Food insecurity in canadian adults receiving diabetes care

Purpose: The prevalence of adult-level household food insecurity was examined among clients receiving outpatient diabetes health care services. Methods: Participants were adults diagnosed with diabetes mellitus, who attended individual counselling sessions at Calgary's main clinic from January to April 2010. Clinicians were trained to administer the Household Food Security Survey Module (HFSSM), and did so with clients' assent during their scheduled sessions. Results: The prevalence of adult-level household food insecurity among 314 respondents was 15.0% (95% confidence interval [CI], 11.2 to 19.4); 6.7% (95% CI, 4.2 to 10.0) of clinic attendees were categorized as severely food insecure. The comparable rates obtained in Alberta in 2007 using the same instrument (HFSSM) were 5.6% and 1.2%, respectively. Conclusions: Household food insecurity rates among individuals with diabetes in active care are higher than rates reported in Canadian population surveys. Severe food insecurity, indicating reduced food intake and disrupted eating patterns, may affect this population's ability to follow a pattern of healthy eating necessary for effective diabetes management. This study reinforces the importance of assessing clients' inability to access food because of financial constraints, and indicates that screening with a validated measure may facilitate identification of clients at risk.     

Provision and quality of dialysis services in Libya

Dialysis is entirely funded by the public health care sector in Libya. Access to treatment is unrestricted for citizens but there is a lack of local information and no renal registry to gather national data. This cross-sectional study aimed to investigate dialysis provision and practice in Libyan dialysis facilities in 2009. A structured interview regarding dialysis capacity, staffing and methods of assessment of dialysis patients, and infection control measures was conducted with the medical directors of all 40 dialysis centers and 28 centers were visited. A total of 2417 adult patients were receiving maintenance dialysis in 40 centers, giving a population prevalence of approximately 624 per million. Most dialysis units were located in the northern part of the country and only 12.5% were free-standing units. Only three centers offered peritoneal dialysis. One hundred ninety-two hemodialysis rooms hosted 713 functioning hemodialysis stations, giving a ratio of one machine to 3.4 patients. Around half of centers operated only two dialysis shifts per day. Nephrologist/internist to patient ratio was 1:40 and nurse to patient ratio was 1:3.7. We found a wide variation in monitoring of dialysis patients, with dialysis adequacy assessed only in a minority. Separate rooms were allocated for chronic viral infection seropositive patients in 92.5% of the units. In general, the provision of dialysis is adequate but several areas for improvement have been identified, including a need for implementation of guidelines, recruitment of more nephrologists, and the development of more cost-effective alternatives such as peritoneal dialysis and transplantation.     

Nitrogen and potassium fertilizer vs. nematode and weevil effects on yield and foliar nutrient status of banana in Uganda

Banana (Musa AAA) production is declining in central Uganda. A decline in soil fertility is often cited as one of the causes of the declining production. From 1996 to 1998, we studied banana yield responses to N and K fertilization at three sites in Uganda, where plantations ranged in age from 8 to 50 years. Phosphorus was applied to all treatments at 25 kg ha⁻¹, while N and K were applied (kg ha⁻¹) at 0N-0K, 0N-100K, 100N-0K, 100N-100K, and 100N-200K. Fresh fruit yields ranged from 4 to 67 Mg ha⁻¹ yr⁻¹. At one site the yield response to 100N-100K fertilization was significant (p < 0.01). The other sites showed positive but non-significant yield responses to N or NK fertilization. Economic analysis indicated that fertilizer use would be profitable only at the single site with significant yield increases. This site had negligible banana weevil (Cosmopolites sordidus (Germar)) and nematode (Radopholus similis; Helicotylenchus multicinctus) populations whereas the other sites were characterized by either severe nematode or weevil pressure. Fertilizer did not affect the damage caused by either nematodes or weevils. The best predictor of yield (p< 0.001, r ² = 0.75) was the number of functional leaves during anthesis. Measured soil nutrient parameters were highly variable but fell within sufficiency ranges. Foliar N contents were near diagnostic norms, but K levels fell below them, even when yields were satisfactory, suggesting that norms developed from other regions may not be suitable for Uganda. We conclude that in established plantations soil nutrient status is but one, and often a secondary, factor in the decline of banana yields in the central region of Uganda. Pest and disease infestations that result in reduced plantation productivity will need to be addressed before fertilizer use is likely to make a significant improvement in banana fruit yields. This revised version was published online in June 2006 with corrections to the Cover Date.     

