Factors contributing to attrition behavior in diabetes self-management programs: A mixed method approach

<p>Abstract</p> <p>Background</p> <p>Diabetes self-management education is a critical component in diabetes care. Despite worldwide efforts to develop efficacious DSME programs, high attrition rates are often reported in clinical practice. The objective of this study was to examine factors that may contribute to attrition behavior in diabetes self-management programs.</p> <p>Methods</p> <p>We conducted telephone interviews with individuals who had Type 2 diabetes (n = 267) and attended a diabetes education centre. Multivariable logistic regression was performed to identify factors associated with attrition behavior. Forty-four percent of participants (n = 118) withdrew prematurely from the program and were asked an open-ended question regarding their discontinuation of services. We used content analysis to code and generate themes, which were then organized under the Behavioral Model of Health Service Utilization.</p> <p>Results</p> <p>Working full and part-time, being over 65 years of age, having a regular primary care physician or fewer diabetes symptoms were contributing factors to attrition behaviour in our multivariable logistic regression. The most common reasons given by participants for attrition from the program were conflict between their work schedules and the centre's hours of operation, patients' confidence in their own knowledge and ability when managing their diabetes, apathy towards diabetes education, distance to the centre, forgetfulness, regular physician consultation, low perceived seriousness of diabetes, and lack of familiarity with the centre and its services. There was considerable overlap between our quantitative and qualitative results.</p> <p>Conclusion</p> <p>Reducing attrition behaviour requires a range of strategies targeted towards delivering convenient and accessible services, familiarizing individuals with these services, increasing communication between centres and their patients, and creating better partnerships between centres and primary care physicians.</p

Active-site structure, binding and redox activity of the heme–thiolate enzyme CYP2D6 immobilized on coated Ag electrodes: a surface-enhanced resonance Raman scattering study

Surface-enhance resonance Raman scattering spectra of the heme–thiolate enzyme cytochrome P450 2D6 (CYP2D6) adsorbed on Ag electrodes coated with 11-mercaptoundecanoic acid (MUA) were obtained in various experimental conditions. An analysis of these spectra, and a comparison between them and the RR spectra of CYP2D6 in solution, indicated that the enzyme’s active site retained its nature of six-coordinated low-spin heme upon immobilization. Moreover, the spectral changes detected in the presence of dextromethorphan (a CYP2D6 substrate) and imidazole (an exogenous heme axial ligand) indicated that the immobilized enzyme also preserved its ability to reversibly bind a substrate and form a heme–imidazole complex. The reversibility of these processes could be easily verified by flowing alternately solutions of the various compounds and the buffer through a home-built spectroelectrochemical flow cell which contained a sample of immobilized protein, without the need to disassemble the cell between consecutive spectral data acquisitions. Despite immobilized CYP2D6 being effectively reduced by a sodium dithionite solution, electrochemical reduction via the Ag electrode was not able to completely reduce the enzyme, and led to its extensive inactivation. This behavior indicated that although the enzyme’s ability to exchange electrons is not altered by immobilization per se, MUA-coated electrodes are not suited to perform direct electrochemistry of CYP2D6

Deep sea tests of a prototype of the KM3NeT digital optical module

The first prototype of a photo-detection unit of the future KM3NeT neutrino telescope has been deployed in the deepwaters of the Mediterranean Sea. This digital optical module has a novel design with a very large photocathode area segmented by the use of 31 three inch photomultiplier tubes. It has been integrated in the ANTARES detector for in-situ testing and validation. This paper reports on the first months of data taking and rate measurements. The analysis results highlight the capabilities of the new module design in terms of background suppression and signal recognition. The directionality of the optical module enables the recognition of multiple Cherenkov photons from the same (40)Kdecay and the localisation of bioluminescent activity in the neighbourhood. The single unit can cleanly identify atmospheric muons and provide sensitivity to the muon arrival directions

Acompanhamento de pacientes submetidos à cirurgia bariátrica : aspectos laboratoriais nos períodos pré e pós-operatório

