Enhanced diabetes care to patients of south Asian ethnic origin (the United Kingdom Asian Diabetes Study):a cluster randomised controlled trial

Background - Delivery of high-quality, evidence-based health care to deprived sectors of the community is a major goal for society. We investigated the effectiveness of a culturally sensitive, enhanced care package in UK general practices for improvement of cardiovascular risk factors in patients of south Asian origin with type 2 diabetes. Methods - In this cluster randomised controlled trial, 21 inner-city practices in the UK were assigned by simple randomisation to intervention (enhanced care including additional time with practice nurse and support from a link worker and diabetes-specialist nurse [nine practices; n=868]) or control (standard care [12 practices; n=618]) groups. All adult patients of south Asian origin with type 2 diabetes were eligible. Prescribing algorithms with clearly defined targets were provided for all practices. Primary outcomes were changes in blood pressure, total cholesterol, and glycaemic control (haemoglobin A1c) after 2 years. Analysis was by intention to treat. This trial is registered, number ISRCTN 38297969. Findings - We recorded significant differences between treatment groups in diastolic blood pressure (1·91 [95% CI -2·88 to -0·94] mm?Hg, p=0·0001) and mean arterial pressure (1·36 [-2·49 to -0·23] mm?Hg, p=0·0180), after adjustment for confounders and clustering. We noted no significant differences between groups for total cholesterol (0·03 [-0·04 to 0·11] mmol/L), systolic blood pressure (-0·33 [-2·41 to 1·75] mm?Hg), or HbA1c (-0·15% [-0·33 to 0·03]). Economic analysis suggests that the nurse-led intervention was not cost effective (incremental cost-effectiveness ratio £28?933 per QALY gained). Across the whole study population over the 2 years of the trial, systolic blood pressure, diastolic blood pressure, and cholesterol decreased significantly by 4·9 (95% CI 4·0–5·9) mm?Hg, 3·8 (3·2–4·4) mm?Hg, and 0·45 (0·40–0·51) mmol/L, respectively, and we recorded a small and non-significant increase for haemoglobin A1c (0·04% [-0·04 to 0·13]), p=0·290). Interpretation - We recorded additional, although small, benefits from our culturally tailored care package that were greater than the secular changes achieved in the UK in recent years. Stricter targets in general practice and further measures to motivate patients are needed to achieve best possible health-care outcomes in south Asian patients with diabetes. Funding - Pfizer, Sanofi-Aventis, Servier Laboratories UK, Merck Sharp & Dohme/Schering-Plough, Takeda UK, Roche, Merck Pharma, Daiichi-Sankyo UK, Boehringer Ingelheim, Eli Lilly, Novo Nordisk, Bristol-Myers Squibb, Solvay Health Care, and Assurance Medical Society UK.

Comparative risk of microalbuminuria and proteinuria in UK residents of south Asian and white European ethnic background with type 2 diabetes:a report from UKADS

Objective - This study investigated and compared the prevalence of microalbuminuria and overt proteinuria and their determinants in a cohort of UK resident patients of white European or south Asian ethnicity with type 2 diabetes mellitus. Research design and methods - A total of 1978 patients, comprising 1486 of south Asian and 492 of white European ethnicity, in 25 general practices in Coventry and Birmingham inner city areas in England were studied in a cross-sectional study. Demographic and risk factor data were collected and presence of microalbuminuria and overt proteinuria assessed. Main outcome measures - Prevalences of microalbuminuria and overt proteinuria. Results - Urinary albumin:creatinine measurements were available for 1852 (94%) patients. The south Asian group had a lower prevalence of microalbuminuria, 19% vs. 23% and a higher prevalence of overt proteinuria, 8% vs. 3%, X2?=?15.85, 2df, P?=?0.0004. In multiple logistic regression models, adjusted for confounding factors, significantly increased risk for the south Asian vs. white European patients for overt proteinuria was shown; OR (95% CI) 2.17 (1.05, 4.49), P?=?0.0365. For microalbuminuria, an interaction effect for ethnicity and duration of diabetes suggested that risk for south Asian patients was lower in early years following diagnosis; OR for SA vs. WH at durations 0 and 1 year were 0.56 (0.37, 0.86) and 0.59 (0.39, 0.89) respectively. After 20 years’ duration, OR?=?1.40 (0.63, 3.08). Limitations - Comparability of ethnicity defined groups; statistical methods controlled for differences between groups, but residual confounding may remain. Analyses are based on a single measure of albumin:creatinine ratio. Conclusions - There were significant differences between ethnicity groups in risk factor profiles and microalbuminuria and overt proteinuria outcomes. Whilst south Asian patients had no excess risk of microalbuminuria, the risk of overt proteinuria was elevated significantly, which might be explained by faster progression of renal dysfunction in patients of south Asian ethnicity.

Empirical research into white racialized identities in Britain

The intellectual project of using whiteness as an explicit tool of analysis is not one that has taken root in Britain. However, there are a number of empirical studies that investigate the racialization of white identities. In this article, I look at some empirical sociological fieldwork carried out on white identities in Britain since the early 1990s and identify the key themes arising. These themes are (in)visibility, norms and values, cultural capital and integration, contingent hierarchies and Empire in the present. In Britain, a pertinent distinction is between rural and urban settings for the enactment of white identities vis-a`-vis those of minorities, and there is an exploration of some of the contingency that draws the boundary between ‘white’ and ‘Other’ in different places. Areas of commonality and distinctiveness are noted in terms of the American work. In the last section, I argue that there are a number of issues to resolve around continuing such studies, including linking the micro-level to the macro-level analysis, and expanding to international comparative work.

