Abstract
Background
Diabetes distress is a commonly experienced negative emotional response to the ongoing burden of diabetes. Holistic diabetes care, including attention to diabetes distress, is ...recommended in clinical guidelines, yet not routinely implemented. Diabetes health professionals have highlighted lack of training as a barrier to implementation of psychological care. Therefore, we developed an e-learning: ‘Diabetes distress e-learning: A course for diabetes educators’ to address this need. This pilot study aimed to examine the feasibility of evaluating the e-learning in a randomised controlled trial study, the acceptability of the e-learning to credentialled diabetes educators (CDEs); and preliminary evidence of its effect upon CDEs’ diabetes distress-related knowledge, motivation, confidence, behavioural skills, and barriers to implementation.
Methods
A pilot, unblinded, 2-armed, parallel group randomised controlled trial. Participants were recruited during a 4-month timeframe. Eligible participants were CDEs for ≥ 1 year providing care to ≥ 10 adults with type 1 or type 2 diabetes per week. Participants were randomly allocated (1:1 computer automated) to 1 of 2 learning activities: diabetes distress e-learning (intervention) or diabetes distress chapter (active control). They had 4 weeks to access the activity. They completed online surveys at baseline, 2-week and 12-week follow-up.
Results
Seventy-four eligible CDEs (36 intervention, 38 active control) participated. At baseline, recognition of the clinical importance of diabetes distress was high but knowledge and confidence to provide support were low-to-moderate. Engagement with learning activities was high (intervention: 83%; active control: 92%). Fifty-five percent returned at least 1 follow-up survey. All 30 intervention participants who returned the 2-week follow-up survey deemed the e-learning high quality and relevant. Systemic barriers (e.g., financial limitations and access to mental health professionals) to supporting people with diabetes distress were common at baseline and follow-up.
Conclusions
The e-learning was acceptable to CDEs. The study design was feasible but needs modification to improve follow-up survey return. The e-learning showed potential for improving diabetes distress-related knowledge, confidence and asking behaviours, but systemic barriers to implementation remained. Systemic barriers need to be addressed to facilitate implementation of support for diabetes distress in clinical practice. Future larger-scale evaluation of the e-learning is warranted.
The global variability in nickel (Ni) isotope compositions in ferromanganese crusts is investigated by analysing surface samples of 24 crusts from various ocean basins by MC–ICPMS, using a ...double-spike for mass bias correction. Ferromanganese crusts have δNi60 isotopic compositions that are significantly heavier than any other samples thus far reported (−0.1‰ to 0.3‰), with surface scrapings ranging between 0.9‰ and 2.5‰ (relative to NIST SRM986). There is no well resolved difference between ocean basins, although the data indicate somewhat lighter values in the Atlantic than in the Pacific, nor is there any evidence that the variations are related to biological fractionation, presence of different water masses, or bottom water redox conditions. Preliminary data for laterite samples demonstrate that weathering is accompanied by isotopic fractionation of Ni, which should lead to rivers and seawater being isotopically heavy. This is consistent with the slightly heavier than average isotopic compositions recorded in crusts that are sampled close to continental regions. Furthermore, the isotopic compositions of crusts growing close to a hydrothermal source are clustered around ∼1.5‰, suggesting that hydrothermal fluids entering the ocean may have a Ni isotopic composition similar to this value. Based on these data, the heavy Ni isotopic compositions of ferromanganese crusts are likely due to input of isotopically heavy Ni to the ocean from continental weathering and possibly also from hydrothermal fluids. A depth profile through one crust, CD29-2, from the north central Pacific Ocean displays large variations in Ni isotope composition (1.1–2.3‰) through the last 76Myr. Although there may have been some redistribution of Ni associated with phosphatisation, there is no systematic difference in Ni isotopic composition between deeper, older parts and shallower, younger parts of the crust, which may suggest that oceanic sources and sinks of Ni have largely remained in steady state over the Cenozoic. Additionally, the isotope profile is in agreement with a profile of Mn concentration through the same crust. This implies a link between the Ni isotopic composition recorded in ferromanganese crusts and the release of Ni into the ocean through hydrothermal activity. This supports the conclusions drawn from surface data, that Ni isotope ratios in ferromanganese crusts are largely controlled by the isotopic compositions of the Ni oceanic input sources.
