Assessing Patient-Provider Collaboration in Subjects with Type 2 Diabetes in Jamaica and Effects on Glycemic Control

Background: Type 2 Diabetes Mellitus is a growing health problem worldwide that places patients at increased risk of morbidity and mortality from microvascular and macrovascular complications. Research suggests that a patient-centered approach which focuses on patient-physician communication and collaboration in the management of chronic diseases such as diabetes may improve clinical outcomes in a glycemic parameter such as HbA1c. We measured the degree of this patient-centered approach in a sample population of subjects with Type 2 Diabetes in Jamaica with the use of the Patient Assessment of Care for Chronic Illness (PACIC) questionnaire and assessed the relationship between patient-centered care and glycemic control. Purpose: To compare PACIC scores to hemoglobin A1C values in subjects with Type 2 Diabetes and to determine the correlation between patient-physician collaboration and glycemic control. Methods: Participants were selected from the Diabetes Clinic at the University Hospital of the West Indies in Kingston, Jamaica, in August 2011. A total of 40 patients were screened, but only 19 met eligibility requirements and agreed to participate in the study. Informed consent was obtained. The patients were assigned a study number and then self-administered the Patient Assessment of Care for Chronic Illness (PACIC) questionnaire in a private examination room. The PACIC is a validated instrument consisting of a total of 20 multiple choice questions. It measures five subjective categories: 1) Patient activation; 2) Delivery system design and decision support; 3) Goal setting; 4) Problem solving/contextual counseling; and 5) Follow-up/ coordination. Each category can be averaged individually with scores ranging from 1-5. The overall PACIC score measures patient-physician collaboration with a score ranging from a low of 1.0 to a high of 5.0. Additional study data was collected by one of the authors (PD) for both characterization of the study population and for analysis of potential confounders. These additional independent variables included: patient age, type of treatment (i.e., lifestyle modification), and years diagnosed with diabetes mellitus. Results: There were 19 subjects who were eligible for study and completed the PACIC questionnaire. There were more women than men (78.9%, 15 women and 4 men). The age range was 33-78 years with a mean age of 55. The range for years diagnosed with diabetes was 0.03 – 32 years with a mean of 14 years. Eight of the subjects (42.1%) were on combination therapy with insulin and oral hypoglycemic agents. Hemoglobin A1c values ranged from 5.4% – 15.5% with a mean of 10.8%. The PACIC scores ranged from 1.85 – 4.80 with a mean of 3.15. No statistically significant correlations were found between PACIC scores and HbA1c (r=.184). HbA1c did not significantly correlate with patient age (r=-.408), nor with years diagnosed with diabetes (r=-.244). Further statistical analysis using non-parametric correlation coefficients to take small sample sizes into account did not reveal any significant relationship either. Conclusion: There was no statistically significant trends between our main variables of the patient-physician collaboration (PACIC score) and glycemic control (HbA1c). Analysis of potential confounders also failed to elicit any correlations with HbA1c. The major limitation in this study is the small sample size. An important next step would be to repeat this study with a larger clinic sample

Millimeter-Wave Measurements of High Level and Low Level Activity Glass Melts

The primary objectives of the current research is to develop on-line sensors for characterizing molten glass in high-level and low-activity waste glass melters using millimeter-wave (MMW) technology and to use this technology to do novel research of melt dynamics. Existing and planned waste glass melters lack sophisticated diagnostics due to the hot, corrosive, and radioactive melter environments. Without process control diagnostics, the Defense Waste Processing Facility (DWPF) and the Waste Treatment Plant (WTP) under construction at Hanford operate by a feed forward process control scheme that relies on predictive models with large uncertainties. This scheme severely limits production throughput and waste loading. Also operations at DWPF have shown susceptibility to anomalies such as pouring, foaming, and combustion gas build up, which can seriously disrupt operations. Future waste chemistries will be even more challenging. The scientific goals of this project are to develop new reliable on-line monitoring capability for important glass process parameters such as temperature profiles, emissivity, density, viscosity, and other characteristics using the unique advantages of millimeter wave electromagnetic radiation that can be eventually implemented in the operating melters. Once successfully developed and implemented, significant cost savings would be realized in melter operations by increasing production through put, reduced storage volumes (through higher waste loading), and reduced risks (prevention or mitigation of anomalies)

