The Effectiveness of Registered Dietitians in Diabetes Case Management

OBJECTIVE: The objective of this paper is to investigate the effectiveness of diabetes education provided by registered dietitians (RD) in a diabetes case management (DCMs) model, compared to diabetes education provided by RDs in the usual care model (UCM) at an outpatient endocrinology clinic in Omaha, Nebraska. This study hypothesizes that education by RD DCMs will be equal or more efficacious in regards to primary outcomes of A1C and BMI and secondarily, lipid results and adherence (total encounters) when compared to outcomes of UC. METHODS: This is a cross sectional retrospective review of patients with diabetes (n=946), receiving traditional RD education (n=445) and DCM (n=501). Groups had like distribution of A1C and lipids at baseline. The DCM group had a higher BMI, higher percentage of male subjects and older population compared to the UCM at baseline. BMI, Lipids, A1C and total encounters were compared from initial visit to 12 months. SPSS software provided descriptive statistics of the sample groups and independent samples t-test for differences of means between groups. P-value of \u3c 0.5 was considered statistically significant. RESULTS: Primary outcomes were endpoint A1C and BMI and mean change in A1C and BMI at 1 year. Endpoint A1C was lower in the DCM (8.0 vs. 8.4, p= 0.02). Mean A1C change was -0.4 in DCM, compared with - 0.2 in UCM (p=0.06). Endpoint BMI was higher in the DCM (32.7 vs 31.5, p=0.04), however BMI declined slightly (- 0.04) in DCM and increased slightly (+ 0.2) in the UCM (p=0.07). Secondary findings included greater mean change in LDL in DCM (+1.78 vs - 4.16, p=0.002) and higher number of overall encounters with RD (10.01 vs 7.39) and Endocrinogist (11.11 vs 8.22) (p=0.001) in DCM group. No significant differences were found in HDL or Triglycerides. CONCLUSION: The DCM group had improvements in endpoint and change in A1C and change in LDL. Of note, the DCM group results for mean change in BMI showed a trend toward significance. DCM subjects attended more visits with the RD and Endcrinologist, suggesting more engagement in the DCM than the UCM. Further research should analyze interventions within the DCM model, compared to the UCM. Additional study is needed regarding cardiovascular risk benefit over time and cost-benefits of the model

Proliferation of Hydroelectric Dams in the Andean Amazon and Implications for Andes-Amazon Connectivity

Due to rising energy demands and abundant untapped potential, hydropower projects are rapidly increasing in the Neotropics. This is especially true in the wet and rugged Andean Amazon, where regional governments are prioritizing new hydroelectric dams as the centerpiece of long-term energy plans. However, the current planning for hydropower lacks adequate regional and basin-scale assessment of potential ecological impacts. This lack of strategic planning is particularly problematic given the intimate link between the Andes and Amazonian flood plain, together one of the most species rich zones on Earth. We examined the potential ecological impacts, in terms of river connectivity and forest loss, of the planned proliferation of hydroelectric dams across all Andean tributaries of the Amazon River. Considering data on the full portfolios of existing and planned dams, along with data on roads and transmission line systems, we developed a new conceptual framework to estimate the relative impacts of all planned dams. There are plans for 151 new dams greater than 2 MW over the next 20 years, more than a 300% increase. These dams would include five of the six major Andean tributaries of the Amazon. Our ecological impact analysis classified 47% of the potential new dams as high impact and just 19% as low impact. Sixty percent of the dams would cause the first major break in connectivity between protected Andean headwaters and the lowland Amazon. More than 80% would drive deforestation due to new roads, transmission lines, or inundation. We conclude with a discussion of three major policy implications of these findings. 1) There is a critical need for further strategic regional and basin scale evaluation of dams. 2) There is an urgent need for a strategic plan to maintain Andes-Amazon connectivity. 3) Reconsideration of hydropower as a low-impact energy source in the Neotropics

Supplier-partnering management: a case study of the Kaisha

Over the last decade many business have begun to recognise the competitive advantages that can be found from developing co-operative partnerships with suppliers. The automotive industry has been in the forefront in developing buyer-supplier partnerships as they attempted to remain competitive with the Japanese firms. This case study examines the factors that may influence buyer-supplier relationships, in particular as they relate to the procurement operations of an American automotive subsidiary of a Japanese firm. The Japanese parent company has a long history of keiretsu1 supplier relationships and how these have translated into the American firms operations is of particular consideration. The American subsidiary is undergoing an organization restructuring that will have a future impact on supplier relations. Several factors are proposed for consideration for future research. These include how the parent firm’s keiretsu relationships impact the American firm’s supply base. Also of consideration is how successful the firm will be in determining the particular aspects of different supplier relationship models that will provide the most benefit in establishing a supplier-partnering management program

Social policy recommendations to alleviate stress among informal providers of elder care

Purpose – The purpose of this paper is to examine social policy recommendations to deal with the high level of pressure placed upon informal providers of elder care. Design/methodology/approach – The paper investigates this subject of elder care by first establishing the significance of the problem. The paper provides an examination of how this problem is dealt with in several countries, both at the governmental level and by private enterprise. This forms the basis of a discussion of social (and enterprise) policy implications in particular for the USA. A focus on flexible work scheduling as a viable means to help alleviate the problem is recommended. In particular an approach of voluntary compliance is proposed to encourage wider acceptance by corporations. Findings – The paper finds that priority needs to be given to developing a social policy agenda that focuses on flexible work scheduling. In addition, meaningful effort must be expended to capture input from various stakeholders, and to educate and promote the program itself. Concurrently, efforts targeted at managers must be executed to move them away from the traditional line of sight management schema into one more akin to a target-based schema. Originality/value – The paper offers useful suggestions to promote implementation. © 2008, Emerald Group Publishing Limite

Mixed Evidence for Biotic Homogenization of Southern Appalachian Fish Communities

Anthropogenic impacts on the landscape can drive biotic homogenization, whereby distinct biological communities become more similar to one another over time. Land-use change in the Southern Appalachian region is expected to result in homogenization of the highly diverse freshwater fish communities as in-stream habitat alterations favor widespread cosmopolitan species at the expense of more narrowly distributed highland endemic species. We compiled four datasets spanning 25 years to (1) evaluate the effects of environmental factors on relative abundance and richness of highland endemic vs. cosmopolitan species in this region and (2) test for taxonomic homogenization, measured as a change in beta diversity over time. We found that several environmental factors differentially affected highland endemic and cosmopolitan species, with the proportion of forested land cover in a watershed most strongly predicting higher relative abundance and richness of highland endemic species. Our analysis of beta diversity change, however, shows mixed evidence of taxonomic homogenization, depending on how common species are weighted. Shifts in community composition, with or without homogenization, may warrant attention in biodiversity conservation planning.The accepted manuscript in pdf format is listed with the files at the bottom of this page. The presentation of the authors' names and (or) special characters in the title of the manuscript may differ slightly between what is listed on this page and what is listed in the pdf file of the accepted manuscript; that in the pdf file of the accepted manuscript is what was submitted by the author