•This is the first study of Ni isotope ratios in ferromanganese crusts.•Crusts are isotopically heavy relative to all other geological samples studied so far.•This is most likely due to input of isotopically heavy inputs of Ni to the ocean.•No changes in sources or fractionations affecting Ni inputs over the Cenozoic.
We present new mass independent and mass dependent Cr isotope compositions for meteorites measured by double spike thermal ionisation mass spectrometry. Small differences in both mass independent ...53Cr and 54Cr relative to the Bulk Silicate Earth are reported and are very similar to previously published values. Carbonaceous chondrites are characterised by an excess in 54Cr compared to ordinary and enstatite chondrites which make mass independent Cr isotopes a useful tool for distinguishing between meteoritic groups. Mass dependent stable Cr isotope compositions for the same samples are also reported. Carbonaceous and ordinary chondrites are identical within uncertainty with average δ53Cr values of −0.118±0.040‰ and −0.143±0.074‰ respectively. The heaviest isotope compositions are recorded by an enstatite chondrite and a CO carbonaceous chondrite, both of which have relatively reduced chemical compositions implying some stable Cr isotope fractionation related to redox processes in the circumstellar disk. The average δ53Cr values for chondrites are within error of the estimate for the Bulk Silicate Earth (BSE) also determined by double spiking. The lack of isotopic difference between chondritic material and the BSE provides evidence that Cr isotopes were not fractionated during core formation on Earth. A series of high-pressure experiments was also carried out to investigate stable Cr isotope fractionation between metal and silicate and no demonstrable fractionation was observed, consistent with our meteorites data. Mass dependent Cr isotope data for achondrites suggest that Cr isotopes are fractionated during magmatic differentiation and therefore further work is required to constrain the Cr isotopic compositions of the mantles of Vesta and Mars.
•We report high precision mass dependent Cr isotope variations in meteorites.•The average δ53Cr values for chondrites are within error of the Bulk Silicate Earth.•There is no equilibrium fractionation between metal and silicate during HP–HT experiments.•Cr isotopes are not fractionated during core formation on Earth.
Recommendations for screening patients with lower-extremity arterial disease (LEAD) to detect asymptomatic carotid stenosis (ACS) are conflicting. Prediction models might identify patients at high ...risk of ACS, possibly allowing targeted screening to improve preventive therapy and compliance.
A systematic search for prediction models for at least 50 per cent ACS in patients with LEAD was conducted. A prediction model in screened patients from the USA with an ankle : brachial pressure index of 0.9 or less was subsequently developed, and assessed for discrimination and calibration. External validation was performed in two independent cohorts, from the UK and the Netherlands.
After screening 4907 studies, no previously published prediction models were found. For development of a new model, data for 112 117 patients were used, of whom 6354 (5.7 per cent) had at least 50 per cent ACS and 2801 (2.5 per cent) had at least 70 per cent ACS. Age, sex, smoking status, history of hypercholesterolaemia, stroke/transient ischaemic attack, coronary heart disease and measured systolic BP were predictors of ACS. The model discrimination had an area under the receiver operating characteristic (AUROC) curve of 0.71 (95 per cent c.i. 0.71 to 0.72) for at least 50 per cent ACS and 0.73 (0.72 to 0.73) for at least 70 per cent ACS. Screening the 20 per cent of patients at greatest risk detected 12.4 per cent with at least 50 per cent ACS (number needed to screen (NNS) 8 and 5.8 per cent with at least 70 per cent ACS (NNS 17). This yielded 44.2 and 46.9 per cent of patients with at least 50 and 70 per cent ACS respectively. External validation showed reliable discrimination and adequate calibration.
