Implementation and evaluation of the VA DPP clinical demonstration: protocol for a multi-site non-randomized hybrid effectiveness-implementation type III trial.

BackgroundThe Diabetes Prevention Program (DPP) study showed that lifestyle intervention resulted in a 58% reduction in incidence of type 2 diabetes among individuals with prediabetes. Additional large randomized controlled trials have confirmed these results, and long-term follow-up has shown sustained benefit 10-20 years after the interventions ended. Diabetes is a common and costly disease, especially among Veterans, and despite strong evidence supporting the feasibility of type 2 diabetes prevention, the DPP has not been widely implemented. The first aim of this study will evaluate implementation of the Veterans Affairs (VA) DPP in three VA medical centers. The second aim will assess weight and hemoglobin A1c (A1c) outcomes, and the third aim will determine the cost-effectiveness and budget impact of implementation of the VA DPP from a health system perspective.Methods/designThis partnered multi-site non-randomized systematic assignment study will use a highly pragmatic hybrid effectiveness-implementation type III mixed methods study design. The implementation and administration of the VA DPP will be funded by clinical operations while the evaluation of the VA DPP will be funded by research grants. Seven hundred twenty eligible Veterans will be systematically assigned to the VA DPP clinical demonstration or the usual care VA MOVE!® weight management program. A multi-phase formative evaluation of the VA DPP implementation will be conducted. A theoretical program change model will be used to guide the implementation process and assess applicability and feasibility of the DPP for VA. The Consolidated Framework for Implementation Research (CFIR) will be used to guide qualitative data collection, analysis, and interpretation of barriers and facilitators to implementation. The RE-AIM framework will be used to assess Reach, Effectiveness, Adoption, Implementation, and Maintenance of the VA DPP. Twelve-month weight and A1c change will be evaluated for the VA DPP compared to the VA MOVE!ProgramMediation analyses will be conducted to identify whether program design differences impact outcomes.DiscussionFindings from this pragmatic evaluation will be highly applicable to practitioners who are tasked with implementing the DPP in clinical settings. In addition, findings will determine the effectiveness and cost-effectiveness of the VA DPP in the Veteran population

Eclipse studies of the dwarf-nova Ex Draconis

We report on high speed photometry of EX Dra in quiescence and in outburst. The analysis of the lightcurves indicates that the outbursts do not start in the outer disc regions. The disc expands during rise to maximum and shrinks during decline and along the quiescent period. At the end of two outbursts the system was seen to go through a phase of lower brightness, characterized by an out-of-eclipse level ~15 per cent lower than the typical quiescent level and by the fairly symmetric eclipse of a compact source at disc centre with little evidence of a bright spot at disc rim. New eclipse timings were measured and a revised ephemeris was derived. The residuals with respect to the linear ephemeris are well described by a sinusoid of amplitude 1.2 minutes and period \~4 years and are possibly related to a solar-like magnetic activity cycle in the secondary star. Eclipse phases of the compact central source and of the bright spot were used to derive the geometry of the binary. By constraining the gas stream trajectory to pass through the observed position of the bright spot we find q=0.72+/-0.06 and i= 85 +3/-2 degrees. The binary parameters were estimated by combining the measured mass ratio with the assumption that the secondary star obeys an empirical main sequence mass-radius relation. We find M_1= 0.75+/-0.15 M_sun and M_2= 0.54+/-0.10 M_sun. The white dwarf at disc centre is surrounded by an extended and variable atmosphere or boundary layer of at least 3 times its radius and a temperature of T ~28000 K. The fluxes at mid-eclipse yield an upper limit to the contribution of the secondary star and lead to a lower limit photometric parallax distance of D= 290+/-80 pc. The fluxes of the secondary star are well matched by those of a M0+/-2 main sequence star.Comment: submitted to MNRAS, 12 pages, 9 figures; coded with MNRAS latex styl

Evaluation of Biopolymer Materials and Synthesis Techniques to Develop a Rod-Shaped Biopolymer Surrogate for Legionella pneumophila

