Awareness of Diabetes Risk Associated with Individuals 18 and Older

The risk of developing Type 2 diabetes is increasing at epidemic proportions, and is 12-17% higher in Marion County Florida than it is across the state, based on Florida Department of Health statistics. The purpose of this DNP project was to determine if awareness of individual risk of developing Type 2 diabetes through a questionnaire would result in high-risk participants agreeing to attend a diabetes prevention program (DPP) at a local medical clinic. The health belief model and Rosswurm and Larrabee\u27s model for change were used as frameworks. The review of the literature showed that prevention programs were highly effective in reducing the risk of developing diabetes. A validated diabetes risk questionnaire was placed at reception desks at 3 clinic sites. Forty-four anonymous participants completed the questionnaire. The convenience sample obtained from the questionnaire provided a score that categorized individuals into a high-risk and a low-risk group. Quantitative data from the participants were analyzed using descriptive statistics. Twenty-one of the participants indicated they were at high risk of developing diabetes. Ninety-five percent of those who received a high-score on the diabetes risk questionnaire responded that they would be interested in participating in a DPP at a local medical clinic. As a result of the DNP project completion, a DPP with the goal of reducing the risk of developing Type 2 diabetes will be implemented in the Marion County medical clinic. Future collaboration with health care and community organizations will assist to expand DPP\u27s, bring awareness of diabetes risk, and promote social change

Chronic Care of Diabetes in the Rural Setting: A Quality Improvement Project

Diabetes is a national health care concern that costs that health care system approximately $245 billion per year. The prevalence of diagnosed diabetes has increased 157% in Colorado. As a part of the Affordable Care Act, accountable care organizations (ACO) were developed to help manage the chronic care of diabetes. The purpose of ACOs is to improve outcomes and decrease overall costs. Banner Health is a participating ACO and has clinics in six of the Northeast Colorado counties. Three counties in which Banner has clinics have a disproportionately higher incidence of diabetes compared to the rest of the state. As a means to meet ACO standards, Banner has developed a strategic initiative O1.5. Under this strategic initiative, Banner Health clinics will strive to improve the number of diabetic patients with current A1C measurements and glycemic control of an A1C \u3c9%. This quality improvement project was designed to use Delphi method and the Plan-Do-Study-Act cycle to improve documentation of diabetes-specific metrics. Data obtained prior to intervention were used to establish baseline reporting of A1C in Morgan County clinics. Data revealed that in adults 18-75, 78.2% of patients in the clinics were at A1C control of 9% or lower. A RE-AIM assessment was done to identify areas for improvement; the greatest areas of improvement were in EHR utilization and in process flow. A Delphi method study was used to identify practice change guidelines. For this quality improvement project, the Doctor of Nursing Practice student focused on the documentation and specific process flow to improve the number of patients meeting the chronic care of diabetes initiative goals of having an A1C \u3c9% and current diabetes care within the past year

Representing Aboutness: Automatically Indexing 19th- Century Encyclopedia Britannica Entries

Representing aboutness is a challenge for humanities documents, given the linguistic indeterminacy of the text. The challenge is even greater when applying automatic indexing to historical documents for a multidisciplinary collection, such as encyclopedias. The research presented in this paper explores this challenge with an automatic indexing comparative study examining topic relevance. The setting is the NEH-funded 19th-Century Knowledge Project, where researchers in the Digital Scholarship Center, Temple University, and the Metadata Research Center, Drexel University, are investigating the best way to index entries across four historical editions of the Encyclopedia Britannica (3rd, 7th, 9th, and 11th editions). Individual encyclopedia entry entries were processed using the Helping Interdisciplinary Vocabulary Engineering (HIVE) system, a linked-data, automatic indexing terminology application that uses controlled vocabularies. Comparative topic relevance evaluation was performed for three separate keyword extraction algorithms: RAKE, Maui, and Kea++. Results show that RAKE performed the best, with an average of 67% precision for RAKE, and 28% precision for both Maui and Kea++. Additionally, the highest-ranked HIVE results with both RAKE and Kea++ demonstrated relevance across all sample entries, while Maui’s highest-ranked results returned zero relevant terms. This paper reports on background information, research objectives and methods, results, and future research prospects for further optimization of RAKE’s algorithm parameters to accommodate for encyclopedia entries of different lengths, and evaluating the indexing impact of correcting the historical Long S

Carbon Free Boston: Transportation Technical Report

Part of a series of reports that includes: Carbon Free Boston: Summary Report; Carbon Free Boston: Social Equity Report; Carbon Free Boston: Technical Summary; Carbon Free Boston: Buildings Technical Report; Carbon Free Boston: Waste Technical Report; Carbon Free Boston: Energy Technical Report; Carbon Free Boston: Offsets Technical ReportOVERVIEW: Transportation connects Boston’s workers, residents and tourists to their livelihoods, health care, education, recreation, culture, and other aspects of life quality. In cities, transit access is a critical factor determining upward mobility. Yet many urban transportation systems, including Boston’s, underserve some populations along one or more of those dimensions. Boston has the opportunity and means to expand mobility access to all residents, and at the same time reduce GHG emissions from transportation. This requires the transformation of the automobile-centric system that is fueled predominantly by gasoline and diesel fuel. The near elimination of fossil fuels—combined with more transit, walking, and biking—will curtail air pollution and crashes, and dramatically reduce the public health impact of transportation. The City embarks on this transition from a position of strength. Boston is consistently ranked as one of the most walkable and bikeable cities in the nation, and one in three commuters already take public transportation. There are three general strategies to reaching a carbon-neutral transportation system: • Shift trips out of automobiles to transit, biking, and walking;1 • Reduce automobile trips via land use planning that encourages denser development and affordable housing in transit-rich neighborhoods; • Shift most automobiles, trucks, buses, and trains to zero-GHG electricity. Even with Boston’s strong transit foundation, a carbon-neutral transportation system requires a wholesale change in Boston’s transportation culture. Success depends on the intelligent adoption of new technologies, influencing behavior with strong, equitable, and clearly articulated planning and investment, and effective collaboration with state and regional partners.Published versio

