Naresuan University Journal
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An Exploration of Self-Care Practice and Self-Care Support Provision for Patients with Type 2 Diabetes in Malaysia
No full textBackground: A marked increase of type 2 diabetes and associated morbidity and mortality rate over the last 10 years has been recorded in Malaysia. Ineffective diabetes management and a lack of self-care practice among type 2 diabetic patients have been identified as the major reasons for this problem. Research in other countries has highlighted a range of factors influencing effective self-care of type 2 diabetes including patients' perspectives of diabetes, sociocultural issues, religious beliefs and support from healthcare. Nevertheless, there is paucity of research conducted in Malaysia. Therefore, the exploration of self-care practice and self-care support provision in patients with type 2 diabetes in Malaysia is needed to understand the problem.Aims: To understand the self-care practice of patients with type 2 diabetes in Malaysia and the factors that influence the patients' self-care practice. To understand the type 2 diabetes’ self-care support provision in Malaysia from the perspective of patients, healthcare professionals, and healthcare system.Methods: A qualitative, single embedded case study design was utilised. Eighteen patients with type 2 diabetes and 19 healthcare professionals (physicians, diabetes educators, nurse, pharmacist and dietician), involved in self-care support provision primary- and secondary-care settings in Kuala Lumpur and Putrajaya, Malaysia, participated in in-depth semi-structured interviews between November 2012 and June 2013. In addition, data were collected through participant-observation of clinic consultations, and analysis of relevant documents used in the provision of diabetes management in the respective clinics. The framework technique supported analysis of data. Data were stored and managed using Nvivo 9 software. Findings: The findings indicate that patients with type 2 diabetes had a good understanding of diabetes and self-care, but a lack of self-care support meant that effective self-care was difficult to sustain. Healthcare processionals’ (HCPs’) provision of self-care support was restricted due to several factors, including lack of opportunity to provide self-care support, unsuitable clinic environment and a fragmented management within primary and secondary care. Additionally, barriers in patient–HCP communication, a combination of the personal, interpersonal and inter-professional HCP factors, and traditional medical model adopted by Malaysian healthcare system, seem to have influenced the practice and quality of the service delivered. Conclusion: It is clear that the increased incidence of uncontrolled type 2 diabetes is not merely due to poor self-care practice by patients, but also due to constraint in service delivery and underdevelopment of self-care support provision. The evidence generated can assist in the development of strategies to improve the quality of care and facilitate changes in the self-care support provision in Malaysia
Carbon fibres with ordered graphitic-like aggregate structures from a regenerated cellulose fibre precursor
No full textThe production of carbon fibres is reported from regenerated cellulose fibres. They were heat treated at 200 °C and graphitised at a temperature of 2000 °C. Transmission Electron Microscope imaging reveals a sub-structure containing aggregates of oriented concentric turbostratic carbon domains, some of which are reminiscent of carbon nanotubes. These high strength fibres (1.5 GPa) could be possible alternatives to E-glass fibres (~30% lighter than E-glass) in low weight, high volume automotive and marine applications. It is also shown that the cellulose fibres can be converted in a woven precursor form to a carbon fibre fabric without the need to weave brittle filaments
Dominant Mutations in the Autoimmune Regulator AIRE Are Associated with Common Organ-Specific Autoimmune Diseases.
No full textThe autoimmune regulator (AIRE) gene is crucial for establishing central immunological tolerance and preventing autoimmunity. Mutations in AIRE cause a rare autosomal-recessive disease, autoimmune polyendocrine syndrome type 1 (APS-1), distinguished by multi-organ autoimmunity. We have identified multiple cases and families with mono-allelic mutations in the first plant homeodomain (PHD1) zinc finger of AIRE that followed dominant inheritance, typically characterized by later onset, milder phenotypes, and reduced penetrance compared to classical APS-1. These missense PHD1 mutations suppressed gene expression driven by wild-type AIRE in a dominant-negative manner, unlike CARD or truncated AIRE mutants that lacked such dominant capacity. Exome array analysis revealed that the PHD1 dominant mutants were found with relatively high frequency (>0.0008) in mixed populations. Our results provide insight into the molecular action of AIRE and demonstrate that disease-causing mutations in the AIRE locus are more common than previously appreciated and cause more variable autoimmune phenotypes
Re-constructing Dispute Settlement Mechanism in Trade and Investment Agreements: Key considerations for the PACER Plus Negotiating Parties
No full textTaking inspiration from the WTO dispute settlement system and the dispute settlement system established under the North American Free Trade Agreement (NAFTA), this paper will examine the relevance of disputes settlement mechanism in trade and investment agreements. In so doing, it will answer a fundamental question namely whether a single dispute settlement system should be established under PACER Plus or whether it would be necessary to establish a separate mechanism for settling trade disputes and another for investment disputes as is the case under NAFTA owing to the specificities of investment disputes
Using sense-making theory to aid understanding of the recognition, assessment and management of pain in patients with dementia in acute hospital settings.
