Baseline Assessment of Providers\u27 Perspectives on Integrating Community Health Workers into Primary Care Teams to Improve Diabetes Prevention

• Type 2 Diabetes Mellitus (T2DM) affects 11% of U.S. adults • Additional 35% considered pre-diabetic, at-risk for developing T2DM1 • Bellevue Hospital and the VA NY Harbor Hospital disproportionately affected: 2x the prevalence in the general population, and increasing2 • Only 55% of adults receive recommended preventive services3 • Panel management: each care team is responsible for preventive care, disease management, and acute care of a patient panel • Community health worker (CHW): non-clinical frontline public health professional trained in behavioral counseling, care follow-up, program referrals, and health education4-8 • Come from the community that they serve, so they can offer ongoing social support, key to successful behavior change9-12 • CHW interventions have been shown to improve diabetes outcomes and progression to diabetes13 • Lack of literature on integrating CHWs on a larger scale into a clinical care team • CHORD study: Community Health Outreach to Reduce Diabetes • Randomized controlled intervention trial to assess the efficacy of integrating CHWs into primary care teams at Bellevue and the VA to prevent T2DM in pre-diabetic patients • Present study is a baseline assessment in preparation for the CHORD studyhttps://jdc.jefferson.edu/cwicposters/1036/thumbnail.jp

Possible Signatures Of Dissipation From Time-Series Analysis Techniques Using A Turbulent Laboratory Magnetohydrodynamic Plasma

The frequency spectrum of magnetic fluctuations as measured on the Swarthmore Spheromak Experiment is broadband and exhibits a nearly Kolmogorov 5/3 scaling. It features a steepening region which is indicative of dissipation of magnetic fluctuation energy similar to that observed in fluid and magnetohydrodynamic turbulence systems. Two non-spectrum based time-series analysis techniques are implemented on this data set in order to seek other possible signatures of turbulent dissipation beyond just the steepening of fluctuation spectra. Presented here are results for the flatness, permutation entropy, and statistical complexity, each of which exhibits a particular character at spectral steepening scales which can then be compared to the behavior of the frequency spectrum

EFFECTS OF AN ANGLED STARTING BLOCK ON SPRINT START KINEMATICS

The sprint start mechanics have changed over the years with the invention of the starting blocks. The most recent modification of the starting block developed by Gill Athletics was to create an outward angle of the foot position in the block in order to match the .28 rad. (16 deg.) oblique axis of the ankle. This study examined the effects of an outward angled foot position in a starting block prototype on the first four steps during sprinting kinematics

Religiosity in patients with Parkinson’s disease

OBJECTIVE. To study clinical correlates of religiosity in Parkinson's disease (PD). METHODS. Measures of life goals, religiosity, mood, and neuropsychologic function were assessed in 22 persons with mid-stage PD and 20 age-matched healthy controls. Levodopa dose equivalents (LDE) were also computed for the patients. RESULTS. Relative to other major life goals parkinsonian patients were significantly more likely to report that "my religion or life philosophy" was less important than were age-matched controls. Scores on a battery of religiosity scales were consistently lower for Parkinson's patients than those of age-matched controls. While Mini Mental State Exam, logical memory recall, Stroop, and selected (depression and anxiety) mood scales reliably distinguished patients from controls, only measures of prefrontal function correlated with religiosity scores. CONCLUSIONS. Patients with PD express less interest in religion and report consistently lower scores on measures of religiosity than age-matched controls. Prefrontal dopaminergic networks may support motivational aspects of religiosity.Office of Research and Development; Medical Research Service; Department of Veteran's Affair

Where Have We Been and Where Are We Going? A Conceptual Framework for Child Advocacy

The primary goal of this article is to chart the development of child advocacy as an interdisciplinary field of study and conclude with a conceptual framework for research and higher education in child advocacy. Historically, child advocacy has justifiably focused on protection needs. Values and assumptions about children\u27s best interest have also governed child advocacy, in part because evidence to inform decisions was lacking and in part because of its history as an activist movement. Against this historical backdrop, we describe contemporary trends in child advocacy that reconcile children\u27s protection with their inherent rights to personhood. We rely on the principles and articles of the United Nations Convention on the Rights of the Child, most notably children\u27s rights to participation and self-expression. At the same time, we demonstrate how values and ideology are being integrated with empiricism and objective analysis to inform policy and practice in child advocacy. The future of child advocacy depends on continued synthesis of rights and protection as well as values and rigorous analysis. From this perspective, we offer a conceptual framework for research and education in child advocacy

