Text Message Intervention for Latino Adults To Improve Diabetes Outcomes in an Urban Free Clinic Setting

Introduction: This text message intervention sought to help patients at a free clinic in the Southeastern U.S. that have uncontrolled diabetes (DM) (A1C \u3e or = 7) improve their DM clinical and behavioral outcomes, and thereby help them to live healthier, more hopeful and productive lives as they deal daily with this chronic illness. Eight weeks of educational text messages were sent to help improve DM care and outcomes. Method: Free clinic patient Latino adults with DM (n=25) pre-post one group design. Results: Statistically significant results (p \u3c .05) were seen in three (SKILLD, p=.001, DSES, p = .000, and SDSCA, p = .042) of the four tools/surveys administered. A1C improvements were significant from the pre-intervention (M = 9.10, SD = 1.51) and the trended post-intervention values/results (M=8.26, SD = 1.29, t [21] = 2.79, p = .0110). Discussion: Does personalized communication, education and follow up for patients at the free clinic improve diabetes knowledge, self-efficacy and self-care? This text message intervention shows great promise to improve outcomes for diabetes self-management

A Rigorous Evaluation of Family Finding in North Carolina

Child Trends evaluated Family Finding services in nine North Carolina counties through a rigorous impact evaluation and an accompanying process study. The impact evaluation involved random assignment of eligible children to a treatment or control group. The treatment group received Family Finding services in addition to traditional child welfare services, whereas the control group received traditional child welfare services only. Eligible children were in foster care; were 10 or older at the time of referral; did not have a goal of reunification; and lacked an identified permanent placement. The accompanying process study examined program outputs, outcomes, and linkages between the project components and other contextual factors

Submarine eruption-fed and resedimented pumice-rich facies: the Dogashima Formation (Izu Peninsula, Japan)

In the Izu Peninsula (Japan), the Pliocene pumice-rich Dogashima Formation (4.55?±?0.87 Ma) displays exceptional preservation of volcaniclastic facies that were erupted and deposited in a below wave-base marine setting. It includes high-concentration density current deposits that contain clasts that were emplaced hot, indicating an eruption-fed origin. The lower part of the Dogashima 2 unit consists of a very thick sequence (&lt;12 m) of massive grey andesite breccia restricted to the base of a submarine channel, gradationally overlain by pumice breccia, which is widespread but much thinner and finer in the overbank setting. These two breccias share similar mineralogy and crystal composition and are considered to be co-magmatic and derived from the destruction of a submarine dome by an explosive, pumice-forming eruption. The two breccias were deposited from a single, explosive eruption-fed, sustained, sea floor-hugging, water-supported, high-concentration density current in which the clasts were sorted according to their density. At the rim of the channel, localised good hydraulic sorting of clasts and stratification in the pumice breccia are interpreted to reflect local current expansion and unsteadiness rather than to be the result of hydraulic sorting of clasts during fall from a submarine eruption column and/or umbrella plume. A bimodal coarse (&gt;1 m) pumice- and ash-rich bed overlying the breccias may be derived from delayed settling of pyroclasts from suspension. In Dogashima 1 and 2, thick cross- and planar-bedded facies composed of sub-rounded pumice clasts are intercalated with eruption-fed facies, implying inter-eruptive mass-wasting on the flank of a submarine volcano, and reworking and resedimentation by high-energy tractional currents in a below wave-base environment.<br/

Decrease in health-related quality of life associated with awareness of hepatitis C virus infection among people who inject drugs in Scotland

Chronic hepatitis C virus (HCV) infection can significantly reduce health-related quality of life (QoL), but it is not clear if reduction is associated with the infection or with being aware of one's infection status. Understanding the impact of a HCV diagnosis on QoL is essential to inform decision-making regarding screening/testing and treatment. Using a cross-sectional design, we assessed QoL in 2898 people who inject drugs (PWID), surveyed in Scotland during 2010 using EQ-5D. Multifactorial regression compared self-reported QoL between PWID who were (i) chronically HCV-infected and aware of their infected status, (ii) chronically HCV-infected but unaware, and (iii) not chronically infected. Median time since onset of injecting was 10years; not chronically infected PWID were younger and had shorter injecting careers than chronically infected PWID. Median EQ-5D was highest for the not chronically infected and the chronic/unaware groups (0.73) compared with the chronic/aware group (0.66). After adjustment for demographic and behavioural co-factors, QoL was significantly reduced in chronic/aware compared with chronic/unaware PWID (adjusted B=-0.09, p=0.005); there was no evidence for a difference in QoL between not chronically infected and chronic/unaware PWID (adjusted B=-0.03, p=0.13). Awareness of one's chronic HCV status was associated with reduced health-related QoL, but there was no evidence for further reduction attributable to chronic infection itself after adjusting for important covariate differences

