Evaluating the Association Between Depressive Symptoms and Glycemic Control Among Residents of Rural Appalachia

Introduction: Type 2 diabetes mellitus (T2DM) is associated with a range of co-morbid physical and psychological conditions, including depression. Yet there is a dearth of evidence regarding the prevalence of depression among those in Appalachia living with T2DM; this gap persists despite the higher regional prevalence of T2DM and challenging social determinants of health. Purpose: This study aimed to provide greater detail about the relationships between T2DM and depressive symptoms in adults living in Appalachia Kentucky. Methods: The present study was a cross-sectional analysis of baseline data derived from an ongoing study of Appalachia Kentucky adults living with T2DM. Outcome data included demographics, Center for Epidemiologic Studies Depression Scale, point-of-care HbA1c, and the Summary of Diabetes Self-Care Activities. Bivariate analysis was conducted using Pearson’s correlation to determine the statistically significant relationships between variables which were then included in a multiple regression model. Results: The sample (N=365), consisted primarily of women (n=230, 64.6%) of mean age 64 years (±10.6); almost all (98%) were non-Hispanic White (n=349), and most were married (n=208, 59.1%). The majority (47.2%) reported having two comorbid conditions (n=161), including T2DM, and the mean HbA1c was 7.7% (1.7). Nearly 90% were nonsmokers (n=319). Depressive symptoms were reported in 25% (n=90) of participants. A higher number of comorbid conditions, increased age, Medicaid insurance, tobacco use, lower financial status, female sex, and disability compared to fully employed status all were correlated with a higher rate of depressive symptoms (r ≤ 0.2). The regression indicated that depressive symptoms were associated with age (β = –0.010, p = 0.001); full-time employment status compared to those who are disabled (β = –.0209, p = 0.18); men compared to women (β = –0.122, p = 0.042), and those who smoke compared to nonsmokers (β = 0.175, p = 0.038). Implications: Depressive symptoms were correlated with T2DM among this sample of Appalachian residents with poorly controlled T2DM, especially among women. Given the vast number of social determinants (e.g., poverty, food insecurity, and rurality) affecting this population, healthcare providers must assess for depression and consider its negative influence on the patient’s ability to achieve glycemic control

The Mediating/Moderating Role of Cultural Context Factors on Self-Care Practices among Those Living with Diabetes in Rural Appalachia

Background The aim of this study was to examine whether cultural factors, such as religiosity and social support, mediate/moderate the relationship between personal/psychosocial factors and T2DM self-care in a rural Appalachian community. Methods Regression models were utilized to assess for mediation and moderation. Multilevel linear mixed effects models and GEE-type logistic regression models were fit for continuous (social support, self-care) and binary (religiosity) outcomes, respectively. Results The results indicated that cultural context factors (religiosity and social support) can mediate/moderate the relationship between psychosocial factors and T2DM self-care. Specifically, after adjusting for demographic variables, the findings suggested that social support may moderate the effect of depressive symptoms and stress on self-care. Religiosity may moderate the effect of distress on self-care, and empowerment was a predictor of self-care but was not mediated/moderated by the assessed cultural context factors. When considering health status, religiosity was a moderately significant predictor of self-care and may mediate the relationship between perceived health status and T2DM self-care. Conclusions This study represents the first known research to examine cultural assets and diabetes self-care practices among a community-based sample of Appalachian adults. We echo calls to increase the evidence on social support and religiosity and other contextual factors among this highly affected population. Trial registration US National Library of Science identifier NCT03474731. Registered March 23, 2018, www.clinicaltrials.gov

Using the L1 in L2 writing : the role of writing strategies across proficiency levels and writing tasks