SDSS J092455.87+021924.9: an Interesting Gravitationally Lensed Quasar from the Sloan Digital Sky Survey

We report the discovery of a new gravitationally lensed quasar from the Sloan Digital Sky Survey, SDSS J092455.87+021924.9 (SDSS J0924+0219). This object was selected from among known SDSS quasars by an algorithm that was designed to select another known SDSS lensed quasar (SDSS 1226-0006A,B). Five separate components, three of which are unresolved, are identified in photometric follow-up observations obtained with the Magellan Consortium's 6.5m Walter Baade telescope at Las Campanas Observatory. Two of the unresolved components (designated A and B) are confirmed to be quasars with z=1.524; the velocity difference is less than 100 km sec^{-1} according to spectra taken with the W. M. Keck Observatory's Keck II telescope on Mauna Kea. A third stellar component, designated C, has the colors of a quasar with redshift similar to components A and B. The maximum separation of the point sources is 1.78". The other two sources, designated G and D, are resolved. Component G appears to be the best candidate for the lensing galaxy. Although component D is near the expected position of the fourth lensed component in a four image lens system, its properties are not consistent with being the image of a quasar at z~1.5. Nevertheless, the identical redshifts of components A and B and the presence of component C strongly suggest that this object is a gravitational lens. Our observations support the idea that a foreground object reddens the fourth lensed component and that another unmodeled effect (such as micro- or milli-lensing) demagnificates it, but we cannot rule out the possibility that SDSS0924+0219 is an example of the relatively rare class of ``three component'' lens systems.Comment: 24 pages, 6 figures, accepted by A

Gravitational Lensing by Nearby Clusters of Galaxies

We present an estimation of the expected number of arcs and arclets in a sample of nearby (z<0.1) clusters of galaxies, that takes into account the magnitude limit of the objects as well as seeing effects. We show that strong lensing effects are not common, but also they are not as rare as usually stated. Indeed, for a given cluster, they present a strong dependence with the magnitude limit adopted in the analysis and the seeing of the observations. We also describe the procedures and results of a search for lensing effects in a sample of 33 clusters spanning the redshift range of 0.014 to 0.076, representative of the local cluster distribution. This search produced two arc candidates. The first one is in A3408 (z=0.042), the same arc previously discovered by Campusano & Hardy (1996), with z=0.073 and associated to the brightest cluster galaxy. The second candidate is in the cluster A3266 (z=0.059) and is near a bright elliptical outside the cluster center, requiring the presence of a very massive sub-structure around this galaxy to be produced by gravitational lensing.Comment: 22 pages including 9 Figures and 2 Tables, submitted to A

Search for Heavy Leptons at Hadron Colliders

Four models are considered which contain heavy leptons beyond the three families of the standard model. Two are fourth-generation extensions of the standard model in which the right-handed heavy leptons are either isosinglets or in an isodoublet; the other two are motivated by the aspon model of CP violation. In all these models, the heavy neutrino can either be heavier than, or comparable in mass to, the charged lepton leading to the possibility that the charged lepton is very long-lived. Production cross section and signatures for the heavy leptons are computed for the SSC and LHC.Comment: 17 pages(8 figures are not included),TRI-PP-92-9

A Randomized Phase II Trial of Pioglitazone for Lung Cancer Chemoprevention in High Risk Current and Former Smokers

