive symptoms and/or SS, and HRQoL were included. Linear regression analysis was used to investigate the association among depressive symptoms, SS, and HRQoL. In addition, we explored the mediating and moderating role of SS in the relationship between depressive symptoms and HRQoL. More depressive symptoms were associated with lower physical HRQoL (B = −0.64, p <.001) and lower mental HRQoL (B = −0.83, p <.001). SS (B = 0.07, p =.02), specifically subjective SS (B = 0.09, p =.03), was positively related to mental HRQoL. After adjusting for covariates, we found no evidence for a mediating role of SS in the relationship between depressive symptoms and HRQoL, while SS (subjective SS and objective SS) moderated the association between depressive symptoms and mental HRQoL. Due to the low voluntary participation rate of employees, participants represented approximately 50% of the individuals approached, thus limiting the generalizability of our findings. Data collected through self-report scales could lead to information bias. SS does not appear to underlie the relationship between depressive symptoms and HRQoL. However, interventions to increase SS (in particular, subjective SS and objective SS) should be studied to determine whether they may be beneficial in alleviating the adverse impact of depressive symptoms on mental HRQoL. • Depressive symptoms eroded health-related quality of life (HRQoL). • Social support (SS) and subjective SS were positively associated with mental HRQoL. • SS did not mediate the association between depressive symptoms and HRQoL. • SS moderated the association between depressive symptoms and mental HRQoL. [ABSTRACT FROM AUTHOR]

Abstract: This paper reports upon a qualitative interview study of 22 matrons, infection control staff and operating theatre staff who were questioned about their working lives and the role they played in the control of healthcare acquired infections such as MRSA virus in the UK. A theoretical framework drawing upon the work of Bourdieu is deployed as his notion of habitus captures the combination of practical work, physical disposition and ways of looking at the world which are displayed in the interview accounts of labour in the healthcare field. Three themes emerged from the analysis: first, the ‘securitization’ of healthcare work, concerned with control, supervision, ‘making sure’ and the management of risk through inspection, audit and the exercise of responsibility; second, the sense of struggle against doctors who were seen to represent a threat to the carefully organized boundaries, through such alleged violations as not washing their hands, wandering between theatre and canteen areas in soiled clothing and thinking the rules did not apply to them; third, in a ‘back to basics’ theme participants emphasised the fundamentals of what they saw to be nursing work and were concerned with cleanliness and practically based training – the habitus of hygiene itself. This was formulated in nostalgic terms with reminiscences about basic training earlier in the participants'' careers. The preoccupation with hygiene and its ‘basic’ processes can be seen as a way of managing uncertainty, accumulating a certain kind of symbolic capital and constructing and maintaining boundaries in the healthcare field. It also makes for self-governing, self-exploiting individuals who accrue responsibility to themselves for implementing the ‘habitus of hygiene’. [Copyright &y& Elsevier]

Abstract: Aim: The study aimed to explore how community mental health nurses (CMHNs) UK perceived their working lives. This was subdivided into questions related to: [•] How do nurses perceive their professional status in terms of public image compared with their understanding of their working lives? [•] How does the relationship between professional aspirations and experiences of working life affect their feelings about their work and their self image? Background: In a rapidly changing organizational context CMHNs face the challenge of achieving a coherent professional identity. Method: An interview study was conducted and analyzed using semi-structured interviews and a thematic analysis to identify categories and themes in 34 CMHN''s accounts of their working lives. Findings: The data were classified into four major themes: (i) The client focus: the public service identity of the profession; (ii) Not being a profession: skepticism, doubt and uncertainty; (iii) Growing out of the role: professional development as exit strategy; (iv) Waiting to be discovered: the search for recognition. Conclusions: The metaphor of nurses searching for recognition has demonstrated its usefulness as a means of illuminating the quest undertaken by CMHNs to establish the legitimacy of their work, and achieve acknowledgment and appreciation. This underlies the search for professional identity in community mental health nursing. [Copyright &y& Elsevier]

Health professionals have often been described as if they were in conflict with the new managerialist spirit in health care. However, because of their distributed and mobile sites of intervention, the work of community teams presents particular problems for traditional notions of management. In this UK study we identify how mental health team members are regulated by means of a subtle ‘deep management’. Team members point to a lack of management direction from senior colleagues, even though some of them participate in the management process themselves. However, the lack of overt management leads them to prioritise clients and foreground professional identities in performing their duties and much additional administrative work besides. This also meant that the organisational structure—the team—was defined in subjective terms. Participants had become self-regulating ‘deep managed’ subjects under a largely hands-off management regime. [Copyright &y& Elsevier]

Summarizes a study in the `Journal of the Science of Food and Agriculture' which suggests that the high resistant starch content of infant purees decreases their nutritional value. Lower caloric density as result; Evaluation of formation of in-vivo undigestible starch under conditions present during canning of infant purees; Retrograded amylose content of undigested starch.