Niveau de préparation des diplômés à une carrière en médecine interne générale avant et après la reconnaissance de la surspécialité : objectifs atteints et besoins évolutifs dans le programme d’études

Background: A survey of General Internal Medicine (GIM) graduates published in 2006 revealed large training gaps that informed the development of the first national GIM objectives of training in 2010. The first recognized GIM certification examination was written by candidates in 2014. The landscape is again changing with the introduction in 2019 of competency-by-design (CBD) to GIM training. This study aims to examine pre-existing and emerging training gaps with standardization of GIM curricula and identify new training needs to inform CBD curricula.  Methods: GIM graduates from all 16 Canadian programs from 2014 -2019 were emailed a survey modeled after the original study published in 2006. Graduates were asked about their preparedness and importance ratings for various elements of practice. Results: Many of the previously identified gaps (difference between importance and preparedness ratings) have been resolved in specific clinical areas (obstetrical and perioperative medicine) and skills (exercise stress testing) although some still require ongoing work in areas such as substance use disorders. Importantly, gaps still exist in preparedness for some intrinsic roles (e.g. managerial skills). Conclusions:  The development of a national GIM curriculum has helped close some educational gaps but some still exist. Our study provides data needed to meet the evolving needs of our graduates.Contexte : Une enquête auprès des diplômés en médecine interne générale (MIG), publiée en 2006, a révélé d’importantes lacunes dans leur formation, menant à l’élaboration des premiers objectifs nationaux de formation en MIG en 2010. Le premier examen de certification en MIG a été organisé en 2014. Le paysage est à nouveau en train de changer avec l’introduction en 2019 de la compétence par conception (CPC) dans la formation en MIG. Cette étude vise à examiner les lacunes de formation préexistantes et émergentes avec la normalisation de la formation en MIG et à identifier les nouveaux besoins de formation pour éclairer la définition des programmes de formation selon l’approche fondée sur les compétences.  Méthodes : Les diplômés des 16 programmes canadiens en MIG entre 2014 et 2019 ont reçu par courriel un sondage inspiré de l’étude originelle publiée en 2006. Les diplômés ont été interrogés sur leur état de préparation et sur l’importance qu’ils accordaient à divers éléments de la pratique. Résultats : Un grand nombre des lacunes décelées précédemment (différence entre les cotes d’importance et de préparation) ont été comblées dans des domaines cliniques spécifiques (médecine obstétrique et périopératoire) et par rapport à des compétences spécifiques (tests de stress à l’effort); dans certains domaines, comme les troubles liés à l’utilisation de substances psychoactives, les efforts doivent être poursuivis. Il est important de noter que des lacunes subsistent dans la préparation à certains rôles intrinsèques (par exemple, les compétences de gestionnaire). Conclusion : L’élaboration d’un programme national de formation en MIG a permis de combler certaines lacunes en matière de formation, mais des carences subsistent. Notre étude fournit les données nécessaires pour répondre aux besoins évolutifs de nos diplômés

User acceptance of observation and response charts with a track and trigger system: A multisite staff survey

