Self-monitoring of blood glucose in Black Caribbean and South Asian Canadians with non-insulin treated Type 2 diabetes mellitus:a qualitative study of patients' perspectives

Background: To examine the views and current practice of SMBG among Black Caribbean and South Asian individuals with non-insulin treated Type 2 diabetes mellitus. Methods: Twelve participants completed semi-structured interviews that were guided by the Health Belief Model and analyzed using thematic network analysis. Results: The frequency of monitoring among participants varied from several times a day to once per week. Most participants expressed similar experiences regarding their views and practices of SMBG. Minor differences across gender and culture were observed. All participants understood the benefits, but not all viewed SMBG as beneficial to their personal diabetes management. SMBG can facilitate a better understanding and maintenance of self-care behaviours. However, it can trigger both positive and negative emotional responses, such as a sense of disappointment when high readings are not anticipated, resulting in emotional distress. Health care professionals play a key role in the way SMBG is perceived and used by patients. Conclusion: While the majority of participants value SMBG as a self-management tool, barriers exist that impede its practice, particularly its cost. How individuals cope with these barriers is integral to understanding why some patients adopt SMBG more than others. © 2013 Gucciardi et al.; licensee BioMed Central Ltd.

Identification of key temperature measurement technologies for the enhancement of product and equipment integrity in the light controlled factory

Thermal effects in uncontrolled factory environments are often the largest source of uncertainty in large volume dimensional metrology. As the standard temperature for metrology of 20°C cannot be achieved practically or economically in many manufacturing facilities, the characterisation and modelling of temperature offers a solution for improving the uncertainty of dimensional measurement and quantifying thermal variability in large assemblies. Technologies that currently exist for temperature measurement in the range of 0-50°C have been presented alongside discussion of these temperature measurement technologies' usefulness for monitoring temperatures in a manufacturing context. Particular aspects of production where the technology could play a role are highlighted as well as practical considerations for deployment. Contact sensors such as platinum resistance thermometers can produce accuracy closest to the desired accuracy given the most challenging measurement conditions calculated to be ∼0.02°C. Non-contact solutions would be most practical in the light controlled factory (LCF) and semi-invasive appear least useful but all technologies can play some role during the initial development of thermal variability models.

An exploration of pharmacy-specific reasons for non-adherence to prescribed medicines in a socioeconomically deprived, ethnically diverse UK cohort

Methods - Ethical approval for the study was granted by both the local National Health Service (NHS) Research Ethics Committee (REC) and Aston University’s REC. Seven focus groups were conducted between October and December 2011 in medical or community settings within inner-city Birmingham (UK). Discussions were guided by a theme plan which was developed from key themes identified by a literature review and piloted via a Patient Consultation Group. Each focus group had between 3 and 7 participants. The groups were digitally recorded and subsequently transcribed verbatim. The transcriptions were then subjected to thematic analysis via constant comparison in order to identify emerging themes. Results - Participants recognised the pharmacist as an expert source of advice about prescribed medicines, a source they frequently felt a need to consult as a result of the inadequate supply of medicines information from the prescriber. However, an emerging theme was a perception that pharmacists had an oblique profit motive relating to the supply of generic medicines with frequent changes to the ‘brand’ of generic supplied being attributed to profit-seeking by pharmacists. Such changes had a negative impact on the patient’s perceived efficacy of the therapy which may make non-adherence more likely. Conclusions - Whilst pharmacists were recognised as medicines experts, trust in the pharmacist was undermined by frequent changes to generic medicines. Such changes have the potential to adversely impact adherence levels. Further, quantitative research is recommended to examine if such views are generalisable to the wider population of Birmingham and to establish if such views impact on adherence levels.

Returns on key accounts:do the results justify the expenditures?

Purpose – The use of key accounts has become a mature trend and most industrial firms use this concept in some form. Selling firms establish key account teams to attend to important customers and consolidate their selling activities. Yet, despite such increased efforts on behalf of key accounts, sufficient research has not quantified the returns on key account strategy nor has it firmly established performance differences between key and non-key accounts within a firm. In response to this shortcoming, this study aims to examine returns on key accounts. Design Methodology/approach – Data were collected from a global consulting firm. The data collection started two years after the implementation of the key account program. Data were collected on recently acquired customers (within the previous year) at two time periods: year 1 and year 3 (based on company access of data). Findings – Initially, key accounts perform as well or better than other types of accounts. However, in the long term, key accounts are less satisfied, less profitable and less beneficial for a firm’s growth than other types of accounts. Because the returns to key account expenditures, thus, appear mixed, firms should be cautious in expanding their key account strategies. Research limitations implications – The study contributes to research in three areas. First, most research on the effectiveness of key accounts refers to the between-firm level, whereas this study examines the effect within a single firm. Second, this study examines the temporal aspects of key accounts, namely, what happens to key accounts over time, in comparison with other accounts in a fairly large sample. Third, it considers the survival rates of key accounts versus other types of accounts. Practical implications – The authors suggest that firms also need to track their key accounts better because the results show that key accounts are less satisfied, less profitable and less beneficial for a firm’s growth than other types of accounts. Originality/value – Extant research has not examined these issues.