Tesis (Profesor de Inglés para la Enseñanza Básica y Media, Licenciado en Educación)Several studies have investigated how students integrate the first language (L1) for the function of acquiring L2 writing proficiency (Murphy & Roca de Larios, 2010; Sasaki, 2000; Stapa & Majid, 2012; Wang & Wen, 2002). In the case of L2 writers, their language ability is limited whereas L1 can be used to sustain their writing (Wolfersberger, 2003). English as a Foreign Language learners rely on their first language since they use it as an instrument for their writing when they attempt to compose a written piece. They might use transfer as a tool to learn or as a means to convey their meaning, and they may also use it to formulate hypotheses about target language and to test those hypotheses (Khaled & Hossein, 2013). However, there is still no consensus that relates the degree of L1 use and various writing strategies in L2 writing to student proficiency levels and writing genres or writing tasks (Kim & Yoon, 2014). Furthermore, L1 use on L2 writing tasks has been found to be harmful for students since different structures from the L1 can cause interference in the L2. L1 interference with regard to the terms ‘cross-linguistic’ and ‘language transfer’ refers to the influence of native language structures on students’ performance and development in the target language (Hashim, 1999). There are many cases, in which interference from students’ mother tongue can influence second language acquisition. Therefore, the present study sought to explore the writing strategies utilized by these participants when generating a writing piece. The amount of L1 use was analyzed to determine if it had an impact on their writing proficiency across writing tasks and writing proficiency levels. The data was collected through a placement test (Appendix D), writing tasks (Appendices F and G), and think aloud protocols (Appendix E) (the process of recording the learners’ thoughts while they complete each task). The writing tasks consisted on producing one narrative and argumentative text per participant. Results showed the different writing strategies used by the participants when they performed the L2 writing activities. These strategies were identified and discussed in light of the different proficiency levels of these participants. Furthermore, the researchers determined the amount of L1 and L2 employed by the participants during the L2 writing process and the frequency of strategy use by the participants on each writing task narrative and argumentative. Finally, researchers came up with some recommendations for future research regarding the use of the L1 in L2 writing.Múltiples estudios han investigado cómo estudiantes integran su lengua materna mientras adquieren la habilidad de escribir en un segundo idioma (Murphy & Roca de Larios, 2010; Sasaki, 2000; Stapa & Majid, 2012; Wang & Wen, 2002). En el caso de estos aprendices, el lenguaje tiende a ser limitado así que pueden recurrir a su lengua materna para apoyar su proceso de escritura (Wolfersberger, 2003). Los estudiantes de Inglés como Idioma Extranjero dependen de su primer idioma, ya que lo usan como un instrumento para su escritura en el proceso de composición de una pieza escrita. Pueden usar esta estrategia como herramienta o como medio para comunicar el significado de su mensaje; puede que la usen para formular hipótesis acerca del lenguaje que están aprendiendo, y para probar éstas mismas (Khaled & Hossein, 2013). Sin embargo, todavía no existe consenso que se relacione al grado de uso de la lengua materna y estrategias para escribir en el lenguaje que está siendo adquirido, con los niveles de competencia en el idioma y los géneros y tareas de escritura (Kim & Yoon, 2014). No obstante, se ha descubierto que el uso de la lengua materna en tareas de escritura en el segundo idioma es perjudicial para los estudiantes, ya que las diferentes estructuras del primer idioma pueden causar interferencia con la lengua extranjera. La interferencia en términos de translingüística y transferencia del idioma se refieren a la influencia de estructuras del idioma nativo en el desempeño de los estudiantes y su desarrollo en el lenguaje extranjero. Hay muchos casos en que la interferencia está presente debido al uso de la lengua materna en el segundo idioma. Este estudio exploró las estrategias de escritura utilizadas por estos participantes mientras creaban una pieza escrita. La cantidad del uso de la lengua materna fue analizada para determinar si tendría algún impacto en su nivel de escritura. Los datos fueron recolectados a través de una prueba de nivel, tareas escritas, y protocolos de ‘pensar en voz alta’ (el proceso de grabar los pensamientos de los estudiantes mientras completan una tarea). Las tareas escritas consistieron en producir un texto narrativo y uno argumentativo por participante. Los resultados mostraron las diferentes estrategias de escritura usadas por los participantes mientras completaban tareas en el idioma extranjero. Estas estrategias fueron identificadas y discutidas junto al nivel de cada participante. Además, los investigadores determinaron la cantidad de lengua materna y lengua extranjera usada por los participantes en el proceso de escritura en su segundo idioma y la frecuencia del uso de estrategias en cada tarea escrita, ya fuese de tipo narrativa o argumentativa. Finalmente, los investigadores crearon algunas recomendaciones para futuras investigaciones sobre el uso del idioma nativo en el idioma extranjer