Aims and objectives: To examine user acceptance with a new format of charts for recording observations and as a prompt for responding to episodes of clinical deterioration in adult medical–surgical patients. Background: Improving recognition and response to clinical deterioration remains a challenge for acute healthcare institutions globally. Five chart templates were developed in Australia, combining human factors design principles with a track and trigger system for escalation of care. Two chart templates were previously tested in simulations, but none had been evaluated in clinical practice. Design: Prospective multisite survey of user acceptance of the charts in practice. Methods: New observation and response charts were trialled in parallel with existing charts for 24 hours across 36 adult acute medical–surgical wards, covering 108 shifts, in five Australian states. Surveys were completed by 477 staff respondents, with open-ended comments and narrative from short informal feedback groups providing elaboration and context of user experiences. Results: Respondents were broadly supportive of the chart format and content for monitoring patients, and as a prompt for escalating care. Some concerns were noted for chart size and style, use of ranges to graph vital signs and with specific human factors design features. Information and training issues were identified to improve usability and adherence to chart guidelines and to support improved detection and response for patients with clinical deterioration. Conclusions: This initial evaluation demonstrated that the charts were perceived as appropriate for documenting observations and as a prompt to detect clinical deterioration. Further evaluation after some minor modifications to the chart is recommended. Relevance to clinical practice: Explicit training on the principles and rationale of human factors chart design, use of embedded change management strategies and addressing practical issues will improve authentic engagement, staff acceptance and adoption by all clinical users when implementing a similar observation and response chart into practice

Grain-size distribution of volcaniclastic rocks 2: Characterizing grain size and hydraulic sorting

Quantification of the grain size distribution of sediments allows interpretation of processes of transport and deposition. Jutzeler et al. (2012) developed a technique to determine grain size distribution of consolidated clastic rocks using functional stereology, allowing direct comparison between unconsolidated sediments and rocks. Here, we develop this technique to characterize hydraulic sorting and infer transport and deposition processes. We compare computed grain size and sorting of volcaniclastic rocks with field-based characteristics of volcaniclastic facies for which transport and depositional mechanisms have been inferred. We studied pumice-rich, subaqueous facies of volcaniclastic rocks from the Oligocene Ohanapecosh Formation (Ancestral Cascades, Washington, USA), Pliocene Dogashima Formation (Izu Peninsula, Honshu, Japan), Miocene Manukau Subgroup (Northland, New Zealand) and the Quaternary Sierra La Primavera caldera (Jalisco State, Mexico). These sequences differ in bed thickness, grading and abundance of matrix. We propose to evaluate grain size and sorting of volcaniclastic deposits by values of their modes, matrix proportion (< 2 mm; F-1) and D16, instead of median diameter (D50) and standard deviation parameters. F-1 and D16 can be uniformly used to characterize and compare sieving and functional stereology data. Volcaniclastic deposits typically consist of mixtures of particles that vary greatly in density and porosity. Hydraulic sorting ratios can be used to test whether inferred density of mixed clast populations of pumice and dense clasts are hydraulically sorted with each other, considering various types of transport under water. Evaluation of this ratio for our samples shows that most studied volcaniclastic facies are deposited by settling from density currents, and that basal dense clast breccia are emplaced by shear rolling. These hydraulic sorting ratios can be applied to any type of clastic rocks, and indifferently on consolidated and unconsolidated samples

Neural correlates of cognitive ability and visuo-motor speed: validation of IDoCT on UK Biobank Data

Automated online and App-based cognitive assessment tasks are becoming increasingly popular in large-scale cohorts and biobanks due to advantages in affordability, scalability and repeatability. However, the summary scores that such tasks generate typically conflate the cognitive processes that are the intended focus of assessment with basic visuomotor speeds, testing device latencies and speed-accuracy tradeoffs. This lack of precision presents a fundamental limitation when studying brain-behaviour associations. Previously, we developed a novel modelling approach that leverages continuous performance recordings from large-cohort studies to achieve an iterative decomposition of cognitive tasks (IDoCT), which outputs data-driven estimates of cognitive abilities, and device and visuomotor latencies, whilst recalibrating trial-difficulty scales. Here, we further validate the IDoCT approach with UK BioBank imaging data. First, we examine whether IDoCT can improve ability distributions and trial-difficulty scales from an adaptive picture-vocabulary task (PVT). Then, we confirm that the resultant visuomotor and cognitive estimates associate more robustly with age and education than the original PVT scores. Finally, we conduct a multimodal brain-wide association study with free-text analysis to test whether the brain regions that predict the IDoCT estimates have the expected differential relationships with visuomotor vs. language and memory labels within the broader imaging literature. Our results support the view that the rich performance timecourses recorded during computerised cognitive assessments can be leveraged with modelling frameworks like IDoCT to provide estimates of human cognitive abilities that have superior distributions, re-test reliabilities and brain-wide associations