The importance of institutions in expansionary fiscal consolidations. A critical assessment of non-Keynesian effects

The short-term effects of fiscal consolidation have attracted an increasing attention from both the academia and policy makers in the recent years. Authors in the literature on non- Keynesian effects usually put the emphasis on the need for the devaluation of the national currency, the accommodating reaction of the monetary authority and the favourable international economic conditions as the necessary accompanying tools of fiscal consolidation, in order to realise short-term expansionary effects. Some also add the necessity of large-scale adjustment; while others support the view that a high and increasing debt ratio or increasing government spending, by triggering an unavoidable adjustment, is the key to experiencing short-term expansionary effects. The composition of adjustment also became a crucial explanation for non-Keynesian effects. However, as the following critical assessment of the literature on expansionary fiscal consolidations will reveal, institutional conditions, such as the importance of the depth of financial intermediation and the influencing role of labour market structure, can prove to be crucial in the occurrence of the desired expansionary short-term effects.

Valued occupational roles and life satisfaction among south Florida HIV-infected and non-infected homosexual males: An exploratory study

A study was conducted in order to describe and understand the occupational role behavior of gay men with particular interest on understanding the impact of an HIV diagnosis on their roles and life satisfaction. A 137-item questionnaire was developed for this study and distributed through various gay community groups in south Florida. The process resulted in ranked description of 24 valued occupational roles of gay men (n = 80) along with a general understanding of potential shifts that may occur in those roles as a result of becoming infected with HIV. The study concludes that a diagnosis of HIV infection impacts gay men both by altering their value for particular roles and by darkening the images they hold of their future. The study also identified key factors which may contribute to the greater life satisfaction of gay men including greater confidence in personal knowledge of HIV, a more optimistic outlook an life, the use of stronger coping styles, and perceiving stronger social support and lower stress. ^

Law Enforcement Actions in Urban Spaces Governed by Violent Non-State Entities: Lessons from Latin America

In response to a crime epidemic afflicting Latin America since the early 1990s, several countries in the region have resorted to using heavy-force police or military units to physically retake territories de facto controlled by non-State criminal or insurgent groups. After a period of territory control, the heavy forces hand law enforcement functions in the retaken territories to regular police officers, with the hope that the territories and their populations will remain under the control of the state. To a varying degree, intensity, and consistency, Brazil, Colombia, Mexico, and Jamaica have adopted such policies since the mid-1990s. During such operations, governments need to pursue two interrelated objectives: to better establish the state’s physical presence and to realign the allegiance of the population in those areas toward the state and away from the non-State criminal entities. From the perspective of law enforcement, such operations entail several critical decisions and junctions, such as: Whether or not to announce the force insertion in advance. The decision trades off the element of surprise and the ability to capture key leaders of the criminal organizations against the ability to minimize civilian casualties and force levels. The latter, however, may allow criminals to go to ground and escape capture. Governments thus must decide whether they merely seek to displace criminal groups to other areas or maximize their decapitation capacity. Intelligence flows rarely come from the population. Often, rival criminal groups are the best source of intelligence. However, cooperation between the State and such groups that goes beyond using vetted intelligence provided by the groups, such as a State tolerance for militias, compromises the rule-of-law integrity of the State and ultimately can eviscerate even public safety gains. Sustaining security after initial clearing operations is at times even more challenging than conducting the initial operations. Although unlike the heavy forces, traditional police forces, especially if designed as community police, have the capacity to develop trust of the community and ultimately focus on crime prevention, developing such trust often takes a long time. To develop the community’s trust, regular police forces need to conduct frequent on-foot patrols with intensive nonthreatening interactions with the population and minimize the use of force. Moreover, sufficiently robust patrol units need to be placed in designated beats for substantial amount of time, often at least over a year. Establishing oversight mechanisms, including joint police-citizens’ boards, further facilities building trust in the police among the community. After disruption of the established criminal order, street crime often significantly rises and both the heavy-force and community-police units often struggle to contain it. The increase in street crime alienates the population of the retaken territory from the State. Thus developing a capacity to address street crime is critical. Moreover, the community police units tend to be vulnerable (especially initially) to efforts by displaced criminals to reoccupy the cleared territories. Losing a cleared territory back to criminal groups is extremely costly in terms of losing any established trust and being able to recover it. Rather than operating on a priori determined handover schedule, a careful assessment of the relative strength of regular police and criminal groups post-clearing operations is likely to be a better guide for timing the handover from heavy forces to regular police units. Cleared territories often experience not only a peace dividend, but also a peace deficit – in the rise new serious crime (in addition to street crime). Newly – valuable land and other previously-inaccessible resources can lead to land speculation and forced displacement; various other forms of new crime can also significantly rise. Community police forces often struggle to cope with such crime, especially as it is frequently linked to legal business. Such new crime often receives little to no attention in the design of the operations to retake territories from criminal groups. But without developing an effective response to such new crime, the public safety gains of the clearing operations can be altogether lost.

