Diabetes Distress: Understanding the Hidden Struggles of Living with Diabetes and Exploring Intervention Strategies

Diabetes Distress is a rational emotional response to the threat of a life-changing illness. Distinct from depression, it is rooted in the demands of diabetes management and is a product of psychological adjustment. Diabetes distress has been found to be significantly associated with HbA1c and self-care, which demonstrates its clinical use in treatment outcomes. Interpersonal factors such as perceived support and protectiveness of partners significantly contribute to elevated distress, suggesting that these are valued areas of focus for interventions. Pioneering large-scale research, DAWN2, gives voices to the families of those with diabetes and reaffirms the need to consider psychosocial factors in routine diabetes care. Structured diabetes education programmes are the most widely used in helping individuals cope with diabetes, but they fail to consider the psychological or interpersonal aspects of diabetes management. Psycho-educational approaches are found to be effective in reducing diabetes distress while also improving HbA1c. Certain limitations in the current literature are discussed, along with future directions. Of utmost importance is the need for health practitioners, irrespective of background, to demonstrate an understanding of diabetes distress and actively engage in discussion with individuals struggling to cope with diabetes; to normalize this and integrate it into routine diabetes practice.

Progressing from internal to supply chain level environmental strategies: The influence of internal support processes

The need for companies to consider the environmental impact of their operations and supply chains has been highlighted in the literature. However, few studies appear to consider how companies’ progress from proactive environmental strategies implemented at the internal, operations level to proactive environmental strategies implemented at the supply chain level. This study assesses the implementation process through the lens of the natural resource-based view and dynamic capabilities perspective. First, the link between the internal strategy ‘pollution prevention’ and the supply chain strategy ‘process stewardship’ is assessed. Second, the mediating influence of the internal support processes ‘integration’ and ‘learning’ on the implementation process is considered. Data collected from a sample of 1200 UK-based food manufacturing companies is analysed using multiple regression analysis. The findings suggest that the progression to environmental efforts at the supply chain level begins with internally-based environmental efforts and that the integration of these efforts and experience gained from them are important supporting factors in this progression.

Fluid strategies and outcomes in patients with acute respiratory distress syndrome, systemic inflammatory response syndrome and sepsis: a protocol for a systematic review and meta-analysis

Background
Fluid administration to critically ill patients remains the subject of considerable controversy. While intravenous fluid given for resuscitation may be life-saving, a positive fluid balance over time is associated with worse outcomes in critical illness. The aim of this systematic review is to summarise the existing evidence regarding the relationship between fluid administration or balance and clinically important patient outcomes in critical illness.

Methods
We will search Medline, EMBASE, the Cochrane Central Register of Controlled Trials from 1980 to the present and key conference proceedings from 2009 to the present. We will include studies of critically ill adults and children with acute respiratory distress syndrome (ARDS), sepsis and systemic inflammatory response syndrome (SIRS). We will include randomised controlled trials comparing two or more fluid regimens of different volumes of fluid and observational studies reporting the relationship between volume of fluid administered or fluid balance and outcomes including mortality, lengths of intensive care unit and hospital stay and organ dysfunction. Two independent reviewers will assess articles for eligibility, data extraction and quality appraisal. We will conduct a narrative and/or meta-analysis as appropriate.

Discussion
While fluid management has been extensively studied and discussed in the critical care literature, no systematic review has attempted to summarise the evidence for post-resuscitation fluid strategies in critical illness. Results of the proposed systematic review will inform practice and the design of future clinical trials.

Systematic review registration
PROSPERO CRD42013005608. (http://​www.​crd.​york.​ac.​uk/​PROSPERO/​)

The Baltic Dry Index: cyclicalities, forecasting and hedging strategies

The cyclical properties of the Baltic Dry Index (BDI) and their implications for forecasting performance are investigated. We find that changes in the BDI can lead to permanent shocks to trade of major exporting economies. In our forecasting exercise, we show that commodities and trigonometric regression can lead to improved predictions and then use our forecasting results to perform an investment exercise and to show how they can be used for improved risk management in the freight sector.

Branding strategies for high technology products: The effects of consumer and product innovativeness

Choice of an appropriate branding strategy is a critical determinant of new product success. Prior work on fast-moving-consumer-goods (FMCG) prescribes that new products carry new (vs. existing) brand names to appeal to earlier adopters - a critical target for new products. However, such a prescription may not be prudent for high-technology (HT) products, as they often involve considerably more consumer perceived risk than FMCG. By drawing on Dowling and Staelin's (1994) framework of perceived-risk handling, we propose that both earlier and later adopters will favor existing brands to cope with the elevated risk associated with an innovative HT product. Two studies - one conducted in an experimental setting and the other in a field setting - support the proposition that both earlier and later adopters respond more favorably to existing (vs. new) brands on innovative HT products.

Partially Ordered Preferences in Decision Trees: Computing Strategies with Imprecision in Probabilities

Partially ordered preferences generally lead to choices that do not abide by standard expected utility guidelines; often such preferences are revealed by imprecision in probability values. We investigate five criteria for strategy selection in decision trees with imprecision in probabilities: “extensive” Γ-maximin and Γ-maximax, interval dominance, maximality and E-admissibility. We present algorithms that generate strategies for all these criteria; our main contribution is an algorithm for Eadmissibility that runs over admissible strategies rather than over sets of probability distributions.

Potential strategies for the eradication of multi-drug resistant Gram-negative bacterial infections

Antimicrobial resistance is one of the leading threats to society. The increasing burden of multidrug-resistant Gram-negative infection is particularly concerning as such bacteria are demonstrating resistance to nearly all currently licensed therapies. Various strategies have been hypothesized to treat multidrug-resistant Gram-negative infections including: targeting the Gram-negative outer membrane; neutralization of lipopolysaccharide; inhibition of bacterial efflux pumps and prevention of protein folding. Silver and silver nanoparticles, fusogenic liposomes and nanotubes are potential strategies for extending the activity of licensed, Gram-positive selective, antibiotics to Gram-negatives. This may serve as a strategy to fill the current void in pharmaceutical development in the short term. This review outlines the most promising strategies that could be implemented to solve the threat of multidrug-resistant Gram-negative infections