Innovations in healthcare delivery and policy: Implications for the role of the psychologist in preventing and treating diabetes

Although the biomedical model has dominated U.S. health care for more than a century, it has failed to adequately address current U.S. health care challenges, including the treatment and prevention of chronic disease; the epidemic rise in diabetes is one important example. In response, newer models of health care have been developed that address patients' mental and physical health concerns by multidisciplinary care teams that place the patient and family in the center of shared decision making. These new models of care offer many important opportunities for psychologists to play a larger role in the prevention and treatment of diabetes. However, for psychology's role to be fully realized, both external and internal challenges must be addressed. This will require psychologists to become more interdisciplinary, more familiar with the larger health care culture, more willing to expand their skill sets, and more collaborative with other health disciplines both from a patient-care and a larger advocacy perspective

Interview with Bob Bennett

Bob Bennett, a homosexual professor at Kenyon College, describes coming out to students and co-workers, the discrimination he and his partner have faced over their lifetime, and how things have changed in public opinion since his youth. He addresses the theory of homosexuality as innate or as a choice, and describes his relationship with the Episcopal Church.https://digital.kenyon.edu/lt_interviews/1005/thumbnail.jp

Aphasia simulation: A perspective from the student and standardized patient

The aim of the current study was to examine student ability, student and standardized patient perceptions of competency, and student perceptions of effectiveness of simulation methodology for conducting language screenings on individuals with aphasia. Graduate students enrolled in a mandatory course on acquired language disorders (n = 36) completed a variety of simulated learning experiences using videos, high-fidelity manikins, and standardized patients, in preparing them for clinical practice with persons with aphasia. 5-point Likert scales and open-ended survey questions relating to student and standardized patients’ perceptions were administered. Results demonstrated a strong positive perception that simulation promotes student understanding of assessment procedures and aids in the development of clinical judgment. Data also illuminate that certain skills may be slower to emerge and require greater experience and supervisory feedback, for example, problem-solving difficult moments. There was an overall positive response to the use of simulation methodology to build skills in screening patients with PWA. Students’ perceptions matched that of the standardized patients, and students excelled in the final summative skill activity. Keywords: aphasia; simulated learning; academic education; clinical educatio

Advanced load-testing techniques for a science archive

Performance goals for data archive systems need to be established early in the design process to ensure stability and acceptable response throughput. Load testing is one technique used to measure the progress towards these performance goals. Providing resources for load-test planning is critical, and this planning must include feasibility studies, tool analyses, and generation of an overall load-test strategy. This strategy is much different for science data archives than other systems, including commercial websites and high-volume data centers. This paper will provide an overview of the load testing performed on the Spitzer Space Telescope's science archive, which is part of Science Operations System at the Spitzer Science Center (SSC). Methods used for planning and conducting SSC load tests will be presented, and advanced load-testing techniques will be provided to address runtime issues and enhance verification results. This work was performed at the California Institute of Technology under contract to the National Aeronautics and Space Administration

The Spitzer Science Center: using metrics analysis to improve system stability

The Spitzer Science Center (SSC) Software Science Operations System (SOS) is a large, complex software system. Over 1.2 million lines of code had been written for the SOS by time of launch (August 2003). The SSC uses a defect tracking tool called GNATS to enter defect reports and change requests. GNATS has been useful beyond just tracking defects to closure. Prior to launch a number of charts and graphs were generated using metrics collected from GNATS. These reports demonstrated trends and snapshots of the state of the SOS and enabled the SSC to better identify risks to the SOS and focus testing efforts. This paper will focus primarily on the time period of Spitzer's launch and In Orbit Checkout. It will discuss the metrics collected, the analyses done, the format the analyses was presented in, and lessons learned. This work was performed at the California Institute of Technology under contract to the National Aeronautics and Space Administration

Urinary Tubular Injury Biomarkers Are Associated With ESRD and Death in the REGARDS Study.

IntroductionUrinary neutrophil gelatinase-associated lipocalin (uNGAL) and urinary kidney injury molecule-1 (uKIM-1) are established markers of subclinical acute kidney injury. In persons with reduced estimated glomerular filtration rate (eGFR) and albuminuria who are at high risk for end-stage renal disease (ESRD) and death, the associations of these urinary markers with incident ESRD or death is an area of active investigation.MethodsAmong 1472 black and white participants from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study with eGFR ≤60 ml/min per 1.73 m2 (Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI] cystatin, 2012) and albumin-to-creatinine ratio (ACR) ≥30 mg/g, we evaluated the associations of baseline uNGAL and uKIM-1 with progression to ESRD and all-cause death. Cox models were sequentially adjusted for urinary creatinine, traditional risk factors, C-reactive protein, ACR, and eGFR.ResultsThere were 257 ESRD events and 819 deaths over a median follow-up of 5.7 and 6.5 years, respectively. In demographic adjusted models, higher levels of uNGAL were associated with increased risk of ESRD and death, but these associations were attenuated in fully adjusted models including baseline eGFR for both ESRD (hazard ratio [HR] = 1.06 per doubling, 95% confidence interval [CI] 0.98-1.14) and death (HR = 1.04, 95% CI = 1.00-1.08). Higher levels of uKIM-1 were associated with increased risk of ESRD and death in demographic-adjusted models, and although attenuated in fully adjusted models, remained statistically significant for both ESRD (HR = 1.24 per doubling, 95% CI = 1.08-1.42) and death (HR = 1.10, 95% CI =1.03-1.19).ConclusionIn this cohort of high-risk patients with baseline eGFR ≤60 ml/min per 1.73 m2 and albuminuria, renal tubular injury is associated with higher mortality and progression to ESRD. Further studies are necessary to investigate the mechanism underlying this increased risk