Dissertação (mestrado) - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Programa de Pós-Graduação em Farmácia, Florianópolis, 2017A obesidade é uma doença crônica e endócrino-metabólica caracterizada pelo acúmulo excessivo de triacilgliceróis no tecido adiposo, capaz de ser revertida ou amenizada através de intervenção cirúrgica. Epidemiologicamente têm sido descritas associações entre o excesso de peso, resistência à insulina e processo inflamatório crônico. Além disso, nas últimas décadas o sistema complemento foi associado a doenças metabólicas e cardiovasculares e intimamente relacionado com a obesidade e resistência à insulina. Sendo assim, a melhora do estado metabólico e a remissão da inflamação em pacientes obesos submetidos à cirurgia bariátrica foram avaliadas, bem como a associação dos fatores 3 e 4 (C3 e C4) do sistema complemento com a sensibilidade à insulina e a perda de peso após a cirurgia bariátrica. Para isso, a presença de comorbidades e as concentrações séricas de leptina, adiponectina, resistina e grelina foram avaliados em pacientes obesos mórbidos antes, 1, 3 e 6 meses após a cirurgia bariátrica. Também foram medidas as concentrações de IL-1ß, IL-6, TNF-a, proteína amiloide sérica A (SAA), proteína quimiotática de monócitos 1 (MCP-1), C3, C4, glicose, insulina, colesterol total, triacilglicerol, LDL- colesterol, HDL-colesterol e foi realizado o cálculo do modelo de avaliação da homeostase da resistência à insulina (HOMA-IR) durante o seguimento da cirurgia, bem como em comparação com um grupo de indivíduos não-obesos. Como resultado, observou-se uma redução significativa de peso acompanhada de melhora do perfil lipídico, da sensibilidade à insulina e das comorbidades. Ainda, houve diminuição de leptina e aumento de adiponectina no período pós-cirúrgico. IL-1ß, IL-6, TNF-a, MCP-1 e SAA não mostraram diferença no acompanhamento da cirurgia, porém SAA correlacionou-se com o IMC e apresentou-se muito mais alto no grupo de pacientes obesos. Além disso, C3 e C4 foram significativamente maiores em indivíduos obesos quando comparados aos indivíduos não-obesos e C3 e C4 foram positivamente correlacionados com HOMA-IR e as concentrações de C3 foram significativamente diminuídas após a cirurgia. Com base nesses resultados, a cirurgia bariátrica mostrou melhorar o estado metabólico melhorando as comorbidades associadas à obesidade e os biomarcadores de adiposidade leptina e adiponectina, mas não os demais hormônios e citocinas inflamatórias e C3 e C4 foram fortemente associados à sensibilidade à insulina.Abstract: Obesity is a chronic and endocrine-metabolic disease characterized by triacylglycerol accumulation in the adipose tissue, which can be reversed or improved through surgical intervention. Epidemiologically, associations between overweight, insulin resistance and chronic inflammatory process have been described. Furthermore, in the last decades the complement system was associated with metabolic and cardiovascular diseases and related to obesity and insulin resistance. Thus, metabolic status improvement and inflammation remission in obese patients undergoing bariatric surgery were evaluated, as well as the association of complement system factors 3 and 4 (C3 and C4) with insulin sensitivity and weight loss after bariatric surgery. For this, comorbidities and leptin, adiponectin, resistin and ghrelin serum concentrations were evaluated in morbidly obese patients before, 1, 3 and 6 months after bariatric surgery. IL-1ß, IL-6, TNF-a, serum amyloid A protein (SAA), monocyte chemotactic protein 1 (MCP-1), C3, C4, glucose, insulin, total cholesterol, triacylglycerol, LDL-cholesterol, HDL-cholesterol concentrations and the calculation of the homeostasis model of insulin resistance (HOMA-IR) were performed during the surgery follow-up, as well in a group of non-obese individuals. As a result, significant weight loss followed by improvement in lipid profile, insulin sensitivity and comorbidities were observed. Still, there was a decrease in leptin and an increase in adiponectin in the postoperative period. IL-1ß, IL-6, TNF-a, MCP-1 and SAA showed no difference after surgery, but SAA correlated with BMI and was much higher in obese patients. In addition, both C3 and C4 were significantly higher in obese individuals when compared to lean individuals and positively correlated with HOMA-IR. C3 concentrations were significantly decreased after surgery. Based on these results, bariatric surgery has been shown to improve metabolic status by improving obesity-associated comorbidities and adiposity biomarkers leptin and adiponectin but not the other hormones and inflammatory cytokines and C3 and C4 were strongly associated with insulin sensitivity

Search for gravitational waves associated with gamma-ray bursts detected by Fermi and Swift during the LIGO–Virgo run O3b

We search for gravitational-wave signals associated with gamma-ray bursts (GRBs) detected by the Fermi and Swift satellites during the second half of the third observing run of Advanced LIGO and Advanced Virgo (2019 November 1 15:00 UTC–2020 March 27 17:00 UTC). We conduct two independent searches: a generic gravitational-wave transients search to analyze 86 GRBs and an analysis to target binary mergers with at least one neutron star as short GRB progenitors for 17 events. We find no significant evidence for gravitational-wave signals associated with any of these GRBs. A weighted binomial test of the combined results finds no evidence for subthreshold gravitational-wave signals associated with this GRB ensemble either. We use several source types and signal morphologies during the searches, resulting in lower bounds on the estimated distance to each GRB. Finally, we constrain the population of low-luminosity short GRBs using results from the first to the third observing runs of Advanced LIGO and Advanced Virgo. The resulting population is in accordance with the local binary neutron star merger rate