The present risk score can predict significant ACS in patients with LEAD. This approach may inform targeted screening of high-risk individuals to enhance the detection of ACS.
Ferromanganese crusts provide records of long term change in ocean circulation and continental weathering. However, calibrating their age prior to 10 Ma has been entirely based on empirical growth ...rate models using Co concentrations, which have inherently large uncertainties and fail to detect hiatuses and erosional events. We present a new method for dating these crusts by measuring their osmium (Os) isotope record and matching it to the well-known marine Os isotope evolution of the past 80 Ma. The well-characterised crust CD29-2 from the central Pacific, was believed to define a record of paleooceanographic change from 50 Ma. Previous growth rate estimates based on the Co method are consistent with the new Os isotope stratigraphy but the dating was grossly inaccurate due to long hiatuses that are now detectable. The new chronology shows that it in fact started growing prior to 70 Ma in the late Cretaceous and stopped growing or was eroded between 13.5 and 47 Ma. With this new technique it is now possible to exploit the full potential of the oceanographic and climatic records stored in Fe–Mn crusts.
Background
The efficacy of biologic therapies is greater among biologic‐naïve vs. biologic‐experienced psoriasis patients. However, little is known as to whether prior use of other systemic therapies ...impacts secukinumab efficacy in patients with moderate‐to‐severe psoriasis.
Objective
To investigate the impact of prior exposure to systemic therapies upon the efficacy and safety of secukinumab 300 mg for moderate‐to‐severe psoriasis.
Methods
Post hoc analysis of six randomised controlled trials (RCTs) comparing secukinumab with placebo, ustekinumab or etanercept at 12 weeks of treatment. Data comparing secukinumab with placebo and ustekinumab were meta‐analysed, while comparisons between secukinumab and etanercept were from a single RCT. Four subgroups of patients were assessed: (i) naïve to non‐biologic systemics (NBS) and biologics; (ii) exposed to NBS but naïve to biologics; (iii) naïve to NBS but exposed to biologics; and (iv) exposed to NBS and biologics. Outcomes of interest included the following: investigator’s global assessment (IGA) score, absolute psoriasis area and severity index (PASI) response, PASI 75, PASI 90 and PASI 100 responses, and dermatology life quality index (DLQI). Safety was also assessed.
Results
One thousand three hundred and eighty‐three patients were included in the secukinumab vs. placebo meta‐analysis: 1776 in the secukinumab vs. ustekinumab meta‐analysis and 653 in the within‐trial analyses of secukinumab vs. etanercept. For all subgroups, secukinumab was significantly more efficacious than placebo for all outcomes measured. Secukinumab generated greater responses in biologic‐naïve patients, while prior NBS had a negligible impact on treatment response. Furthermore, secukinumab was more efficacious than both ustekinumab and etanercept on many outcomes, with an even greater difference for biologic‐naïve than biologic‐exposed patients. Safety results were consistent with individual clinical trial results.
Conclusions
Twelve‐week treatment with secukinumab 300 mg is consistently more efficacious than placebo, etanercept and ustekinumab in patients with moderate‐to‐severe psoriasis, regardless of prior exposure to biologics or NBS. Secukinumab had a comparable safety profile to both etanercept and ustekinumab.
The iron (Fe) isotope compositions of 37 hydrogenetic ferromanganese deposits from various oceans have been analysed by MC-ICPMS; they permit the construction of a global map of Fe isotopic values. ...The isotopic compositions range between -1.2 and -0.1 in delta super(57)Fe sub(IRMM14). Averages for the Atlantic and the Pacific are -0.41 and -0.88, but their standard deviations are identical (0.27, 1 capital sigma ) and the data very largely overlap. No correlation is found with Pb or Nd isotope compositions and there is no evidence that the observed oceanic Fe isotopic heterogeneity is directly controlled by variations in continental sources. The small quantities of Fe that can be introduced from hydrothermal sources render as unlikely the possibility that the isotopic variations reflect variable proportions of continental and hydrothermal Fe, as recently proposed. The more likely explanation is that the variations are induced locally within the ocean. The exact sources of fractionation remain unclear. Likely possibilities are the dissolution and reprecipitation processes that liberate Fe from sediments during anoxic events, dissolution in surface waters or processes occurring during growth of the crusts.