No full textBACKGROUND: The recognition, assessment and management of pain in hospital settings is suboptimal, and is a particular challenge in patients with dementia. The existing process guiding pain assessment and management in clinical settings is based on the assumption that nurses follow a sequential linear approach to decision making. In this paper we re-evaluate this theoretical assumption drawing on findings from a study of pain recognition, assessment and management in patients with dementia. AIM: To provide a revised conceptual model of pain recognition, assessment and management based on sense-making theories of decision making. METHODS: The research we refer to is an exploratory ethnographic study using nested case sites. Patients with dementia (n=31) were the unit of data collection, nested in 11 wards (vascular, continuing care, stroke rehabilitation, orthopaedic, acute medicine, care of the elderly, elective and emergency surgery), located in four NHS hospital organizations in the UK. Data consisted of observations of patients at bedside (170h in total); observations of the context of care; audits of patient hospital records; documentary analysis of artefacts; semi-structured interviews (n=56) and informal open conversations with staff and carers (family members). FINDINGS: Existing conceptualizations of pain recognition, assessment and management do not fully explain how the decision process occurs in clinical practice. Our research indicates that pain recognition, assessment and management is not an individual cognitive activity; rather it is carried out by groups of individuals over time and within a specific organizational culture or climate, which influences both health care professional and patient behaviour. CONCLUSIONS: We propose a revised theoretical model of decision making related to pain assessment and management for patients with dementia based on theories of sense-making, which is reflective of the reality of clinical decision making in acute hospital wards. The revised model recognizes the salience of individual cognition as well as acknowledging that decisions are constructed through social interaction and organizational context. The model will be used in further research to develop decision support interventions to assist with the assessment and management of patients with dementia in acute hospital settings
Disentangling the Effects of Colocalizing Genomic Annotations to Functionally Prioritize Non-coding Variants within Complex-Trait Loci.
No full textIdentifying genomic annotations that differentiate causal from trait-associated variants is essential to fine mapping disease loci. Although many studies have identified non-coding functional annotations that overlap disease-associated variants, these annotations often colocalize, complicating the ability to use these annotations for fine mapping causal variation. We developed a statistical approach (Genomic Annotation Shifter [GoShifter]) to assess whether enriched annotations are able to prioritize causal variation. GoShifter defines the null distribution of an annotation overlapping an allele by locally shifting annotations; this approach is less sensitive to biases arising from local genomic structure than commonly used enrichment methods that depend on SNP matching. Local shifting also allows GoShifter to identify independent causal effects from colocalizing annotations. Using GoShifter, we confirmed that variants in expression quantitative trail loci drive gene-expression changes though DNase-I hypersensitive sites (DHSs) near transcription start sites and independently through 3' UTR regulation. We also showed that (1) 15%-36% of trait-associated loci map to DHSs independently of other annotations; (2) loci associated with breast cancer and rheumatoid arthritis harbor potentially causal variants near the summits of histone marks rather than full peak bodies; (3) variants associated with height are highly enriched in embryonic stem cell DHSs; and (4) we can effectively prioritize causal variation at specific loci
Theoretical and experimental study of self-reference intensity-modulated plastic fibre optic linear array displacement sensor
No full textA self-reference intensity-modulated plastic fibre optic displacement sensor of linear array configuration is presented in this paper. It consists of receivers categorised into two reference groups. The effect of the number of receivers in each reference group on the group and displacement ratio responses is investigated. Theoretical analysis, based on Gaussian beam model for multiple receivers at different offset distances, is presented. Simulation results that are based on the derived model are employed to study the ratio function for different reference groups. The predicted sensor performance, in terms of linear range and sensitivity, is verified by experiment. There is a very good agreement between the predicted and measured characteristics. The effects of the number of receivers in each reference group on linear operation range and sensitivity are compared and discussed. Both theoretical and experimental results show that the optimal linear array configuration is the (10,1) configuration. This configuration gives the best performance in terms of sensitivity and linear operational range and it is shown to have a linear sensitivity of 0.25 mm-1 with non-linearity error of less than 2.0% (without additional nonlinear compensation) within a linear operation range of 15 mm. In addition, the linear range of the optimal linear array (10,1) configuration is up to 10 times greater than existing plastic fibre configurations, and about 30 times greater than existing glass fibre configurations
