Factors for Supporting Primary Care Physician Engagement With Patient Apps for Type 2 Diabetes Self-Management That Link to Primary Care: Interview Study.

BACKGROUND: The health burden of type 2 diabetes can be mitigated by engaging patients in two key aspects of diabetes care: self-management and regular contact with health professionals. There is a clear benefit to integrating these aspects of care into a single clinical tool, and as mobile phone ownership increases, apps become a more feasible platform. However, the effectiveness of online health interventions is contingent on uptake by health care providers, which is typically low. There has been little research that focuses specifically on barriers and facilitators to health care provider uptake for interventions that link self-management apps to the user's primary care physician (PCP). OBJECTIVE: This study aimed to explore PCP perspectives on proposed features for a self-management app for patients with diabetes that would link to primary care services. METHODS: Researchers conducted 25 semistructured interviews. The interviewer discussed potential features that would link in with the patient's primary care services. Interviews were audio-recorded, transcribed, and coded. Framework analysis and the Consolidated Criteria for Reporting Qualitative Research checklist were employed to ensure rigor. RESULTS: Our analysis indicated that PCP attitudes toward proposed features for an app were underpinned by perceived roles of (1) diabetes self-management, (2) face-to-face care, and (3) the anticipated burden of new technologies on their practice. Theme 1 explored PCP perceptions about how an app could foster patient independence for self-management behaviors but could also increase responsibility and liability for the PCP. Theme 2 identified beliefs underpinning a commonly expressed preference for face-to-face care. PCPs perceived information was more motivating, better understood, and presented with greater empathy when delivered face to face rather than online. Theme 3 described how most PCPs anticipated an initial increase in workload while they learned to use a new clinical tool. Some PCPs accepted this burden on the basis that the change was inevitable as health care became more integrated. Others reported potential benefits were outweighed by effort to implement an app. This study also identified how app features can be positively framed, highlighting potential benefits for PCPs to maximize PCP engagement, buy-in, and uptake. For example, PCPs were more positive when they perceived that an app could facilitate communication and motivation between consultations, focus on building capacity for patient independence, and reinforce rather than replace in-person care. They were also more positive about app features that were automated, integrated with existing software, flexible for different patients, and included secondary benefits such as improved documentation. CONCLUSIONS: This study provided insight into PCP perspectives on a diabetes app integrated with primary care services. This was observed as more than a technological change; PCPs were concerned about changes in workload, their role in self-management, and the nature of consultations. Our research highlighted potential facilitators and barriers to engaging PCPs in the implementation process

Gamma-Ray Spectra & Variability of the Crab Nebula Emission Observed by BATSE

We report ~ 600 days of BATSE earth-occultation observations of the total gamma-ray (30 keV to 1.7 MeV) emission from the Crab nebula, between 1991 May 24 (TJD 8400) and 1994 October 2 (TJD 9627). Lightcurves from 35-100, 100-200, 200-300, 300-400, 400-700, and 700-1000 keV, show that positive fluxes were detected by BATSE in each of these six energy bands at significances of approximately 31, 20, 9.2, 4.5, 2.6, and 1.3 sigma respectively per day. We also observed significant flux and spectral variations in the 35-300 keV energy region, with time scales of days to weeks. The spectra below 300 keV, averaged over typical CGRO viewing periods of 6-13 days, can be well described by a broken power law with average indices of ~ 2.1 and ~ 2.4 varying around a spectral break at ~ 100 keV. Above 300 keV, the long-term averaged spectra, averaged over three 400 d periods (TJD 8400-8800, 8800-9200, and 9200-9628, respectively) are well represented by the same power law with index of ~ 2.34 up to ~ 670 keV, plus a hard spectral component extending from ~ 670 keV to ~ 1.7 MeV, with a spectral index of ~ 1.75. The latter component could be related to a complex structure observed by COMPTEL in the 0.7-3 MeV range. Above 3 MeV, the extrapolation of the power-law continuum determined by the low-energy BATSE spectrum is consistent with fluxes measured by COMPTEL in the 3-25 MeV range, and by EGRET from 30-50 MeV. We interpret these results as synchrotron emission produced by the interaction of particles ejected from the pulsar with the field in different dynamical regions of the nebula system, as observed recently by HST, XMM-Newton, and Chandra.Comment: To be published in the November 20, 2003, Vol 598 issue of the Astrophysical Journa

Children of prisoners: exploring the impact of families' reappraisal of the role and status of the imprisoned parent on children's coping strategies

Qualitative data from a larger study on the impact of parental imprisonment in four countries found that children of prisoners face fundamentally similar psychological and social challenges. The ways that children cope, however, are influenced by the interpretative frame adopted by the adults around them, and by how issues of parental imprisonment are talked about in their families. This article argues that families have to reappraise their view of the imprisoned parent and then decide on their policy for how to deal with this publicly. Their approach may be based on openness and honesty or may emphasise privacy and secrecy, or a combination of these. Children are likely to be influenced by their parents'/carers' views, although these may cause conflict for them. Where parents/carers retain a positive view of the imprisoned parent, children are likely to benefit; where parents/carers feel issues of shame and stigma acutely, this is likely to be transmitted to their children. This is important for social workers and practitioners involved in supporting prisoners' families and for parenting programmes

Learners' experience and perceived impact of a health literacy program in adult basic education: a qualitative study.