Study of residual elastic- and plastic-deformation in uniaxial tensile strained nickel-based Alloy 600 samples by polychromatic X-ray microdiffraction (PXM) and neutron diffraction methods

In order to assess the reliability of the relatively new polychromatic X-ray microdiffraction (PXM) method for measuring the magnitude and distribution of mechanical strains, PXM and the traditional technique—neutron diffraction measurements were made on the gauge section of an uniaxially 1% strained Alloy 600 tensile specimen and an unstressed sample of the same alloy. The average strain magnitudes for the grains analyzed by PXM were found to be similar with those measured from neutron diffraction within the large experimental uncertainty. Of particular interest was the behavior of dislocations in opposing grains across grain boundaries of differing orientations, which was studied by comparing the elongation and splitting of PXM spots. Similar dislocation densities, operating on the similar slip systems, were found on both sides of 60° boundaries, while considerable differences in the degree of elongation and splitting of diffraction spots occurred between grains with other misorientation angles.     

Developing a Traffic Closure Integrated Linear Schedule for Highway Rehabilitation Projects

In recent years, the state departments of transportation have implemented a number of highway rehabilitation projects across the country. These projects differ fundamentally from new highway projects in that they require an uninterrupted flow of traffic throughout both the duration and geometric length of the project. Synchronization of traffic closure with the construction activities is crucial in such projects to avoid the traffic conflicts and prevent idle time for equipment and labor. Although most highway rehabilitation projects involve predominantly linear activities, the techniques of linear scheduling are not readily applicable to highway rehabilitation projects due to the conflict between the workzone and traffic flow. This paper documents the development of a traffic closure integrated linear schedule (TCILS) that addresses both traffic closure and work progress issues. The TCILS generates a single schedule for both the construction activities and the associated traffic closures. Visual and graphical features are also applied in the system, which makes it particularly applicable for highway rehabilitation projects. An actual concrete pavement rehabilitation project using the TCILS is presented as a sample of application. The findings from the sample project, although they are limited, show that the TCILS can be applied to an actual project. With recommended future development, the system is believed to be beneficial for both construction practitioners and academics.     

Collection of daily patient reported outcomes is feasible and demonstrates differential patient experience in chronic kidney disease

Introduction: Patient reported outcomes (PROs) are a critical metric documenting the impact of disease and treatment from the patient's perspective. A variety of generic and disease specific PRO measures (PROMs) are used in chronic kidney disease (CKD) but studies are primarily cross‐sectional. None of the available PROMs are designed for frequent iterative application. Methods: An online PROM for daily use in dialysis and CKD 4/5 patients was developed. The custom website utilised visual analogue scales to capture 6 PROs (general well being (GWB), pain, sleep, breathing, energy, and appetite). Outcomes of interest were uptake, response rates, intermodality variation, and change in PRO corresponding to predefined events. Findings: Forty‐three patients submitted at least once and 34 submitted beyond 30 days. Median follow‐up was 247 days, 64% male, age 62 ± 12 years. In individuals submitting for >30 days, dialysis patients had significantly worse median scores compared to CKD for sleep (47[32–80], 97[76–99], P = 0.003), appetite (66[50–96], 97[88–100], P = 0.008), energy (47[40–89], 84[67–96], P = 0.031), and GWB (63[49–94], 93[71–98], P = 0.026). Patients demonstrated a variety of stable bandwidths of response, deviations from this were associated with specific events e.g., acute admission, vascular procedures, disturbed fluid status, and dialysis start. Discussion: We successfully introduced an online, patient acceptable, iterative PROM that discriminates symptom burden, cross‐sectionally, and longitudinally. Further work will prospectively examine the predictive power of changes in PRO and more rigorously investigate the potential use of these methods to optimise patient care.     

Cervicothoracic vascular injuries

Arterial and venous trauma of the cervicothoracic region continues to present challenging problems for the surgeon, despite advances in vascular diagnostics and surgical technique. Whether due to penetrating or blunt mechanisms, overall incidence of these injuries is low, whereas morbidity and mortality remain high. Despite collective experience from busy trauma centers, there still remain controversies regarding diagnostic evaluation, operative approach, and surgical treatment of these potentially devastating injuries. Therefore, this article compares and contrasts recent literature and controversies surrounding the treatment of cervicothoracic trauma. Pros and cons of duplex ultrasonography and angiography in the diagnosis of carotid and vertebral artery injury are highlighted, and selective versus mandatory neck exploration for zone II penetrating injuries are discussed. Increasing awareness of blunt carotid artery injury is emphasized, including management dilemmas that frequently accompany this type of injury. In addition, we review interventional radiological techniques for the management of vertebral artery injury and surgical approaches for aortic arch branch vessel or major cervicothoracic vein injury.