[Pemetrexed + Sorafenib] lethality is increased by inhibition of ERBB1/2/3-PI3K-NFκB compensatory survival signaling

In the completed phase I trial NCT01450384 combining the anti-folate pemetrexed and the multi-kinase inhibitor sorafenib it was observed that 20 of 33 patients had prolonged stable disease or tumor regression, with one complete response and multiple partial responses. The pre-clinical studies in this manuscript were designed to determine whether [pemetrexed + sorafenib] –induced cell killing could be rationally enhanced by additional signaling modulators. Multiplex assays performed on tumor material that survived and re-grew after [pemetrexed + sorafenib] exposure showed increased phosphorylation of ERBB1 and of NFκB and IκB; with reduced IκB and elevated G-CSF and KC protein levels. Inhibition of JAK1/2 downstream of the G-CSF/KC receptors did not enhance [pemetrexed + sorafenib] lethality whereas inhibition of ERBB1/2/4 using kinase inhibitory agents or siRNA knock down of ERBB1/2/3 strongly promoted killing. Inhibition of ERBB1/2/4 blocked [pemetrexed + sorafenib] stimulated NFκB activation and SOD2 expression; and expression of IκB S32A S36A significantly enhanced [pemetrexed + sorafenib] lethality. Sorafenib inhibited HSP90 and HSP70 chaperone ATPase activities and reduced the interactions of chaperones with clients including c-MYC, CDC37 and MCL-1. In vivo, a 5 day transient exposure of established mammary tumors to lapatinib or vandetanib significantly enhanced the anti-tumor effect of [pemetrexed + sorafenib], without any apparent normal tissue toxicities. Identical data to that in breast cancer were obtained in NSCLC tumors using the ERBB1/2/4 inhibitor afatinib. Our data argue that the combination of pemetrexed, sorafenib and an ERBB1/2/4 inhibitor should be explored in a new phase I trial in solid tumor patients

Quantifying public preferences for different bowel preparation options prior to screening CT colonography: a discrete choice experiment

Objectives: CT colonography (CTC) may be an acceptable test for colorectal cancer screening but bowel preparation can be a barrier to uptake. This study tested the hypothesis that prospective screening invitees would prefer full-laxative preparation with higher sensitivity and specificity for polyps, despite greater burden, over less burdensome reduced-laxative or non-laxative alternatives with lower sensitivity and specificity. Design: Discrete choice experiment. Setting: Online, web-based survey. Participants: 2819 adults (45–54 years) from the UK responded to an online invitation to take part in a cancer screening study. Quota sampling ensured that the sample reflected key demographics of the target population and had no relevant bowel disease or medical qualifications. The analysis comprised 607 participants. Interventions: After receiving information about screening and CTC, participants completed 3–4 choice scenarios. Scenarios showed two hypothetical forms of CTC with different permutations of three attributes: preparation, sensitivity and specificity for polyps. Primary outcome measures: Participants considered the trade-offs in each scenario and stated their preferred test (or chose neither). Results: Preparation and sensitivity for polyps were both significant predictors of preferences (coefficients: −3.834 to −6.346 for preparation, 0.207–0.257 for sensitivity; p<0.0005). These attributes predicted preferences to a similar extent. Realistic specificity values were non-significant (−0.002 to 0.025; p=0.953). Contrary to our hypothesis, probabilities of selecting tests were similar for realistic forms of full-laxative, reduced-laxative and non-laxative preparations (0.362–0.421). However, they were substantially higher for hypothetical improved forms of reduced-laxative or non-laxative preparations with better sensitivity for polyps (0.584–0.837). Conclusions: Uptake of CTC following non-laxative or reduced-laxative preparations is unlikely to be greater than following full-laxative preparation as perceived gains from reduced burden may be diminished by reduced sensitivity. However, both attributes are important so a more sensitive form of reduced-laxative or non-laxative preparation might improve uptake substantially.JRC.I.2-Public Health Policy Suppor

Demonstrating HIVE and HIVE-ES: Supporting Term Browsing and Automatic Text Indexing with Linked Open Vocabularies

Abstract y presentación presentados en el WorkshopThe HIVE (Helping Interdisciplinary Vocabulary Engineering) and HIVE-España (ES) projects both support dynamic, automatic metadata generation using multiple vocabularies. This demonstration will present both the HIVE and HIVE-ES projects and showcase the overarching HIVE framework and functionalities, and give insight into the broader issues relating to linked open vocabularies&#8212;LOV. HIVE relies on the Simple Knowledge Organization System (SKOS) and the Kea++/Maui algorithms, which enable more sophisticated terminological selection compared to frequency counts. Baseline studies provide some positive, yet mixed results, and a framework for further study. The adequacy of HIVE and HIVE-ES's searching and browsing capabilities are required to be addressed; and the research should target SKOS use for different types of vocabularies (thesaurus vs. subject heading lists) and, specially on the performance of the text indexing algorithms used depending on the type of vocabulary, the features of the training set documents and those indexed, and the language of all of them