Self-management support for chronic disease in primary care: frequency of patient self-management problems and patient reported priorities, and alignment with ultimate behavior goal selection.

BackgroundTo enable delivery of high quality patient-centered care, as well as to allow primary care health systems to allocate appropriate resources that align with patients' identified self-management problems (SM-Problems) and priorities (SM-Priorities), a practical, systematic method for assessing self-management needs and priorities is needed. In the current report, we present patient reported data generated from Connection to Health (CTH), to identify the frequency of patients' reported SM-Problems and SM-Priorities; and examine the degree of alignment between patient SM-Priorities and the ultimate Patient-Healthcare team member selected Behavioral Goal.MethodsCTH, an electronic self-management support system, was embedded into the flow of existing primary care visits in 25 primary care clinics and was used to assess patient-reported SM-Problems across 12 areas, patient identified SM-Priorities, and guide the selection of a Patient-Healthcare team member selected Behavioral Goal. SM-Problems included: BMI, diet (fruits and vegetables, salt, fat, sugar sweetened beverages), physical activity, missed medications, tobacco and alcohol use, health-related distress, general life stress, and depression symptoms. Descriptive analyses documented SM-Problems and SM-Priorities, and alignment between SM-Priorities and Goal Selection, followed by mixed models adjusting for clinic.Results446 participants with ≥ one chronic diseases (mean age 55.4 ± 12.6; 58.5% female) participated. On average, participants reported experiencing challenges in 7 out of the 12 SM-Problems areas; with the most frequent problems including: BMI, aspects of diet, and physical activity. Patient SM-Priorities were variable across the self-management areas. Patient- Healthcare team member Goal selection aligned well with patient SM-Priorities when patients prioritized weight loss or physical activity, but not in other self-management areas.ConclusionParticipants reported experiencing multiple SM-Problems. While patients show great variability in their SM-Priorities, the resulting action plan goals that patients create with their healthcare team member show a lack of diversity, with a disproportionate focus on weight loss and physical activity with missed opportunities for using goal setting to create targeted patient-centered plans focused in other SM-Priority areas. Aggregated results can assist with the identification of high frequency patient SM-Problems and SM-Priority areas, and in turn inform resource allocation to meet patient needs.Trial registrationClinicalTrials.gov ID: NCT01945918

Automatic radioxenon analyzer for CTBT monitoring

Over the past 3 years, with support from US DOE`s NN-20 Comprehensive Test Ban Treaty (CTBT) R&D program, PNNL has developed and demonstrated a fully automatic analyzer for collecting and measuring the four Xe radionuclides, {sup 131m}Xe(11.9 d), {sup 133m}Xe(2.19 d), {sup 133}Xe (5.24 d), and {sup 135}Xe(9.10 h), in the atmosphere. These radionuclides are important signatures in monitoring for compliance to a CTBT. Activity ratios permit discriminating radioxenon from nuclear detonation and that from nuclear reactor operations, nuclear fuel reprocessing, or medical isotope production and usage. In the analyzer, Xe is continuously and automatically separated from the atmosphere at flow rates of about 7 m{sup 3}/h on sorption bed. Aliquots collected for 6-12 h are automatically analyzed by electron-photon coincidence spectrometry to produce sensitivities in the range of 20-100 {mu}Bq/m{sup 3} of air, about 100-fold better than with reported laboratory-based procedures for short time collection intervals. Spectral data are automatically analyzed and the calculated radioxenon concentrations and raw gamma- ray spectra automatically transmitted to data centers

Inverse Compton Scattering as the Source of Diffuse EUV Emission in the Coma Cluster of Galaxies

We have examined the hypothesis that the majority of the diffuse EUV flux in the Coma cluster is due to inverse Compton scattering of low energy cosmic ray electrons (0.16 < epsilon < 0.31 GeV) against the 3K black-body background. We present data on the two-dimensional spatial distribution of the EUV flux and show that these data provide strong support for a non-thermal origin for the EUV flux. However, we show that this emission cannot be produced by an extrapolation to lower energies of the observed synchrotron radio emitting electrons and an additional component of low energy cosmic ray electrons is required.Comment: 11 pages, 5 figure

X-ray Signatures of an Ionized Reprocessor in the Seyfert galaxy Ton S 180

We discuss the hard X-ray properties of the Seyfert galaxy Ton S 180, based upon the analysis of ASCA data. We find the X-ray flux varied by a factor ~2 on a time scale of a few thousand seconds. The source showed significantly higher amplitude of variability in the 0.5-2 keV band than in the 2-10 keV band. The continuum is adequately parameterized as a Gamma ~ 2.5 power-law across the 0.6--10 keV band . We confirm the recent discovery of an emission line of high equivalent width, due to Fe K-shell emission from highly-ionized material. These ASCA data show the Fe line profile to be broad and asymmetric and tentatively suggest it is stronger during the X-ray flares, consistent with an origin from the inner parts of an accretion disk. The X-ray spectrum is complex below 2 keV, possibly due to emission from a blend of soft X-ray lines, which would support the existence of an ionized reprocessor, most likely due to a relatively high accretion rate in this source.Comment: 24 pages, 8 figures. LaTeX with encapsulated postscript. To appear in the Astrophysical Journa

Pionium Production in the Cooler

This research was sponsored by the National Science Foundation Grant NSF PHY-931478

Cooler Target Development

This research was sponsored by the National Science Foundation Grant NSF PHY-931478

Pionium Production in the Cooler

This research was sponsored by the National Science Foundation Grant NSF PHY-931478

The EUV Emission in the Coma Cluster of Galaxies and the Underlying Source of this Radiation

Observations with the Extreme Ultraviolet Explorer (EUVE) have shown the Coma Cluster to be a source of EUV emission in excess of that produced by X-ray gas in the cluster. We have re-examined the EUVE data on this cluster in an attempt to obtain clues as to the origin of this emission. We find two important new results. First, the ratio between the azimuthally averaged EUV excess emission and the ROSAT hard X-ray flux is constant as a function of distance from the cluster center outward. Second, a correlation analysis between the EUV excess emission and the X-ray emission shows that on a detailed level the EUV excess is spatially closely related to the X-ray emission. These findings contradict previous suggestions as to the underlying source of the diffuse EUV emission in Coma and provide important information in regards to the true source of this emission. We propose a new explanation for the source of this emission: inverse Compton scattering of microwave background photons by secondary electrons and positrons. We explore this possibility in some detail and show that it is consistent with all of the available observational evidence. The parent cosmic ray protons may have been produced by any of a number of sources, including supernovae, active galaxies, galactic winds, and cluster formation shocks, but we believe that the most likely source is cluster formation shocks. If the EUV emission in the Coma Cluster is, in fact, the result of secondary electrons, this may be the only direct evidence for secondary electrons in the intracluster medium of a cluster of galaxies, since recent work suggests that secondary electrons may not be the cause of radio halos.Comment: 17 pages, 7 eps figures inline, submitted to Ap