Barriers to Participating in Diabetes Care Behaviors in Hard to Reach Older Hispanics

The purpose of this study was to present the challenges faced when implementing a diet and exercise intervention for low-income older Hispanics with type 2 diabetes. This was a first of its kind observational study of recruitment, attendance, and characteristics in a Spanish-speaking community government funded congregate meal site. This report evaluated retention and diabetes self-management beliefs of Hispanic adults ≥60 years with type 2 diabetes (n=17) at baseline, and completion of the six-month intervention in terms of the Health Belief Model. There was limited interest in controlling diabetes with diet and exercise. Major barriers included lack of perceived vulnerability to diabetes complications and a belief that medication alone is sufficient to stabilize blood glucose. Environmental barriers included lack of transportation, access to exercise groups, access grocery stores, and limited ability to pay for healthy foods. A lesson learned from this intervention was that the diet and exercise intervention given was insufficient as a cue to action to engage in diet and exercise behavior changes. Interventions to engage low-income, older Hispanics with diabetes in diet and exercise need to consider strategies to overcome barriers such as health beliefs, transportation issues, and lack of access to nutritious food

Managing Chronic Pain in an Opioid Crisis: What is the Role of Shared Decision-Making?

Shared decision-making (SDM) is a widely-advocated practice that has been linked to improved patient adherence, satisfaction, and clinical outcomes. SDM is a process in which patients and providers share information, express opinions, and build consensus toward a treatment decision. Chronic pain and its treatment present unique challenges for SDM, especially in the current environment in which opioids are viewed as harmful and a national opioid crisis has been declared. The purpose of this qualitative study is to understand treatment decision-making with patients taking opioids for chronic pain. Ninety-five clinic visits and 31 interviews with patients and primary care providers (PCPs) were analyzed using the constant comparison method. Results revealed that 1) PCPs desire patient participation in treatment decisions, but with caveats where opioids are concerned; 2) Disagreements about opioids, including perceptions of lack of listening, presented challenges to SDM; and 3) PCPs described engaging in persuasion or negotiation to convince patients to try alternatives to opioids, or appeasing patients requesting opioids with very small amounts in an effort to maintain the patient-provider relationship. Results are discussed through the lens of Charles, Gafni, and Whelan’s SDM model, and implications of the role of the patient-provider relationship in SDM and chronic pain treatment are discussed

“I’m Not Gonna Pull the Rug out from under You”: Patient-Provider Communication about Opioid Tapering

In response to increases in harms associated with prescription opioids, opioid prescribing has come under greater scrutiny, leading many healthcare organizations and providers to consider or mandate opioid dose reductions (tapering) for patients with chronic pain. Communicating about tapering can be difficult, particularly for patients on long-term opioids who perceive benefits and are using their medications as prescribed. Given the importance of effective patient-provider communication for pain management and recent health system-level initiatives and provider practices to taper opioids, this study used qualitative methods to understand communication processes related to opioid tapering, to identify best practices and opportunities for improvement. Up to 3 clinic visits per patient were audio-recorded, and individual interviews were conducted with patients and their providers. Four major themes emerged: 1) Explaining—Patients needed to understand individualized reasons for tapering, beyond general, population-level concerns such as addiction potential; 2) Negotiating—Patients needed to have input, even if it was simply the rate of tapering; 3) Managing difficult conversations—When patients and providers did not reach a shared understanding, difficulties and misunderstandings arose; 4) Non-abandonment—Patients needed to know that their providers would not abandon them throughout the tapering process

Cambial Phenology Informs Tree-Ring Analysis of Fire Seasonality in Coastal Plain Pine Savannas

