Patient-Centered Outcomes for GoStrong: A Self-Management Diabetes Program in Savannah, GA

Background: To advance the goal of health improvement for diverse populations with diabetes, a patient-centered approach is foundational. Methods: Innovative methods were used to initiate and advance an approach to diabetes engagement and self-management. We began with a strategy to understand how patients with diabetes view and interact with the disease via the medical community and moved to program development through patient-centered design and to the development of strategic partnerships and continuous learning from patients, stakeholders, and academic research partners. Results: The mean age of the participants in the GoStrong™ program (n=106) was 51 ±9.2 (SD) years. There were significant differences in the HbA1c levels over time compared to the Control group (n=100). The mean HbA1c level from baseline to 36 months decreased from 7.49% to 6.89%, with the largest decline (to 6.28%, p\u3c0.01) at 12 months. The mean HbA1c level for the control group increased from 8.38% to 8.49% from baseline to 36 months, with the largest increase (to 8.89%, p\u3c0.01) at 18 months. There were significant differences for total medical costs at 12 months prior to and 12 months after starting the GoStrong program, a difference in total prescription drug costs at 12 months, and differences within the total group in number of emergency room (ER) visits. Claims information showed that GoStrong produced significantly lower total medical costs and ER visits. There was also an increase in total prescription drug costs that may be due to better medication adherence. Conclusions: For diabetics, the GoStrong program results in reduced HbA1c levels, reduced costs, and reduced ER visits

A NONLINEAR VISCOELASTIC MODEL FOR THE RELAXATION BEHAVIOR OF TENDON

INTRODUCTION Tendons are viscoelastic materials which undergo stress relaxation when held at a constant strain. The most successful model used to describe the viscoelastic behavior of tendons is the quasi-linear viscoelastic (QLV) model In this study, a transversely isotropic nonlinear viscoelastic model for the stress relaxation of rat tail tendon fascicles is presented. The model is formulated within the nonlinear viscoelastic framework set forth by Pipkin and Rogers [3] by considering recent theoretical developments by Rajagopal and Wineman [4] for anisotropic materials. The current model represents a departure from current viscoelastic models widely used in biomechanics for soft biological tissues because it incorporates a nonseparable relaxation which is a function of the strain invariants and time. It is validated using stress relaxation data collected at multiple strain levels from rat tail tendon fascicles and compared to the predictions of the QLV model

Modulation of interleukin 2 high affinity binding to human T cells by a pyrimidodiazepine insect metabolite

AbstractAn insect metabolite containing the little known pyrimido[4,5-b][l,4]diazepine ring system has been found to act as an effective mimic of tetrahydrobiopterin in its ability to modulate the affinity of interleukin 2 (IL-2) for its receptors on human T cells. Semi-empirical molecular orbital calculations reveal that while tetrahydrobiopterin has considerable flexibility, the pyrimidodiazepine has rather few conformational options and offers a useful model for exploring the nature of the pterin binding site

Possible Transport of Basal Debris to the Surface of a Mid-Latitude Glacier on Mars

International audience<p><strong>Introduction:</strong> We observe internal flow structures within a viscous flow feature (VFF; 51.24°W, 42.53°S) interpreted as a debris-covered glacier in Nereidum Montes, Mars. The structures are exposed in the wall of a gully that is incised through the VFF, parallel to its flow-direction. They are near to the glacier terminus and appear to connect its deep interior (and possibly its bed) to arcuate flow-transverse foliations on its surface. Such foliations are common on VFF surfaces, but their relation to VFF-internal structures and ice flow is poorly understood. The VFF-internal structures we observe are reminiscent of up-glacier dipping shear structures that transport basal debris to glacier surfaces on Earth.</p><p>Subglacial environments on Mars are of astrobiological interest due to the availability of water ice and shelter from Mars’ surface radiation environment. However, current limitations in drilling technology prevent their direct exploration. If debris on VFF surfaces contains a component of englacial and/or subglacial debris, those materials could be sampled without access to the subsurface. This could reduce the potential cost and complexity of future missions that aim to explore englacial and subglacial environments on Mars.</p><p><strong>Methods: </strong>We use a 1 m/pixel digital elevation model (DEM) derived from 25 cm/pixel High Resolution Imaging Science Experiment (HiRISE) stereo-pair images, and a false-colour (merged IRB) HiRISE image. We measured the dip and strike of the VFF-internal structures using ArcGIS 10.7 and QGIS software. We also input the DEM (and an inferred glacier bed topography derived from it) into ice flow simulations using the Ice Sheet System Model, assuming no basal sliding and present-day mean annual surface temperature (210K).</p><p><strong>Results and Discussion: </strong>The VFF-internal structures dip up-glacier at ~20° from the bed. This is inconsistent with their formation by bed-parallel ice-accumulation layering without modification by ice flow. The VFF-internal structures and surface foliations are spectrally ‘redder’ than adjacent VFF portions, which appear ‘bluer’. This could result from differences in debris concentration and/or surficial dust trapping between the internal structures and the bulk VFF. Modelling experiments suggest that the up-glacier-dipping structures occur at the onset of a compressional regime as ice flow slowed towards the VFF terminus.</p><p>In cold-based glaciers on Earth, up-glacier-dipping folds are common approaching zones of enhanced ice rigidity near the glacier margin. Where multiple folds co-exist, the outermost typically comprises basal ice with a component of subglacial debris entrained in the presence of interfacial films of liquid water at sub-freezing temperatures. In polythermal glaciers, debris-rich up-glacier-dipping thrust faults form where sliding wet-based ice converges with cold-based ice.</p><p><strong>Conclusions: </strong>We propose that the observed up-glacier-dipping VFF-internal structures are englacial shear zones formed by compressional ice flow. They could represent transport pathways for englacial and subglacial material to the VFF surface. The majority of extant mid-latitude VFF on Mars are thought to have been perennially cold-based; thus we favour the hypothesis that the VFF-internal structures are folds formed under a cold-based thermal regime. Under this mechanism, the outermost surface foliation, and its corresponding VFF-internal structure, is the most likely to contain subglacial debris.</p&gt

