Self-management support for chronic disease in primary care: frequency of patient self-management problems and patient reported priorities, and alignment with ultimate behavior goal selection.

BackgroundTo enable delivery of high quality patient-centered care, as well as to allow primary care health systems to allocate appropriate resources that align with patients' identified self-management problems (SM-Problems) and priorities (SM-Priorities), a practical, systematic method for assessing self-management needs and priorities is needed. In the current report, we present patient reported data generated from Connection to Health (CTH), to identify the frequency of patients' reported SM-Problems and SM-Priorities; and examine the degree of alignment between patient SM-Priorities and the ultimate Patient-Healthcare team member selected Behavioral Goal.MethodsCTH, an electronic self-management support system, was embedded into the flow of existing primary care visits in 25 primary care clinics and was used to assess patient-reported SM-Problems across 12 areas, patient identified SM-Priorities, and guide the selection of a Patient-Healthcare team member selected Behavioral Goal. SM-Problems included: BMI, diet (fruits and vegetables, salt, fat, sugar sweetened beverages), physical activity, missed medications, tobacco and alcohol use, health-related distress, general life stress, and depression symptoms. Descriptive analyses documented SM-Problems and SM-Priorities, and alignment between SM-Priorities and Goal Selection, followed by mixed models adjusting for clinic.Results446 participants with ≥ one chronic diseases (mean age 55.4 ± 12.6; 58.5% female) participated. On average, participants reported experiencing challenges in 7 out of the 12 SM-Problems areas; with the most frequent problems including: BMI, aspects of diet, and physical activity. Patient SM-Priorities were variable across the self-management areas. Patient- Healthcare team member Goal selection aligned well with patient SM-Priorities when patients prioritized weight loss or physical activity, but not in other self-management areas.ConclusionParticipants reported experiencing multiple SM-Problems. While patients show great variability in their SM-Priorities, the resulting action plan goals that patients create with their healthcare team member show a lack of diversity, with a disproportionate focus on weight loss and physical activity with missed opportunities for using goal setting to create targeted patient-centered plans focused in other SM-Priority areas. Aggregated results can assist with the identification of high frequency patient SM-Problems and SM-Priority areas, and in turn inform resource allocation to meet patient needs.Trial registrationClinicalTrials.gov ID: NCT01945918

Theory-based predictors of multiple clinician behaviors in the management of diabetes

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Contemplating Mindfulness at Work: An Integrative Review

Mindfulness research activity is surging within organizational science. Emerging evidence across multiple fields suggests that mindfulness is fundamentally connected to many aspects of workplace functioning, but this knowledge base has not been systematically integrated to date. This review coalesces the burgeoning body of mindfulness scholarship into a framework to guide mainstream management research investigating a broad range of constructs. The framework identifies how mindfulness influences attention, with downstream effects on functional domains of cognition, emotion, behavior, and physiology. Ultimately, these domains impact key workplace outcomes, including performance, relationships, and well-being. Consideration of the evidence on mindfulness at work stimulates important questions and challenges key assumptions within management science, generating an agenda for future research

A Randomized Controlled Trial of Device Guided, Slow-Paced Respiration in Women with Overactive Bladder Syndrome.

PurposeWe evaluated the effects of device guided, slow-paced respiration on urgency associated urinary symptoms, perceived stress and anxiety, and autonomic function in women with overactive bladder syndrome.Materials and methodsWe performed a randomized, parallel group trial of slow-paced respiration to improve perceived stress and autonomic dysfunction as potential contributors to overactive bladder. Ambulatory women who reported at least 3 voiding or incontinence episodes per day associated with moderate to severe urgency were randomized to use a portable biofeedback device to practice daily, slow, guided breathing exercises or a control device which appeared identical and was reprogrammed to play music without guiding breathing. During 12 weeks we evaluated changes in urinary symptoms by voiding diaries, perceived stress and anxiety by validated questionnaires, and autonomic function by heart rate variability and impedance cardiography.ResultsIn the 161 randomized participants, including 79 randomized to paced respiration and 82 randomized to the control group, the average ± SD baseline frequency of voiding or incontinence associated with moderate to severe urgency was 6.9 ± 3.4 episodes per day. Compared to controls the participants randomized to paced respiration demonstrated greater improvement in perceived stress (average Perceived Stress Scale score decrease 2.8 vs 1.1, p=0.03) but not in autonomic function markers. During 12 weeks the average frequency of voiding or incontinence associated with moderate to severe urgency, which was the study primary outcome, decreased by a mean of 0.9 ± 3.2 episodes per day but no significant between group difference was detected.ConclusionsAmong women with overactive bladder slow-paced respiration was associated with a modest improvement in perceived stress during 12 weeks. However, it was not superior to a music listening control for reducing urinary symptoms or changing autonomic function