Lung cancer chemoprevention, especially in high-risk former smokers, has great potential to reduce lung cancer incidence and mortality. Thiazolidinediones prevent lung cancer in preclinical studies, and diabetics receiving thiazolidinediones have lower lung cancer rates which led to our double-blind, randomized, phase II placebo-controlled trial of oral pioglitazone in high risk current or former smokers with sputum cytologic atypia or known endobronchial dysplasia. Bronchoscopy was performed at study entry and after completing of six months of treatment. Biopsies were histologically scored, and primary endpoint analysis tested worst biopsy scores (Max) between groups; Dysplasia index (DI) and average score (Avg) changes were secondary endpoints. Biopsies also received an inflammation score. The trial accrued 92 subjects (47 pioglitazone, 45 placebo), and 76 completed both bronchoscopies (39 pioglitazone, 37 placebo). Baseline dysplasia was significantly worse for current smokers, and 64% of subjects had mild or greater dysplasia at study entry. Subjects receiving pioglitazone did not exhibit improvement in bronchial dysplasia. Former smokers treated with pioglitazone exhibited a slight improvement in Max, while current smokers exhibited slight worsening. While statistically significant changes in Avg and DI were not observed in the treatment group, former smokers exhibited a slight decrease in both Avg and DI. Negligible Avg and DI changes occurred in current smokers. A trend towards decreased Ki-67 labeling index occurred in former smokers with baseline dysplasia receiving pioglitazone. While pioglitazone did not improve endobronchial histology in this high-risk cohort, specific lesions showed histologic improvement and further study is needed to better characterize responsive dysplasia

The prevalence, characteristics and effectiveness of Aichi Target 11 ' s "other effective area-based conservation measures" (OECMs) in Key Biodiversity Areas

Aichi Target 11 of the CBD Strategic Plan for Biodiversity commits countries to the effective conservation of areas of importance for biodiversity, through protected areas and “other effective area-based conservation measures” (OECMs). However, the prevalence and characteristics of OECMs are poorly known, particularly in sites of importance for biodiversity. We assess the prevalence of potential OECMs in 740 terrestrial Key Biodiversity Areas (KBAs) outside known or mapped protected areas across ten countries. A majority of unprotected KBAs (76.5%) were at least partly covered by one or more potential OECMs. The conservation of ecosystem services or biodiversity was a stated management aim in 73% of these OECMs. Local or central government bodies managed the highest number of potential OECMs, followed by local and indigenous communities and private landowners. There was no difference between unprotected KBAs with or without OECMs in forest loss or in a number of state-pressure-response metrics.The project was funded by the CCI Collaborative Fun

Thermal divergences on the event horizons of two-dimensional black holes

The expectation value of the stress-energy tensor \langleT_{\mu\nu}\rangle of a free conformally invariant scalar field is computed in a general static two-dimensional black hole spacetime when the field is in either a zero temperature vacuum state or a thermal state at a nonzero temperature. It is found that for every static two-dimensional black hole the stress-energy diverges strongly on the event horizon unless the field is in a state at the natural black hole temperature which is defined by the surface gravity of the event horizon. This implies that both extreme and nonextreme two-dimensional black holes can only be in equilibrium with radiation at the natural black hole temperature.Comment: 13 pages, REVTe

Effects on mortality of a nutritional intervention for malnourished HIV-infected adults referred for antiretroviral therapy: a randomised controlled trial.

Malnourished HIV-infected African adults are at high risk of early mortality after starting antiretroviral therapy (ART). We hypothesized that short-course, high-dose vitamin and mineral supplementation in lipid nutritional supplements would decrease mortality

1966

Proper Watering by Earl P. Grey (page 1) Soil Structure and Plant Feeding for Trees and Shrubs on the Golf Course by William Teece (2) Power Golf Carts: A Blessing or a Curse by David Dunlavey (3) A Comparison by Paul White (3) Trees on a Golf Course by Oliver Leech (5) Turf Management Majors Want a Golf Team by Richard Rossiter (6) Class Will of \u2766 (7)Famous Last Words from 1966 (8) Turf Heating with Electric Cables by J.R. Barrett, Jr. and W.H. Daniel (A-1) Poa Annua Restriction by C. F. Kerr and W.H. Daniel (A-9) Phosphorus by Marvin H. Ferguson (A-14) Role of Potassium in Turf Grass management by R. E. Wagner (A-16) Role of Minor Elements in Turfgrass Management by Alexander Radko (A-22) Rhizoctonia Brown patch and Pythium Diseas by Malcolm C. Shurtleff (A-27) Sclerotinia Dollar Spot and Snow Mold by Noel Jackson (A-32) Fusarium Blight - Disease of Turf Grasses by George A. Bean (A-35) Observing the Weather - Old and New Techniques by Robert C. Copeland (A-39) Water Supply by Allan Grieve Jr. (A-41) Establishment and Maintenance of Campus Turf by William A. Lambert (A-51) Athletic Field Management by J. T. Williams (A-56