Objectives and importance of the study: Adult literacy programs aim to empower learners to participate more effectively in everyday life. This includes programs with health content embedded in curricula to target health literacy. Adult learners who attend these programs represent a heterogeneous population, but include a high proportion of hard-to-reach or socially disadvantaged groups in terms of age, ethnicity, educational background, language and prevalence of learning disabilities. In 2014, we conducted a cluster-randomised controlled trial of a health literacy program in adult basic education classes across New South Wales, Australia. This paper reports findings from a qualitative study exploring learners' experience of the course and its perceived impact on their lives, as well as their understanding and confidence about health. STUDY TYPE:Qualitative interview study. METHOD:We conducted semistructured interviews as part of the evaluation of the 18-week health literacy program, with participants purposively recruited from six health literacy classes (n = 22). Researchers trained in qualitative methods interviewed adult learners either face to face or over the phone using a topic guide. Data was analysed using the Framework method, a matrix-based approach to thematic analysis. RESULTS:The majority of interviewees were female, lived in metropolitan areas and were from non-English-speaking backgrounds. Most had existing self-reported health problems and inadequate functional health literacy. Most participants described positive impacts of the health literacy course on their language, literacy and numeracy skills, functional health literacy skills, and health knowledge. They also reported being able to translate this into health actions including interacting with providers, accessing and using healthcare, and managing health and illness (e.g. making healthier food choices). Learners also described positive social outcomes of the course, including feelings of connectedness and interpersonal trust within a new network of learners, and reported sharing new knowledge with others in their communities. CONCLUSIONS:The findings add value to existing limited evidence that has demonstrated the untapped potential of adult basic education to develop health literacy skills among socially disadvantaged groups. Learners valued the opportunity to share experiences in structured group learning, and reported confidence to transfer new knowledge into their home and wider social network

Comparative life cycle assessment of aluminium and CFRP composites: the case of aerospace manufacturing

As climate change intensifies and existing resources are depleted, the need for sustainable industries becomes more important. The aviation industry is actively addressing environmental concerns by enhancing fuel efficiency and adopting lighter materials, especially carbon fibre composites. Research has proven that the use of carbon fibre composites provides cumulative benefits in reducing fuel consumption over the entire life cycle of an aircraft. However, existing studies are lack of a comprehensive exploration of the diverse impacts associated with composite manufacturing processes and recycling methods. To address this gap, a comparative life cycle assessment analysis covering the materials’ manufacturing, operation, and end-of-life phases is conducted. This analysis includes aluminium alloy and five different carbon fibre composite materials produced with varied constituents and manufacturing methods. Composite manufacturing processes, encompassing carbon fibre production, resin selection, and composite manufacturing methods, are considered. Weight savings based on the mechanical properties of utilised composite type are also taken into account. Results highlight the potential to mitigate the environmental impact of composite materials through strategic choices in constituent types, manufacturing processes, and disposal scenarios. Moreover, break-even distances indicate that aluminium becomes more environmentally detrimental than the analysed composite structures beyond a flight distance of 300,000 km

Towards a Framework for Open Data Publishers:A Comparison Study between Sweden and Belgium

Public organizations in the role of publishers publish datafor anyone to reuse, which can lead to benets. However, the processdescriptions for this publishing work focus on one or a few issues, whichleaves out important areas and decisions. Little seems to be known aboutvariations between publishers based on one common point of comparison.Therefore, this paper presents a comparison between two publishers:Namur (Belgium) and Linkoping (Sweden). The comparison is based ona process framework, seven in-depth interviews, document studies, anda verication meeting with one respondent. We learned that the OGD manager is an agent of change who need to balance implementation andguidance, the orthodox method of e-mail registration can be used toengage users and monitor impact, the organizational unit for OGD iscross-organizational, and the publisher process framework could be usedas ex-ante strategic guidelines and context-specic recommendations