© 2018, The Author(s). Understanding of historical fire seasonality should facilitate development of concepts regarding fire as an ecological and evolutionary process. In tree-ring based fire-history studies, the seasonality of fire scars can be classified based on the position of the fire scar within or between growth rings. Cambial phenology studies are needed to precisely relate a fire-scar position to months within a year because the timing of dormancy, earlywood production, and latewood production varies by species and location. We examined cambial phenology patterns of longleaf pine (Pinus palustris Mill.), slash pine (P. elliottii Engelm.), and South Florida slash pine (P. densa [Little & K.W Dorman] Silba) at sites in southern Georgia and south-central and northern Florida, USA. We developed long-term (2.5 yr to 12 yr) datasets of monthly growth and dormancy and determined when trees transitioned from producing early-wood to producing latewood each year. Most trees were dormant for a period of 1 to 2 months in the winter and transitioned from earlywood to latewood in June. Given the annual growth ring morphology of the pines that we studied and the timing of the lightning-fire season in our study area, we propose a new classification system for assigning seasonality to fire scars found in the three native upland pine species that we studied. This new system, which we name the Coastal Plain Pine System, accounts for the large proportion of latewood typical of these pines and includes a position (the transition position) that corresponds with the time of year when lightning fires occur most frequently. Our findings demonstrate how cambial phenology data can improve interpretation of fire-scar data for determining historical fire seasonality

Insecure messaging: how clinicians approach potentially problematic messages from patients

Objective: Secure messaging has become an integrated function of patient portals, but misuse of secure messaging by both patients and clinicians can lead to miscommunication and errors, such as overlooked urgent messages. We sought to uncover variations in clinician approaches and responses to messaging with patients. Methods: In this two-part study, 20 primary care clinicians (1) composed message responses to five hypothetical patient vignettes and messages and (2) were subsequently interviewed for their perspectives on appropriate circumstances for secure messaging. Messages and interviews were analyzed for themes. Results: Clinicians have different experiences with, and perceptions of, secure messaging. The messages the clinicians wrote were uniformly respectful, but differed in degrees of patient-centeredness and level of detail. None of the clinicians found their messaging workload to be unmanageable. From the interviews, we found divergent clinician perspectives about when to use secure messaging and how to respond to emotional content. Conclusion: Clinicians have different opinions about the appropriateness of secure messaging in response to specific medical issues. Our results noted a desire and need for greater guidance about secure messaging. This aspect of informatics education warrants greater attention in clinical practice. Practical implications: We summarize the types of issues raised by the participants yet to be addressed by existing guidelines. Further guidance from hospitals, professional societies, and other institutions that govern clinician behavior on the appropriateness and effectiveness of delivering care through secure messaging may aid clinicians and patients

Effects of exercise and diet on body composition and physical function in older hispanics with type 2 diabetes

Type 2 Diabetes mellitus (DM2) affects 9.3% of the U.S. population. Health disparities are evident in DM2; twice as many Hispanics as non-Hispanic Whites have DM2. The objective of this study was to pilot test the feasibility of implementing and evaluating trends of nutrition and exercise interventions to improve diabetes management and physical function in 29 disadvantaged older Hispanics with DM2. We delivered combined diet and exercise (n = 8) and diet-only (n = 6) interventions and compared the results to a control/no intervention group (n = 15). We cluster-randomized the participants into the three arms based on the senior center they attended. The interventions were delivered twice a week for 3 months (24 sessions) and assessments were conducted pre and post intervention. The results indicate the feasibility of implementing the interventions and slight improvements in both intervention groups compared to the control group. The diet-only group tended to have larger improvements on body composition measures (especially in muscle mass), while the diet + exercise group tended to have larger improvements on physical function (especially in chair stands). There was a high rate of attrition, especially in the diet + exercise group, but those who completed the intervention tended to have improvements in body composition and physical function

Molecular alterations in skeletal muscle in rheumatoid arthritis are related to disease activity, physical inactivity, and disability

Abstract Background: To identify molecular alterations in skeletal muscle in rheumatoid arthriti

Measurement of the Lifetime Difference Between B_s Mass Eigenstates

We present measurements of the lifetimes and polarization amplitudes for B_s --> J/psi phi and B_d --> J/psi K*0 decays. Lifetimes of the heavy (H) and light (L) mass eigenstates in the B_s system are separately measured for the first time by determining the relative contributions of amplitudes with definite CP as a function of the decay time. Using 203 +/- 15 B_s decays, we obtain tau_L = (1.05 +{0.16}/-{0.13} +/- 0.02) ps and tau_H = (2.07 +{0.58}/-{0.46} +/- 0.03) ps. Expressed in terms of the difference DeltaGamma_s and average Gamma_s, of the decay rates of the two eigenstates, the results are DeltaGamma_s/Gamma_s = (65 +{25}/-{33} +/- 1)%, and DeltaGamma_s = (0.47 +{0.19}/-{0.24} +/- 0.01) inverse ps.Comment: 8 pages, 3 figures, 2 tables; as published in Physical Review Letters on 16 March 2005; revisions are for length and typesetting only, no changes in results or conclusion