Addressing Risk and Uncertainty in Water Quality Trading Markets

Across the United States, water quality trading is being explored as a mechanism for reducing the costs of cleaning up impaired waterbodies. Trading between point sources, such as wastewater treatment plants, and nonpoint sources, such as agriculture, can cut costs for regulated entities needing to reduce pollutants, and generate revenue for agricultural producers who generate credits. However, water quality trading, particularly between point and nonpoint sources, can face inherent uncertainties around quantification of nonpoint source reductions, participant behavior, regulations, and market supply and demand. Effectively addressing uncertainties is crucial to ensuring the success of these markets and improving water quality. This paper establishes a framework from which to engage federal and state agencies, program developers, and stakeholders in a dialogue about these uncertainties and appropriate mechanisms for addressing them

Evaluating the roles of directed breeding and gene flow in animal domestication

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Quantifying fisher responses to environmental and regulatory dynamics in marine systems

Thesis (Ph.D.) University of Alaska Fairbanks, 2017Commercial fisheries are part of an inherently complicated cycle. As fishers have adopted new technologies and larger vessels to compete for resources, fisheries managers have adapted regulatory structures to sustain stocks and to mitigate unintended impacts of fishing (e.g., bycatch). Meanwhile, the ecosystems that are targeted by fishers are affected by a changing climate, which in turn forces fishers to further adapt, and subsequently, will require regulations to be updated. From the management side, one of the great limitations for understanding how changes in fishery environments or regulations impact fishers has been a lack of sufficient data for resolving their behaviors. In some fisheries, observer programs have provided sufficient data for monitoring the dynamics of fishing fleets, but these programs are expensive and often do not cover every trip or vessel. In the last two decades however, vessel monitoring systems (VMS) have begun to provide vessel location data at regular intervals such that fishing effort and behavioral decisions can be resolved across time and space for many fisheries. I demonstrate the utility of such data by examining the responses of two disparate fishing fleets to environmental and regulatory changes. This study was one of "big data" and required the development of nuanced approaches to process and model millions of records from multiple datasets. I thus present the work in three components: (1) How can we extract the information that we need? I present a detailed characterization of the types of data and an algorithm used to derive relevant behavioral aspects of fishing, like the duration and distances traveled during fishing trips; (2) How do fishers' spatial behaviors in the Bering Sea pollock fishery change in response to environmental variability; and (3) How were fisher behaviors and economic performances affected by a series of regulatory changes in the Gulf of Mexico grouper-tilefish longline fishery? I found a high degree of heterogeneity among vessel behaviors within the pollock fishery, underscoring the role that markets and processor-level decisions play in facilitating fisher responses to environmental change. In the Gulf of Mexico, my VMS-based approach estimated unobserved fishing effort with a high degree of accuracy and confirmed that the regulatory shift (e.g., the longline endorsement program and catch share program) yielded the intended impacts of reducing effort and improving both the economic performance and the overall harvest efficiency for the fleet. Overall, this work provides broadly applicable approaches for testing hypotheses regarding the dynamics of spatial behaviors in response to regulatory and environmental changes in a diversity of fisheries around the world.General introduction -- Chapter 1 Using vessel monitoring system data to identify and characterize trips made by fishing vessels in the United States North Pacific -- Chapter 2 Paths to resilience: Alaska pollock fleet uses multiple fishing strategies to buffer against environmental change in the Bering Sea -- Chapter 3 Vessel monitoring systems (VMS) reveal increased fishing efficiency following regulatory change in a bottom longline fishery -- General Conclusions