Summarizes a study in the journal `Carcinogenesis' on the role of vitamin E in cancer prevention. Nitrosamine-induced esophageal tumors in immunocompromised mice; Combinations of retrovirus infected, NMBzA treated and high dietary vitamin E; Number and size of esophageal tumors; Lipid peroxidation in the liver.

Objective: Optimising the depth and rate of applied chest compressions following out of hospital cardiac arrest is crucial in maintaining end organ perfusion and improving survival. The impedance cardiogram (ICG) measured via defibrillator pads produces a characteristic waveform during chest compressions with the potential to provide feedback on cardiopulmonary resuscitation (CPR) and enhance performance. The objective of this pre-clinical study was to investigate the relationship between mechanical and physiological markers of CPR efficacy in a porcine model and examine the strength of correlation between the ICG amplitude, compression depth and end-tidal CO2 (ETCO2).Methods: Two experiments were performed using 24 swine (12 per experiment). For experiment 1, ventricular fibrillation (VF) was induced and mechanical CPR commenced at varying thrusts (0-60 kg) for 2 min intervals. Chest compression depth was recorded using a Philips QCPR device with additional recording of invasive physiological parameters: systolic blood pressure, ETCO2, cardiac output and carotid flow. For experiment 2, VF was induced and mechanical CPR commenced at varying depths (0-5 cm) for 2 min intervals. The ICG was recorded via defibrillator pads attached to the animal's sternum and connected to a Heartsine 500 P defibrillator. ICG amplitude, chest compression depth, systolic blood pressure and ETCO2 were recorded during each cycle. In both experiments the within-animal correlation between the measured parameters was assessed using a mixed effect model.Results: In experiment 1 moderate within-animal correlations were observed between physiological parameters and compression depth (r=0.69-0.77) and thrust (r=0.66-0.82). A moderate correlation was observed between compression depth and thrust (r=0.75). In experiment 2 a strong within-animal correlation and moderate overall correlations were observed between ICG amplitude and compression depth (r=0.89, r=0.79) and ETCO2 (r=0.85, r=0.64).Conclusion: In this porcine model of induced cardiac arrest moderate within animal correlations were observed between mechanical and physiological markers of chest compression efficacy demonstrating the challenge in utilising a single mechanical metric to quantify chest compression efficacy. ICG amplitude demonstrated strong within animal correlations with compression depth and ETCO2 suggesting its potential utility to provide CPR feedback in the out of hospital setting to improve performance. [ABSTRACT FROM AUTHOR]

Background: There is a large literature suggesting that noise can be detrimental to health and numerous policy documents have promoted noise abatement in clinical settings. Objectives: This paper documents the role of noise in clinical environments and its deleterious effects with a particular focus on mental health care. Our intention however, is to go beyond the notion that noise is simply undesirable and examine the extent to which researchers have explored the meaning of sound in hospital settings and identify new opportunities for research and practice. Data sources and review methods: This is a narrative review which has grouped the literature and issues in the field into themes concerning the general issues of noise in health care; sleep noise and hospital environments; noise in intensive care units; implications for service users and staff; and suggestions for new ways of conceptualising and researching clinical soundscapes. Data sources comprised relevant UK policy documents and the results of a literature search of Pubmed, Scopus and Web of Knowledge using terms such as noise, health, hospital, soundscape and relevant additional terms derived from the papers retrieved. In addition the references of retrieved articles were scanned for additional relevant material and historical items significant in shaping the field. Results: Excess unwanted noise can clearly be detrimental to health and impede recovery, and this is clearly recognised by policymakers especially in the UK context. We use the literature surveyed to argue that it is important also to see the noise in clinical environments in terms of the meaning it conveys and rather than merely containing unwanted sound, clinical environments have a 'soundscape'. This comprises noises which convey meaning, for example about the activities of other people, the rhythms of the day and the nature of the auditory community of the hospital. Unwanted sound may have unwanted effects, especially on those who are most vulnerable, yet this does not necessarily mean that silence is the better option. Therefore it is our contention that it is important to begin thinking about the social functions of sound in the mental health environment. Conclusions: Whilst it can be stressful, sound can also be soothing, reassuring and a rich source of information about the environment as well. It may be used to secure a degree of privacy for oneself, to exclude others or as a source of solidarity among friends and colleagues. The challenge then is to understand the work that sound does in its ecological context in health care settings. [ABSTRACT FROM AUTHOR]