Nonlinear spectral shaping and optical rogue events in fiber-based systems

We provide an overview of our recent work on the shaping and stability of optical continua in the long pulse regime. Fibers with normal group-velocity dispersion at all-wavelengths are shown to allow for highly coherent continua that can be nonlinearly shaped using appropriate initial conditions. In contrast, supercontinua generated in the anomalous dispersion regime are shown to exhibit large fluctuations in the temporal and spectral domains that can be controlled using a carefully chosen seed. A particular example of this is the first experimental observation of the Peregrine soliton which constitutes a prototype of optical rogue-waves.

Nonlinear pulse shaping in fibres for pulse generation and optical processing

The development of new all-optical technologies for data processing and signal manipulation is a field of growing importance with a strong potential for numerous applications in diverse areas of modern science. Nonlinear phenomena occurring in optical fibres have many attractive features and great, but not yet fully explored, potential in signal processing. Here, we review recent progress on the use of fibre nonlinearities for the generation and shaping of optical pulses and on the applications of advanced pulse shapes in all-optical signal processing. Amongst other topics, we will discuss ultrahigh repetition rate pulse sources, the generation of parabolic shaped pulses in active and passive fibres, the generation of pulses with triangular temporal profiles, and coherent supercontinuum sources. The signal processing applications will span optical regeneration, linear distortion compensation, optical decision at the receiver in optical communication systems, spectral and temporal signal doubling, and frequency conversion. © Copyright 2012 Sonia Boscolo and Christophe Finot.

Pulse shaping in mode-locked ring-cavity fibre lasers

By means of extensive numerical modelling we have demonstrated the possibility of nonlinear pulse shaping in a mode-locked fibre laser using control of the intra-cavity propagation dynamics by adjustment of the normal net dispersion and integrated gain. Beside self-similar mode-locking, the existence of a novel type of pulse shaping regime that produces pulses with a triangular temporal intensity profile and a linear frequency chirp has been observed.

Immigrant dislocated identities:Rachid Nini’s Diario de un ilegal

This article describes the process through which the subjectivity of the illegal immigrant is deconstructed and later reconstructed, as revealed by the Moroccan journalist and intellectual Rachid Nini in his book Diario de un ilegal/Diary of an Illegal Immigrant (2002), an account of the author's perils as an illegal immigrant in Spain. The analysis focuses firstly on the narrative form that Nini employs to give an account of his story, and secondly on the spatial displacement to which the subject and his subjectivity are exposed, which leads to the obliteration of his identity. The abrupt changes that the subject faces in a new location are paramount and impel him to a constant quest for self-definition and of negotiation with the new Other. Thus, the privileges that Nini enjoyed while in Morocco, those of a male journalist, poet, translator and intellectual with a university degree, disappear altogether once his plane has landed on the Canary Islands. In this new location, the place of origin and/or race are now what define his identity; he is now simply a moro - a Moor - he is not considered as an individual but, as will be shown, as a member of a homogenizing category which resists definition. The article finishes by addressing how Nini, in his quest to destroy homogenizing stereotypes, employs other stereotypes as though this were the only escape from the schizophrenic state the illegal immigrant identity had been forced into.

Grating design of oppositely chirped FBGs for pulse shaping

In this letter, we analyze and develop the required basis for a precise grating design in a scheme based on two oppositely chirped fiber Bragg gratings, and apply it in several examples which are numerically simulated. We obtain the interesting result that the broader bandwidth of the reshaped pulse, the shorter gratings required.

Critical approaches to care:understanding caring relations, identities and cutures

What does ‘care’ mean in contemporary society? How are caring relationships practised in different contexts? What resources do individuals and collectives draw upon in order to care for, care with and care about themselves and others? How do such relationships and practices relate to broader social processes? Care shapes people’s everyday lives and relationships and caring relations and practices influence the economies of different societies. This interdisciplinary book takes a nuanced and context-sensitive approach to exploring caring relationships, identities and practices within and across a variety of cultural, familial, geographical and institutional arenas. Grounded in rich empirical research and discussing key theoretical, policy and practice debates, it provides important, yet often neglected, international and cross-cultural perspectives. It is divided into four sections covering: caring within educational institutions; caring amongst communities and networks; caring and families; and caring across the life-course. Contributing to broader theoretical, philosophical and moral debates associated with the ethics of care, citizenship, justice, relationality and entanglements of power, Critical Approaches to Care is an important work for students and academics studying caring and care work in the fields of health and social care, sociology, social policy, anthropology, education, human geography and politics.

Respiratory function monitoring using a real-time three-dimensional fiber-optic shaping sensing scheme based upon fiber Bragg gratings

An array of in-line curvature sensors on a garment is used to monitor the thoracic and abdominal movements of a human during respiration. The results are used to obtain volumetric changes of the human torso in agreement with a spirometer used simultaneously at the mouth. The array of 40 in-line fiber Bragg gratings is used to produce 20 curvature sensors at different locations, each sensor consisting of two fiber Bragg gratings. The 20 curvature sensors and adjoining fiber are encapsulated into a low-temperature-cured synthetic silicone. The sensors are wavelength interrogated by a commercially available system from Moog Insensys, and the wavelength changes are calibrated to recover curvature. A three-dimensional algorithm is used to generate shape changes during respiration that allow the measurement of absolute volume changes at various sections of the torso. It is shown that the sensing scheme yields a volumetric error of 6%. Comparing the volume data obtained from the spirometer with the volume estimated with the synchronous data from the shape-sensing array yielded a correlation value 0.86 with a Pearson's correlation coefficient p <0.01.