The North American tree-ring fire-scar network

Fire regimes in North American forests are diverse and modern fire records are often too short to capture important patterns, trends, feedbacks, and drivers of variability. Tree-ring fire scars provide valuable perspectives on fire regimes, including centuries-long records of fire year, season, frequency, severity, and size. Here, we introduce the newly compiled North American tree-ring fire-scar network (NAFSN), which contains 2562 sites, >37,000 fire-scarred trees, and covers large parts of North America. We investigate the NAFSN in terms of geography, sample depth, vegetation, topography, climate, and human land use. Fire scars are found in most ecoregions, from boreal forests in northern Alaska and Canada to subtropical forests in southern Florida and Mexico. The network includes 91 tree species, but is dominated by gymnosperms in the genus Pinus. Fire scars are found from sea level to >4000-m elevation and across a range of topographic settings that vary by ecoregion. Multiple regions are densely sampled (e.g., >1000 fire-scarred trees), enabling new spatial analyses such as reconstructions of area burned. To demonstrate the potential of the network, we compared the climate space of the NAFSN to those of modern fires and forests; the NAFSN spans a climate space largely representative of the forested areas in North America, with notable gaps in warmer tropical climates. Modern fires are burning in similar climate spaces as historical fires, but disproportionately in warmer regions compared to the historical record, possibly related to under-sampling of warm subtropical forests or supporting observations of changing fire regimes. The historical influence of Indigenous and non-Indigenous human land use on fire regimes varies in space and time. A 20th century fire deficit associated with human activities is evident in many regions, yet fire regimes characterized by frequent surface fires are still active in some areas (e.g., Mexico and the southeastern United States). These analyses provide a foundation and framework for future studies using the hundreds of thousands of annually- to sub-annually-resolved tree-ring records of fire spanning centuries, which will further advance our understanding of the interactions among fire, climate, topography, vegetation, and humans across North America

The Longleaf Tree-Ring Network: Reviewing and expanding the utility of Pinus palustris Mill. Dendrochronological data

The longleaf pine (Pinus palustris Mill.) and related ecosystem is an icon of the southeastern United States (US). Once covering an estimated 37 million ha from Texas to Florida to Virginia, the near-extirpation of, and subsequent restoration efforts for, the species has been well-documented over the past ca. 100 years. Although longleaf pine is one of the longest-lived tree species in the southeastern US—with documented ages of over 400 years—its use has not been reviewed in the field of dendrochronology. In this paper, we review the utility of longleaf pine tree-ring data within the applications of four primary, topical research areas: climatology and paleoclimate reconstruction, fire history, ecology, and archeology/cultural studies. Further, we highlight knowledge gaps in these topical areas, for which we introduce the Longleaf Tree-Ring Network (LTRN). The overarching purpose of the LTRN is to coalesce partners and data to expand the scientific use of longleaf pine tree-ring data across the southeastern US. As a first example of LTRN analytics, we show that the development of seasonwood chronologies (earlywood width, latewood width, and total width) enhances the utility of longleaf pine tree-ring data, indicating the value of these seasonwood metrics for future studies. We find that at 21 sites distributed across the species’ range, latewood width chronologies outperform both their earlywood and total width counterparts in mean correlation coefficient (RBAR = 0.55, 0.46, 0.52, respectively). Strategic plans for increasing the utility of longleaf pine dendrochronology in the southeastern US include [1] saving remnant material (e.g., stumps, logs, and building construction timbers) from decay, extraction, and fire consumption to help extend tree-ring records, and [2] developing new chronologies in LTRN spatial gaps to facilitate broad-scale analyses of longleaf pine ecosystems within the context of the topical groups presented