The non-timber forest products sector in nepal : policy issues in plant conservation and utilization

The non-timber forest products (NTFPs) sector in Nepal is being promoted with the concept of sustainable management as articulated by the Convention on Biological Diversity. To promote and regulate this sector, Nepal adopted the Herbs and NTFP Development Policy in 2004. The goal of this thesis was to assess the effectiveness of this policy along with other forestry and natural resource policies in Nepal concerning the conservation and sustainable use of NTFPs. I conducted open-ended semi-structured interviews with 28 key informants in summer 2006 in Nepal where I also collected relevant documents and publications. I did qualitative analysis of data obtained from interviews and document review. The research found many important issues that need to be addressed to promote the NTFP sector as envisioned by the Government of Nepal. The findings of this research will help to further implement the policy and promote the NTFP sector through sustainable management practices.

Adaptive evolution of a key phytoplankton species to ocean acidification

Ocean acidification, the drop in seawater pH associated with the ongoing enrichment of marine waters with carbon dioxide from fossil fuel burning, may seriously impair marine calcifying organisms. Our present understanding of the sensitivity of marine life to ocean acidification is based primarily on short-term experiments, in which organisms are exposed to increased concentrations of CO2. However, phytoplankton species with short generation times, in particular, may be able to respond to environmental alterations through adaptive evolution. Here, we examine the ability of the world's single most important calcifying organism, the coccolithophore Emiliania huxleyi, to evolve in response to ocean acidification in two 500-generation selection experiments. Specifically, we exposed E. huxleyi populations founded by single or multiple clones to increased concentrations of CO2. Around 500 asexual generations later we assessed their fitness. Compared with populations kept at ambient CO2 partial pressure, those selected at increased partial pressure exhibited higher growth rates, in both the single- and multiclone experiment, when tested under ocean acidification conditions. Calcification was partly restored: rates were lower under increased CO2 conditions in all cultures, but were up to 50% higher in adapted compared with non-adapted cultures. We suggest that contemporary evolution could help to maintain the functionality of microbial processes at the base of marine food webs in the face of global change.

Key figure of mobility : The pedestrian

Peer reviewed

Accounting for residential and non-residential environments to measure contextual effects on health behavior : the case of recreational walking behavior

Thèse réalisée en cotutelle entre l'Université de Montréal et l'Université Pierre et Marie Curie, Paris 06, Sorbonne Universités.