Impact of earthquakes on agriculture during the Roman–Byzantine period from pollen records of the Dead Sea laminated sediment

The Dead Sea region holds the archives of a complex relationship between an ever-changing nature and ancient civilisations. Regional pollen diagrams show a Roman–Byzantine period standing out in the recent millennia by its wetter climate that allowed intensive arboriculture. During that period, the Dead Sea formed laminites that display mostly a seasonal character. A multidisciplinary study focused on two earthquakes, 31 BC and AD 363, recorded as seismites in the Ze’elim gully A unit III which has been well dated by radiocarbon in a previous study. The sampling of the sediment was done at an annual resolution starting from a few years before and finishing a decade after each earthquake. A clear drop in agricultural indicators (especially Olea and cereals) is shown. These pollen indicators mostly reflect human activities in the Judean Hills and coastal oases. Agriculture was disturbed in large part of the rift valley where earthquake damage affected irrigation and access to the fields. It took 4 to 5 yr to resume agriculture to previous conditions. Earthquakes must be seen as contributors to factors damaging societies. If combined with other factors such as climatic aridification, disease epidemics and political upheaval, they may lead to civilisation collapse

The impact of Nutrition and Gastrointestinal Symptoms on Health-related Quality of Life in Survivorship after Oesophageal Cancer Surgery

Summary Background and Aims Oesophagectomy is the primary curative treatment for oesophageal cancer but is associated with considerable postoperative morbidity and mortality. To better understand the aetiology of impaired health-related quality of life (HRQL) in oesophageal cancer survivors (OCS), this study sought to determine the longitudinal changes in nutritional status, nutrition-impact symptoms (NIS), and HRQL in this cohort, and to determine which variables have the greatest impact on postoperative HRQL decline. Methods Data, derived from St. James\u27 Hospital, Dublin, included patients who underwent oesophagectomy from October 2017 to May 2019 and attended clinic preoperatively and 6 months postoperatively. A subset attended a further 12-month appointment. HRQL and symptom data were collected using validated questionnaires and anthropometric measures were completed by clinicians. Data were analysed using SPSS. Results A total of 66 patients were studied preoperatively and 6 months postoperatively, of whom 37 were studied at 12 months postoperatively. Malnutrition remained prevalent at each time-point, although rates did not significantly change longitudinally. Conversely, the prevalence of malabsorption (7.6%–14.3%, P\u3c0.001) and dumping syndrome (67.7%–74.3%, P=0.003) significantly increased with increasing time postoperatively. NIS were significantly associated with impaired HRQL function scores and were independent predictors of global quality of life (gQOL) score postoperatively (P=0.004). A diagnostic threshold of gastrointestinal symptom severity (11.5) that identifies patients at risk of impaired gQOL was therefore reported. Conclusion Malnutrition and NIS are prevalent post-oesophagectomy, the latter significantly associated with reduced HRQL. Targeted intervention in those with severe NIS could be highly beneficial, highlighting the need for dietetic input in OCS

Patient and professional experiences of palliative care referral discussions from cancer services : a qualitative interview study

Objectives The aim of this paper was to identify current barriers, facilitators and experiences of raising and discussing palliative care with people with advanced cancer. Methods Semi‐structured interviews were conducted with patients with advanced cancer and healthcare professionals (HCPs). Patients were included who had and had not been referred to palliative care. Transcripts were analysed using framework analysis. Results Twenty‐four patients and eight HCPs participated. Two overarching themes and five sub‐themes emerged: Theme one—referral process: timing and triggers, responsibility. Theme two—engagement: perception of treatment, prognosis and palliative care, psychological and emotional preparedness for discussion, and understanding how palliative care could benefit present and future care. Conclusion There is a need to identify suitable patients earlier in their cancer trajectory, address misconceptions about palliative care, treatment and prognosis, and better prepare patients and HCPs to have meaningful conversations about palliative care. Patients and HCPs need to establish and communicate the relevance of palliative care to the patient's current and future care, and be clear about the referral process