Biopolymer microparticles have been developed for applications that require biocompatibility and biodegradability, such as drug delivery. In this study, we assessed the production of microparticles using carnauba wax, κ-carrageenan, alginate, and poly (lactic-co-glycolic acid) (PLGA) with the aim of developing a novel, DNA-tracer-loaded, biopolymer surrogate with a size, shape, surface charge, and relative hydrophobicity similar to stationary-phase Legionella pneumophila to mimic the bacteria’s mobility and persistence in engineered water systems. We found that the type and concentration of biopolymer, reaction conditions, and synthesis methods affected the morphology, surface charge, relative hydrophobicity, and DNA tracer loading efficiency of the biopolymer microparticles produced. Carnauba wax, κ-carrageenan, and alginate (Protanal®, and low and medium viscosity) produced highly polydisperse microspheres. In contrast, PLGA and alginate-CaCO3 produced uniform microspheres and rod-shaped microparticles, respectively, with high DNA tracer loading efficiencies (PLGA 70% and alginate-CaCO3 95.2 ± 5.7%) and high reproducibilities. Their synthesis reproducibility was relatively high. The relative hydrophobicity of PLGA microspheres closely matched the cell surface hydrophobicity of L. pneumophila but not the bacterial morphology, whereas the polyelectrolyte layer-by-layer assembly was required to enhance the relative hydrophobicity of alginate-CaCO3 microparticles. Following this surface modification, alginate-CaCO3 microparticles represented the best match to L. pneumophila in size, morphology, surface charge, and relative hydrophobicity. This new biopolymer surrogate has the potential to be used as a mimic to study the mobility and persistence of L. pneumophila in water systems where the use of the pathogen is impractical and unsafe

Inhibiting mevalonate pathway enzymes increases stromal cell resilience to a cholesterol-dependent cytolysin

Animal health depends on the ability of immune cells to kill invading pathogens, and on the resilience of tissues to tolerate the presence of pathogens. Trueperella pyogenes causes tissue pathology in many mammals by secreting a cholesterol-dependent cytolysin, pyolysin (PLO), which targets stromal cells. Cellular cholesterol is derived from squalene, which is synthesized via the mevalonate pathway enzymes, including HMGCR, FDPS and FDFT1. The present study tested the hypothesis that inhibiting enzymes in the mevalonate pathway to reduce cellular cholesterol increases the resilience of stromal cells to PLO. We first verified that depleting cellular cholesterol with methyl-β-cyclodextrin increased the resilience of stromal cells to PLO. We then used siRNA to deplete mevalonate pathway enzyme gene expression, and used pharmaceutical inhibitors, atorvastatin, alendronate or zaragozic acid to inhibit the activity of HMGCR, FDPS and FDFT1, respectively. These approaches successfully reduced cellular cholesterol abundance, but mevalonate pathway enzymes did not affect cellular resilience equally. Inhibiting FDFT1 was most effective, with zaragozic acid reducing the impact of PLO on cell viability. The present study provides evidence that inhibiting FDFT1 increases stromal cell resilience to a cholesterol-dependent cytolysin

An overview of historical and contemporary concrete shells, their construction and factors in their general disappearance

Only through understanding why concrete shells’ loss in popularity over the course of modern history can designers be equipped with the skills to create and apply this type of construction. Through modifications to design processes, construction stages, material understanding and relevant formwork improvements will architects and designers be able to meet the demands of the 21st century and beyond. To understand why concrete shells are no longer commonly built is to understand its construction process. An amorphous material, the fundamental relationship between formwork and the resultant concrete shell needs to be raised, appreciated, understood and analyzed for a holistic understanding of concrete shells. Through understanding this, issues and factors affecting concrete shells can be tackled and designed out in reviving this type of structures because they can be efficient in structural performance, economical in cost and provide high aesthetic value. This paper discusses concrete shells as an architectural solution by asking the question to what constituted their popularity and factors that led to their demise in the modern age of technological advancement, construction process and environmental concerns. This paper presents a cultural perspective and an overview of seminal, historical and contemporary concrete shells so as to bring about a renaissance of such structures in our built environment once again because of all the benefits it can offer.</p

Infrared Properties of Cataclysmic Variables from 2MASS: Results from the 2nd Incremental Data Release

Because accretion-generated luminosity dominates the radiated energy of most cataclysmic variables, they have been ``traditionally'' observed primarily at short wavelengths. Infrared observations of cataclysmic variables contribute to the understanding of key system components that are expected to radiate at these wavelengths, such as the cool outer disk, accretion stream, and secondary star. We have compiled the J, H, and Ks photometry of all cataclysmic variables located in the sky coverage of the 2 Micron All Sky Survey (2MASS) 2nd Incremental Data Release. This data comprises 251 systems with reliably identified near-IR counterparts and S/N > 10 photometry in one or more of the three near-IR bands.Comment: 2 pages, including 1 figure. To appear in the proceedings of The Physics of Cataclysmic Variables and Related Objects, Goettingen, Germany. For our followup ApJ paper (in press), also see http://www.ctio.noao.edu/~hoard/research/2mass/index.htm

Why is it so hard to enact responsible change?: Scientists need to work more closely with other social groups to implement sustainable innovation

This is the final version. Available on open access from EMBO Press via the DOI in this record. Biotechnology and Biological Sciences Research Council (BBSRC)UK Research and Innovation | Engineering and Physical Sciences Research Council (EPSRC)Wellcome Trus