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Dissipative Charging of a Quantum Battery

© 2019 American Physical Society.We show that a cyclic unitary process can extract work from the thermodynamic equilibrium state of an engineered quantum dissipative process. Systems in the equilibrium states of these processes serve as batteries, storing energy. The dissipative process that brings the battery to the active equilibrium state is driven by an agent that couples the battery to thermal systems. The second law of thermodynamics imposes a work cost for the process; however, no work is needed to keep the battery in that charged state. We consider simple examples of these batteries and discuss situations in which the charged state has full population inversion, in which case the extractable work is maximal, and circumstances in which the efficiency of the process is maximal

Spectral, scattering and transport properties of quantum systems and graphs

Doctorat en Sciencesinfo:eu-repo/semantics/nonPublishe

The thermodynamic cost of driving quantum systems by their boundaries

Artículo de publicación ISIThe laws of thermodynamics put limits to the efficiencies of thermal machines. Analogues of these laws are now established for quantum engines weakly and passively coupled to the environment providing a framework to find improvements to their performance. Systems whose interaction with the environment is actively controlled do not fall in that framework. Here we consider systems actively and locally coupled to the environment, evolving with a so-called boundary-driven Lindblad equation. Starting from a unitary description of the system plus the environment we simultaneously obtain the Lindblad equation and the appropriate expressions for heat, work and entropy-production of the system extending the framework for the analysis of new, and some already proposed, quantum heat engines. We illustrate our findings in spin 1/2 chains and explain why an XX chain coupled in this way to a single heat bath relaxes to thermodynamic-equilibrium while and XY chain does not. Additionally, we show that an XX chain coupled to a left and a right heat baths behaves as a quantum engine, a heater or refrigerator depending on the parameters, with efficiencies bounded by Carnot efficiencies.Fondecyt 115139

Respuesta productiva de la trucha arcoiris (Oncorhynchus mykiss) alimentadas con dietas extruidas isoproteicas con distintos niveles de energía

Tesis (Ingeniero en Acuicultura)Se midió la respuesta productiva de la trucha arcoiris con un peso inicial de 80 g por 90 días, frente a 3 dietas de distinto tenor lipídico, 16, 22 y 30% , obteniendo niveles energéticos de 3500 , 4000 y 4600 Kcal EM/Kg de alimento respectivamente. El aporte protéico fue de 40% para todas las dietas. La dieta de mayor energía logró una mejor respuesta en la variable consumo de alimento y eficiencia de conversión alimenticia. Los indicadores productivos ganancia de peso y tasa de crecimiento diario no evidenciaron diferencias entre los distintos tratamientos. El rendimiento de la canal al final del ensayo fue superior para la dieta de menor energía. Referente al análisis químico de los filetes, éste arrojó un mayor contenido de grasa y menor tenor protéico a medida que se incrementó el nivel lipídico de la dieta

Influencia de la oralidad en la motivación de las resoluciones judiciales en el marco del nuevo código procesal penal en el Distrito Judicial de Tacna en el año 2013

El objetivo del estudio se centró en determinar la influencia de la oralidad de las resoluciones judiciales en la motivación de las resoluciones judiciales en el marco del nuevo Código Procesal Penal del Distrito Judicial de Tacna en el 2013. El tipo de investigación fue jurídico social y el diseño descriptivo. La población de estudio fueron 13 116 audiencias orales. Los principales resultados indican que la oralidad en las audiencias permite al Juez tomar una decisión, determinando la situación jurídica del procesado. Se concluye que la oralidad ha influido en la decisión del Juez, en la etapa de investigación preparatoria, intermedia y de juzgamiento.Tesi