Acoustic emphasis in four year olds

Acoustic emphasis may convey a range of subtle discourse distinctions, yet little is known about how this complex ability develops in children. This paper presents a first investigation of the factors which influence the production of acoustic prominence in young children’s spontaneous speech. In a production experiment, SVO sentences were elicited from 4 year olds who were asked to describe events in a video. Children were found to place more acoustic prominence both on ‘new’ words and on words that were ‘given’ but had shifted to a more accessible position within the discourse. This effect of accessibility concurs with recent studies of adult speech. We conclude that, by age four, children show appropriate, adult-like use of acoustic prominence, suggesting sensitivity to a variety of discourse distinctions

Adverse and Positive Childhood Experiences of Clinical Mental Health Counselors as Predictors of Compassion Satisfaction, Burnout, and Secondary Traumatic Stress

Despite an emphasis on self-care to avoid burnout and increase compassion satisfaction within the counseling profession, there is a dearth of research on the developmental experiences of counselors that may increase the likelihood of burnout. We examined the impact of mental health counselors’ (N = 140) experiences of adverse childhood experiences and positive childhood experiences on their present rates of compassion satisfaction, burnout, and secondary traumatic stress. We used a cross-sectional, non-experimental correlational design and reported descriptive statistics as well as results of multiple regression models. Results indicated significant relationships among counselors’ rates of adverse childhood experiences, positive childhood experiences, and compassion satisfaction and burnout. We include implications for the use of both the adverse and positive childhood experiences assessments in the training of counseling students and supervisees

Data mining of a remote behavioral tracking system for Type 2 Diabetes patients: A prospective, cohort study

Background: Complications from type 2 diabetes mellitus can be prevented when patients perform health behaviors such as vigorous exercise and glucose-regulated diet. The use of smartphones for tracking such behaviors has demonstrated success in type 2 diabetes management while generating repositories of analyzable digital data, which, when better understood, may help improve care. Data mining methods were used in this study to better understand self-monitoring patterns using smartphone tracking software. Objective: Associations were evaluated between the smartphone monitoring of health behaviors and HbA1c reductions in a patient subsample with type 2 diabetes who demonstrated clinically significant benefits after participation in a randomized controlled trial. Methods: A priori association-rule algorithms, implemented in the C language, were applied to app-discretized use data involving three primary health behavior trackers (exercise, diet, and glucose monitoring) from 29 participants who achieved clinically significant HbA1c reductions. Use was evaluated in relation to improved HbA1c outcomes. Results: Analyses indicated that nearly a third (9/29, 31%) of participants used a single tracker, half (14/29, 48%) used two primary trackers, and the remainder (6/29, 21%) of the participants used three primary trackers. Decreases in HbA1c were observed across all groups (0.97-1.95%), but clinically significant reductions were more likely with use of one or two trackers rather than use of three trackers (OR 0.18, P=.04). Conclusions: Data mining techniques can reveal relevant coherent behavior patterns useful in guiding future intervention structure. It appears that focusing on using one or two trackers, in a symbolic function, was more effective (in this sample) than regular use of all three trackers.The authors would like to thank NexJ Systems Inc. for their partnership in this trial and for the use of the Connected Wellness Platform as a clinical research tool. Funding was provided by the Public Health Agency of Canada and the Federal Development Agency of Southern Ontario. We offer special thanks to the staff of the Black Creek Community Health Centre and trial participants from the Jane-Finch community of Toronto, Ontario. Joel Katz is supported by a Canadian Institutes of Health Research Canada Research Chair in Health Psychology. The authors would like to acknowledge with sadness the untimely passing of study co-author, colleague, and friend, Dr. Nicholas Cercone. Dr. Cercone’s expertise and mentorship on data mining theory and technique was invaluable. His inspiring and supportive presence will be deeply missed

Effects of counterion fluctuations in a polyelectrolyte brush

We investigate the effect of counterion fluctuations in a single polyelectrolyte brush in the absence of added salt by systematically expanding the counterion free energy about Poisson-Boltzmann mean field theory. We find that for strongly charged brushes, there is a collapse regime in which the brush height decreases with increasing charge on the polyelectrolyte chains. The transition to this collapsed regime is similar to the liquid-gas transition, which has a first-order line terminating at a critical point. We find that for monovalent counterions the transition is discontinuous in theta solvent, while for multivalent counterions the transition is generally continuous. For collapsed brushes, the brush height is not independent of grafting density as it is for osmotic brushes, but scales linear with it.Comment: 9 pages, 9 figure