Dissecting the Functional Impacts of Non-Coding Genetic Variation

A large proportion of the variation in traits between individuals can be attributed to variation in the nucleotide sequence of the genome. The most commonly studied traits in human genetics are related to disease and disease susceptibility. Although scientists have identified genetic causes for over 4,000 monogenic diseases, the underlying mechanisms of many highly prevalent multifactorial inheritance disorders such as diabetes, obesity, and cardiovascular disease remain largely unknown. Identifying genetic mechanisms for complex traits has been challenging because most of the variants are located outside of protein-coding regions, and determining the effects of such non-coding variants remains difficult. In this dissertation, I evaluate the hypothesis that such non-coding variants contribute to human traits and diseases by altering the regulation of genes rather than the sequence of those genes. I will specifically focus on studies to determine the functional impacts of genetic variation associated with two related complex traits: gestational hyperglycemia and fetal adiposity. At the genomic locus associated with maternal hyperglycemia, we found that genetic variation in regulatory elements altered the expression of the HKDC1 gene. Furthermore, we demonstrated that HKDC1 phosphorylates glucose in vitro and in vivo, thus demonstrating that HKDC1 is a fifth human hexokinase gene. At the fetal-adiposity associated locus, we identified variants that likely alter VEPH1 expression in preadipocytes during differentiation. To make such studies of regulatory variation high-throughput and routine, we developed POP-STARR, a novel high throughput reporter assay that can empirically measure the effects of regulatory variants directly from patient DNA. By combining targeted genome capture technologies with STARR-seq, we assayed thousands of haplotypes from 760 individuals in a single experiment. We subsequently used POP-STARR to identify three key features of regulatory variants: that regulatory variants typically have weak effects on gene expression; that the effects of regulatory variants are often coordinated with respect to disease-risk, suggesting a general mechanism by which the weak effects can together have phenotypic impact; and that nucleotide transversions have larger impacts on enhancer activity than transitions. Together, the findings presented here demonstrate successful strategies for determining the regulatory mechanisms underlying genetic associations with human traits and diseases, and value of doing so for driving novel biological discovery.

Dissolution of a spatially variable DNAPL (dense non aqueous phase liquid) source

Dissolution of non-aqueous phase liquids (NAPLs) or gases into groundwater is a key process, both for contamination problems originating from organic liquid sources, and for dissolution trapping in geological storage of CO2. Dissolution in natural systems typically will involve both high and low NAPL saturations and a wide range of pore water flow velocities within the same source zone for dissolution to groundwater. To correctly predict dissolution in such complex systems and as the NAPL saturations change over time, models must be capable of predicting dissolution under a range of saturations and flow conditions. To provide data to test and validate such models, an experiment was conducted in a two-dimensional sand tank, where the dissolution of a spatially variable, 5x5 cm**2 DNAPL tetrachloroethene source was carefully measured using x-ray attenuation techniques at a resolution of 0.2x0.2 cm**2. By continuously measuring the NAPL saturations, the temporal evolution of DNAPL mass loss by dissolution to groundwater could be measured at each pixel. Next, a general dissolution and solute transport code was written and several published rate-limited (RL) dissolution models and a local equilibrium (LE) approach were tested against the experimental data. It was found that none of the models could adequately predict the observed dissolution pattern, particularly in the zones of higher NAPL saturation. Combining these models with a model for NAPL pool dissolution produced qualitatively better agreement with experimental data, but the total matching error was not significantly improved. A sensitivity study of commonly used fitting parameters further showed that several combinations of these parameters could produce equally good fits to the experimental observations. The results indicate that common empirical model formulations for RL dissolution may be inadequate in complex, variable saturation NAPL source zones, and that further model developments and testing is desirable.

Energizing the Oak Ridges Moraine? Analyzing the Policy Implications of Three Wind Energy Developments on the Oak Ridges Moraine and their Potential Impact on the Coordinated Land Use Planning Review through the Involvement of First Nations and Environmental Non-governmental Organizations

This research explores the policy implications of the approval of three wind energy projects on the Oak Ridges Moraine, and their impact on the Coordinated Land Use Planning Review process. Specifically, it focuses on the involvement of First Nations and environmental non-governmental organizations (ENGOs). This research was conducted through analyzing submissions to the Coordinated Land Use Planning Review, related legislation and policy, Environmental Review Tribunal hearing documents, and interviews with key informants. This research culminates in a number of recommendations to the Coordinated Review informed by the analysis.

Audit of mathematics learning support in Ireland in 2015 – the key findings

In 2015 the Irish Mathematics Learning Support Network (IMLSN) commissioned a comprehensive audit of the extent and nature of mathematics learning support (MLS) provision on the island of Ireland. An online survey was sent to 32 institutions, including universities, institutes of technology, further education and teacher training colleges, and a 97% response rate was achieved. While the headline figure – 84% of institutions that responded to the survey provide MLS – sounds good, deeper analysis reveals that the true state of MLS is not so solid. For example, in 25% of institutions offering MLS, only five hours per week (at most) of physical MLS are available, while in 20% of institutions the service is provided by only one or two staff members. Furthermore, training of tutors is minimal or non-existent in at least half of the institutions offering MLS. The results provide an illuminating picture, however, identifying the true state of MLS in Ireland is beneficial only if it informs developments in the years ahead. This talk will present some of the findings of the survey in more depth along with conclusions and recommendations. Key among these is the need for institutions to recognise MLS as a vital element of mathematics teaching and learning strategy at third level and devote the necessary resources to facilitate the provision of a service which can grow and adapt to meet student requirements.