Internal Structure of a Glacier on Mars Revealed by Gully Incision

International audienceDebris transport from / A Mars glacier bed to / Flowlines on surface

The Iowa Homemaker vol.7, no.10

The Iowa Homemaker Has a Birthday by Ruth Morrison, page 1 Chow Mein versus Chop Suey by Frances Thomas, page 2 Veishea, 1928 by Ruth M. Davis, page 3 News Bits by Margaret Davidson and Rosemary Koeberle, page 4 Sandwiches for Your Spring Menu by Caroline E. Morrell, page 5 4-H Club by Mrs. Edith Barker, page 6 State Association Page by Marcia E. Turner, page 8 Home Economics Research at Iowa State by Melba Nisewanger, page 10 Editorial, page 11 Who’s There and Where by Vera Caulum, page 12 Window Boxes by Gladys Parker, page 1

Regulating Clothing Outwork: A Sceptic's View

By applying the strategies of international anti-sweatshop campaigns to the Australian context, recent regulations governing home-based clothing production hold retailers responsible for policing the wages and employment conditions of clothing outworkers who manufacture clothing on their behalf. This paper argues that the new approach oversimplifies the regulatory challenge by assuming (1) that Australian clothing production is organised in a hierarchical ‘buyer-led’ linear structure in which core retail firms have the capacity to control their suppliers’ behaviour; (2) that firms act as unitary moral agents; and (3) that interventions imported from other times and places are applicable to the contemporary Australian context. After considering some alternative regulatory approaches, the paper concludes that the new regulatory strategy effectively privatises responsibility for labour market conditions – a development that cries out for further debate

Bostonia: The Boston University Alumni Magazine. Volume 10

Founded in 1900, Bostonia magazine is Boston University's main alumni publication, which covers alumni and student life, as well as university activities, events, and programs

Steam and Flame Applications as Novel Methods of Population Control for Invasive Asian Clam (Corbicula fluminea) and Zebra Mussel (Dreissena polymorpha)

Control strategies for established populations of invasive alien species can be costly and complex endeavours, which are frequently unsuccessful. Therefore, rapid-reaction techniques that are capable of maximising efficacy whilst minimising environmental damage are urgently required. The Asian clam (Corbicula fluminea Müller, 1774), and the zebra mussel (Dreissena polymorpha Pallas, 1771), are invaders capable of adversely affecting the functioning and biodiversity of freshwater ecosystems. Despite efforts to implement substantial population-control measures, both species continue to spread and persist within freshwater environments. As bivalve beds often become exposed during low-water conditions, this study examined the efficacy of steam-spray (≥100 °C, 350 kPa) and open-flame burn treatments (~1000 °C) to kill exposed individuals. Direct steam exposure lasting for 5 min caused 100% mortality of C. fluminea buried at a depth of 3 cm. Further, combined rake and thermal shock treatments, whereby the substrate is disturbed between each application of either a steam or open flame, caused 100% mortality of C. fluminea specimens residing within a 4-cm deep substrate patch, following three consecutive treatment applications. However, deeper 8-cm patches and water-saturated substrate reduced maximum bivalve species mortality rates to 77% and 70%, respectively. Finally, 100% of D. polymorpha specimens were killed following exposure to steam and open-flame treatments lasting for 30 s and 5 s, respectively. Overall, our results confirm the efficacy of thermal shock treatments as a potential tool for substantial control of low-water-exposed bivalves. Although promising, our results require validation through upscaling to field application, with consideration of other substrate types, increased substrate depth, greater bivalve densities, non-target and long-term treatment effects

Why is it difficult to implement e-health initiatives? A qualitative study

<b>Background</b> The use of information and communication technologies in healthcare is seen as essential for high quality and cost-effective healthcare. However, implementation of e-health initiatives has often been problematic, with many failing to demonstrate predicted benefits. This study aimed to explore and understand the experiences of implementers - the senior managers and other staff charged with implementing e-health initiatives and their assessment of factors which promote or inhibit the successful implementation, embedding, and integration of e-health initiatives.<p></p> <b>Methods</b> We used a case study methodology, using semi-structured interviews with implementers for data collection. Case studies were selected to provide a range of healthcare contexts (primary, secondary, community care), e-health initiatives, and degrees of normalization. The initiatives studied were Picture Archiving and Communication System (PACS) in secondary care, a Community Nurse Information System (CNIS) in community care, and Choose and Book (C&B) across the primary-secondary care interface. Implementers were selected to provide a range of seniority, including chief executive officers, middle managers, and staff with 'on the ground' experience. Interview data were analyzed using a framework derived from Normalization Process Theory (NPT).<p></p> <b>Results</b> Twenty-three interviews were completed across the three case studies. There were wide differences in experiences of implementation and embedding across these case studies; these differences were well explained by collective action components of NPT. New technology was most likely to 'normalize' where implementers perceived that it had a positive impact on interactions between professionals and patients and between different professional groups, and fit well with the organisational goals and skill sets of existing staff. However, where implementers perceived problems in one or more of these areas, they also perceived a lower level of normalization.<p></p> <b>Conclusions</b> Implementers had rich understandings of barriers and facilitators to successful implementation of e-health initiatives, and their views should continue to be sought in future research. NPT can be used to explain observed variations in implementation processes, and may be useful in drawing planners' attention to potential problems with a view to addressing them during implementation planning