The degree to which efficient mixing of new material or losses of earlier accreted material to space characterize the growth of Earth-like planets is poorly constrained and probably changed with ...time. These processes can be studied by parallel modelling of data from different radiogenic isotope systems. The tungsten isotope composition of the silicate Earth yields a model timescale for accretion that is faster than current estimates based on terrestrial lead and xenon isotope data and strontium, tungsten and lead data for lunar samples. A probable explanation for this is that impacting core material did not always mix efficiently with the silicate portions of the Earth before being added to the Earth's core. Furthermore, tungsten and strontium isotope compositions of lunar samples provide evidence that the Moon-forming impacting protoplanet Theia was probably more like Mars, with a volatile-rich, oxidized mantle. Impact-driven erosion was probably a significant contributor to the variations in moderately volatile element abundance and oxidation found among the terrestrial planets.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Angrites are amongst the oldest basalts in the solar system and their origins are enigmatic, some even proposing the planet Mercury as the parent body (APB). Whatever their exact provenance their ...chronometry provides insights into early stages of planetary melting and differentiation. We present the first high-precision internal
182Hf–
182W isochrons for such early differentiated objects. Angrites Sahara 99555, D'Orbigny, and Northwest Africa 2999 define ages of 5.1
±
1.3 Ma, 4.7
±
1.3 Ma and 9.5
±
3.3 Ma respectively after formation of calcium–aluminum-rich refractory inclusions (CAIs). These data are in good agreement with
26Al–
26Mg,
53Mn–
53Cr and most
207Pb–
206Pb ages for other angrites and provide evidence for two texturally and temporally well-resolved groups. The quenched angrites (SAH 99555, D'Orbigny and five others) have a weighted mean age of 4562.1
±
0.4 Ma and are the products of igneous crystallization on the APB ∼
5 Ma after the formation of CAIs, whereas the more slowly cooled angrites (NWA 2999, Angra dos Reis, LEW 86010, average age: 4557.7
±0.2 Ma) reflect metamorphic closure ∼
5 Ma later following second reheating process or a complex cooling history. The concordance obtained between various short-lived chronometers provides evidence that
26Al,
53Mn and
182Hf were homogeneously distributed in the solar nebula, although we cannot rule out the possibility of local small heterogeneities. Contrary to recent proposals, the data are also consistent with the previously determined age of the solar system based on
207Pb–
206Pb systematics of CAIs. The Hf–W data are discussed in the context of two endmember models for the early differentiation of the angrite parent body. In the first model, core formation occurred at 3–4 Ma after CAIs and both groups of angrites formed by two distinct partial melting events from the bulk mantle of the angrite parent body. In the second model, the angrite parent body underwent progressive core formation with an increasing degree of W-depletion over time. In this model, the two groups of angrites derive from distinct reservoirs. The heat sources responsible for such late melting and core formation are unclear. Quenched angrites are coeval with non-magmatic IAB iron meteorites and CB chondrules at ∼
4562 Ma. However, demonstration of a genetic link between angrite melting and impact events must await the acquisition of still higher resolution chronometry.
This book is about the use of language in the science classroom. It discusses the evolution of scientific discourse for learning in secondary schools, and examines the form and function of language ...across a variety of levels including lexiogrammar, discourse semantics, register, genre and ideology. Special attention is paid to how this knowledge is imparted. It will be of particular interest to educators involved with linguistics and/or science curriculum and teachers of English for special and academic purposes.; It is aimed at teachers of undergraduates in science and literacy, linguists teaching in English for special and academic purposes and students in higher education with an interest in science and literacy.
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