Bridging Patient Outcome Gap for Type 2 Diabetes : Can We Bridge Physician Practices to Produce Results Achieved in Evidence-Based Lifestyle Intervention Research?

The United States is abounding in the prevalence and incidence of avoidable chronic diseases, and high among these diseases is type 2 diabetes. Further, according to the National Institute of Health (NIH) Common Fund, 40% of harmful health behaviors is what contributes to chronic diseases, such as type 2 diabetes. NIH noted there are few personalized, effective ways to inspire people to change their behaviors in the shortterm, but if done, this behavior is not sustained long-term (The NIH Common Fund, 2011). Yet, this research discovered a Diabetes Prevention Program (DPP) is one of these few personalized, effective interventions that has not become widespread in application. The DPP has over 10 years of effectively demonstrating an impact on diabetes by these outcomes: 1) decrease in the incidence of diabetes, 2) decrease in the costs of diabetes, 3) decrease in death rates of diabetes, 4) absence of differences across ethnic groups, and 5) sustainability over ten years with lifestyle intervention significantly having the greatest impact. Hence this research sought to explore why DPP has not found its way into the practice of treating and preventing diabetes. The over arching research question was: Can we bridge physician practices to produce results achieved in evidence-based lifestyle intervention research? Primary research was conducted with physicians treating diabetic and pre-diabetic patients in Connecticut, New Jersey, New York and Pennsylvania using both quantitative and qualitative methods to pursue this inquiry. Research findings revealed unfamiliarity with DPP, barriers to implementing DPP in real world practices, yet an overwhelming interest in DPP, particularly because of the nutrition-based lifestyle component. Consequently, nutrition educators and counselors have an opportunity to emerge as change agents in translating DPP evidence into practice with the goal of bridging the patient outcome gap for type 2 diabetes. The best opportunity is addressing barriers and limitations identified in this research

Teachers\u27 Characteristic and Exceptional Student Academic Learning Outcomes in Middle School

Federal mandates ensure that each and every child regardless of race, national origins, and socioeconomic status, is entitled to a high-quality education. Reports from the Department of Education have stated that over 80% of exceptional students receive their academic instructions within general education classrooms. There is limited research on exceptional students learning outcomes in general education classrooms with general education curriculum. The purpose of this quantitative study was to test the theory of self-determination that explains the impact of teacher characteristics (N = 85 educators) on the academic outcomes of exceptional students in the special and general education classrooms. Teacher characteristics such as, experience, training, and attitude were measured by the Teacher\u27s Attitude Towards Inclusion scale (TAIS) scores, and student learning outcomes, were reports of student performance ratings and standardized scores, of the exceptional students. Results revealed significant correlations between specific inclusive TAIS attitudes and student learning outcomes. The independent sample t test results indicated that the years of experience and student outcomes of students of general education teachers were significantly higher in comparison to special education teachers. Availability of Instructional Options was also measured; it did not moderate the relationship between teachers\u27 characteristics and academic outcomes of exceptional students. Positive social change thus can be initiated by training teachers in the instructional practices, identified by this study, who deliver the optimal academic outcomes for the exceptional students. This will initiate positive social change for the special child, their families, and the community as a whole

A Modified Trier Social Stress Test for Vulnerable Mexican American Adolescents.

The Trier Social Stress Test (TSST) is a well validated and widely used social stressor that has been shown to induce a 2-4 fold increase in cortisol, the biological output produced by the Hypothalamic-Pituitary-Adrenal (HPA) axis in humans. While studies have explored how modifications to the TSST influence stress responsivity, few studies have created a modified TSST appropriate for vulnerable youth that elicits a significant cortisol stress response. Thus, the current study sought to modify or adjust the TSST in a culturally sensitive way for a vulnerable sample of 14 year-old adolescents. The present study took place within the context of a longitudinal birth cohort study of Mexican American families in California called the Center for the Health Assessment of Mothers and Children of Salinas (CHAMACOS). The CHAMACOS sample was optimal to test the effectiveness of a modified culturally appropriate TSST, as it is comprised of Mexican American youth, who are often excluded from research. These youths also have experienced significant early life adversity. Example modifications included timed prompts, alternative math tasks, use of same-ethnicity peers as confederates, debriefing immediately after the conclusion of the TSST, and using an unknown youth examiner to administer the debrief. Saliva samples were collected at baseline (after a resting phase), and then again at 15, 30, and 45 min post-TSST onset to assess cortisol concentration. A pilot study of 50 participants (50% female) have been analyzed for cortisol reaction to the TSST. Results confirmed that this modified version of the TSST was successful at eliciting a significant cortisol reaction, with a wide range of variability likely due to individual differences. Goals for modifications and ethnicity considerations are discussed. This study provides the foundation for future research to utilize a modified TSST with vulnerable youth

Unbased calculus for functors to chain complexes

Recently, the Johnson-McCarthy discrete calculus for homotopy functors was extended to include functors from an unbased simplicial model category to spectra. This paper completes the constructions needed to ensure that there exists a discrete calculus tower for functors from an unbased simplicial model category to chain complexes over a fixed commutative ring. Much of the construction of the Taylor tower for functors to spectra carries over to this context. However, one of the essential steps in the construction requires proving that a particular functor is part of a cotriple. For this, one needs to prove that certain identities involving homotopy limits hold up to isomorphism, rather than just up to weak equivalence. As the target category of chain complexes is not a simplicial model category, the arguments for functors to spectra need to be adjusted for chain complexes. In this paper, we take advantage of the fact that we can construct an explicit model for iterated fibers, and prove that the functor is a cotriple directly. We use related ideas to provide concrete infinite deloopings of the first terms in the resulting Taylor towers when evaluated at the initial object in the source category.Comment: 20 page

Evidence of quality professional development:a study in childhood practice

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Principal Submatrices, Geometric Multiplicities, and Structured Eigenvectors

It is a straightforward matrix calculation that if λ is an eigenvalue of A, x an associated eigenvector and α the set of positions in which x has nonzero entries, then λ is also an eigenvalue of the submatrix of A that lies in the rows and columns indexed by α. A converse is presented that is the most general possible in terms of the data we use. Several corollaries are obtained by applying the main result to normal and Hermitian matrices. These corollaries lead to results concerning the case of equality in the interlacing inequalities for Hermitian matrices, and to the problem of the relationship among eigenvalue multiplicities in various principal submatrices

The rank filtration and Robinson’s complex

AbstractFor a functor from the category of finite sets to abelian groups, Robinson constructed a bicomplex in [A. Robinson, Gamma homology, Lie representations and E∞ multiplications, Invent. Math. 152 (2) (2003) 331–348] which computes the stable derived invariants of the functor as defined by Dold–Puppe in [A. Dold, D. Puppe, Homologie nicht-additiver Funktoren. Anwendungen., Ann. Inst. Fourier (Grenoble) 11 (1961) 201–312]. We identify a subcomplex of Robinson’s bicomplex which is analogous to a normalization and also computes these invariants. We show that this new bicomplex arises from a natural filtration of the functor obtained by taking left Kan approximations on subcategories of bounded cardinality