Precise Measurements of Atmospheric Muon Fluxes with the BESS Spectrometer

The vertical absolute fluxes of atmospheric muons and muon charge ratio have been measured precisely at different geomagnetic locations by using the BESS spectrometer. The observations had been performed at sea level (30 m above sea level) in Tsukuba, Japan, and at 360 m above sea level in Lynn Lake, Canada. The vertical cutoff rigidities in Tsukuba (36.2 N, 140.1 E) and in Lynn Lake (56.5 N, 101.0 W) are 11.4 GV and 0.4 GV, respectively. We have obtained vertical fluxes of positive and negative muons in a momentum range from 0.6 to 20 GeV/c with systematic errors less than 3 % in both measurements. By comparing the data collected at two different geomagnetic latitudes, we have seen an effect of cutoff rigidity. The dependence on the atmospheric pressure and temperature, and the solar modulation effect have been also clearly observed. We also clearly observed the decrease of charge ratio of muons at low momentum side with at higher cutoff rigidity region.Comment: 35 pages, 9 figures. Submitted to Astroparticle Physic

COVID-19 Misinformation Trends in Australia: Prospective Longitudinal National Survey.

Background: Misinformation about COVID-19 is common and has been spreading rapidly across the globe through social media platforms and other information systems. Understanding what the public knows about COVID-19 and identifying beliefs based on misinformation can help shape effective public health communications to ensure efforts to reduce viral transmission are not undermined. Objective: This study aimed to investigate the prevalence and factors associated with COVID-19 misinformation in Australia and their changes over time. Methods: This prospective, longitudinal national survey was completed by adults (18 years and above) across April (n=4362), May (n=1882), and June (n=1369) 2020. Results: Stronger agreement with misinformation was associated with younger age, male gender, lower education level, and language other than English spoken at home (P<.01 for all). After controlling for these variables, misinformation beliefs were significantly associated (P<.001) with lower levels of digital health literacy, perceived threat of COVID-19, confidence in government, and trust in scientific institutions. Analyses of specific government-identified misinformation revealed 3 clusters: prevention (associated with male gender and younger age), causation (associated with lower education level and greater social disadvantage), and cure (associated with younger age). Lower institutional trust and greater rejection of official government accounts were associated with stronger agreement with COVID-19 misinformation. Conclusions: The findings of this study highlight important gaps in communication effectiveness, which must be addressed to ensure effective COVID-19 prevention

Structured Collaboration Across a Transformative Knowledge Network-Learning Across Disciplines, Cultures and Contexts?

Realising the Sustainable Development Goals (SDGs) will require transformative changes at micro, meso and macro levels and across diverse geographies. Collaborative, transdisciplinary research has a role to play in documenting, understanding and contributing to such transformations. Previous work has investigated the role of this research in Europe and North America, however the dynamics of transdisciplinary research on ‘transformations to sustainability’ in other parts of the world are less well-understood. This paper reports on an international project that involved transdisciplinary research in six different hubs across the globe and was strategically designed to enable mutual learning and exchange. It draws on surveys, reports and research outputs to analyse the processes of transdisciplinary collaboration for sustainability that took place between 2015-2019. The paper illustrates how the project was structured in order to enable learning across disciplines, cultures and contexts, and describes how it also provided for the negotiation of epistemological frameworks and different normative commitments between members across the network. To this end, it discusses lessons regarding the use of theoretical and methodological anchors, multi-loop learning and evaluating emergent change (including the difficulties encountered). It offers insights for the design and implementation of future international transdisciplinary collaborations that address locally-specific sustainability challenges within the universal framework of the 2030 Agenda for Sustainable Development

Immobilised teicoplanin does not demonstrate antimicrobial activity against Staphylococcus aureus

Abstract: Antibacterial bone biomaterial coatings appeal to orthopaedics, dentistry and veterinary medicine. Achieving the successful, stable conjugation of suitable compounds to biomaterial surfaces is a major challenge. A pragmatic starting point is to make use of existing, approved antibiotics which are known to remain functional in a stationary, immobilised state. This includes the macrocyclic glycopeptide, teicoplanin, following the discovery, in the 1990’s, that it could be used as a chiral selector in chromatographic enantiomeric separations. Importantly teicoplanin works at the level of the bacterial cell wall making it a potential candidate for biomaterial functionalisations. We initially sought to functionalise titanium (Ti) with polydopamine and use this platform to capture teicoplanin, however we were unable to avoid the natural affinity of the antibiotic to the oxide surface of the metal. Whilst the interaction between teicoplanin and Ti was robust, we found that phosphate resulted in antibiotic loss. Before contemplating the covalent attachment of teicoplanin to Ti we examined whether a commercial teicoplanin stationary phase could kill staphylococci. Whilst this commercially available material could bind N-Acetyl-L-Lys-D-Ala-D-Ala it was unable to kill bacteria. We therefore strongly discourage attempts at covalently immobilising teicoplanin and/or other glycopeptide antibiotics in the pursuit of novel antibacterial bone biomaterials