Abstract: The development of new communication technologies has created a wide variety of new fields in which human beings can construct identities. The past decade has seen a proliferation of opportunities to use the internet for health related advice and information and many new sites have been created where participants can construct identities, formulate problems and seek solutions concerning health related issues. This paper will report on a study of emails written in to a UK-based website concerned with health issues for young people. Our analysis was driven by corpus linguistics, a computational methodology for interrogating extensive datasets, and we have combined both quantitative and qualitative approaches to the study of language. We interrogated a 400,000 word dataset of messages and were able to identify terms whose usage was elevated compared to the English language as a whole. As well as personal pronouns, these included many terms related to sexual health and bodily development, as well as terms such as ‘normal’ and ‘worried’ which were identified for further exploration. Whereas previous research on sexual health has discovered the use of vague terms and euphemisms, here, young people described themselves, their anatomy and their identities in meticulous detail. This study enables us to define the role of health topics raised, the presentation of health concerns, and contributes towards the discovery of a distinctive ‘genre’ of health messages concerning sexual health which differs from that found by other researchers concentrating on face to face encounters. In conclusion we suggest that for researchers and practitioners working in health with young people in the medium of English there could be valuable lessons in communication to be learned from examination of corpora of the health care language concerned. [Copyright &y& Elsevier]

Abstract: Background: Although the quality of imaging techniques available for neurovascular angiography in the hospital environment has significantly improved over the last decades, the equipment used for clinical work is not always suited for neurovascular research in animal models. We have previously investigated the suitability of synchrotron-based K-edge digital subtraction angiography (KEDSA) after intravenous injection of iodinated contrast agent for neurovascular angiography in radiography mode in both rabbit and pig models. We now have used the KEDSA technique for the acquisition of three-dimensional images and dual energy CT. Materials and methods: All experiments were conducted at the biomedical beamline ID 17 of the European Synchrotron Radiation Facility (ESRF). A solid state germanium (Ge) detector was used for the acquisition of image pairs at 33.0 and 33.3keV. Three-dimensional images were reconstructed from an image series containing 60 single images taken throughout a full rotation of 360°. CT images were reconstructed from two half-acquisitions with 720 projections each. Results: The small detector field of view was a limiting factor in our experiments. Nevertheless, we were able to show that dual energy CT using the KEDSA technique available at ID 17 is suitable for neurovascular research in animal models. [Copyright &y& Elsevier]

Abstract: Background: K-edge digital subtraction angiography (KEDSA) combined with the tunability of synchrotron beam yields an imaging technique that is highly sensitive to low concentrations of contrast agents. Thus, contrast agent can be administered intravenously, obviating the need for insertion of a guided catheter to deliver a bolus of contrast agent close to the target tissue. With the high-resolution detectors used at synchrotron facilities, images can be acquired at high spatial resolution. Thus, the KEDSA appears particularly suited for studies of neurovascular pathology in animal models, where the vascular diameters are significantly smaller than in human patients. Materials and methods: This feasibility study was designed to test the suitability of KEDSA after intravenous injection of iodine-based contrast agent for use in a pig model. Four adult male pigs were used for our experiments. Neurovascular angiographic images were acquired using KEDSA with a solid state Germanium (Ge) detector at the European Synchrotron Radiation Facility (ESRF) in Grenoble, France. Results: After intravenous injection of 0.9ml/kg iodinated contrast agent (Xenetix®), the peak iodine concentrations in the internal carotid and middle cerebral arteries reached 35mg/ml. KEDSA images in radiography mode allowed the visualization of intracranial arteries of less than 1.5mm diameter. [Copyright &y& Elsevier]

Highlights from the article: B Purpose: b Previous studies from our group demonstrated that chest compression (CCs) applied according to depth feedback produced potentially fatal intrathoracic damage in paediatric porcine models. The objective of this study is to assess if CPR feedback from an automated external defibrillator (AED) using the impedance cardiogram (ICG) can guide CC application to achieve high levels of end-tidal carbon dioxide (EtCO SB 2 sb ), shock success (SS) and return of spontaneous circulation (ROSC) without significant intrathoracic damage.