The inclusion of ethnic minority patients and the role of language in telehealth trials for type 2 diabetes: A systematic review

BACKGROUND: Type 2 diabetes is a serious, pervasive metabolic condition that disproportionately affects ethnic minority patients. Telehealth interventions can facilitate type 2 diabetes monitoring and prevent secondary complications. However, trials designed to test the effectiveness of telehealth interventions may underrecruit or exclude ethnic minority patients, with language a potential barrier to recruitment. The underrepresentation of minorities in trials limits the external validity of the findings for this key patient demographic. OBJECTIVE: This systematic review examines (1) the research reporting practices and prevalence of ethnic minority patients included in telehealth randomized controlled trials (RCTs) targeting type 2 diabetes and the trial characteristics associated with recruiting a high proportion of minority patients, and (2) the proportion of included RCTs that report using English language proficiency as a patient screening criterion and how and why they do so. METHODS: Telehealth RCTs published in refereed journals targeting type 2 diabetes as a primary condition for adults in Western majority English-speaking countries were included. Ethnically targeted RCTs were excluded from the main review, but were included in a post hoc subgroup analysis. Abstract and full-text screening, risk of bias assessment, and data extraction were independently conducted by two reviewers. RESULTS: Of 3358 records identified in the search, 79 articles comprising 58 RCTs were included. Nearly two-thirds of the RCTs (38/58) reported on the ethnic composition of participants, with a median proportion of 23.5% patients (range 0%-97.7%). Fourteen studies (24%) that included at least 30% minority patients were all US-based, predominantly recruited from urban areas, and described the target population as underserved, financially deprived, or uninsured. Eight of these 14 studies (57%) offered intervention materials in a language other than English or employed bilingual staff. Half of all identified RCTs (29/58) included language proficiency as a participant-screening criterion. Language proficiency was operationalized using nonstandardized measures (eg, having sufficient "verbal fluency"), with only three studies providing reasons for excluding patients on language grounds. CONCLUSIONS: There was considerable variability across studies in the inclusion of ethnic minority patients in RCTs, with higher participation rates in countries with legislation to mandate their inclusion (eg, United States) than in those without such legislation (eg, United Kingdom). Less than 25% of the RCTs recruited a sizeable proportion of ethnic minorities, which raises concerns about external validity. The lack of objective measures or common procedures for assessing language proficiency across trials implies that language-related eligibility decisions are often based on trial recruiters' impressionistic judgments, which could be subject to bias. The variability and inconsistent reporting on ethnicity and other socioeconomic factors in descriptions of research participants could be more specifically emphasized in trial reporting guidelines to promote best practice

Control strategies for integration of electric motor assist and functional electrical stimulation in paraplegic cycling: Utility for exercise testing and mobile cycling

AIM: The aim of this study was to investigate feedback control strategies for integration of electric motor assist and functional electrical stimulation (FES) for paraplegic cycling, with particular focus on development of a testbed for exercise testing in FES cycling, in which both cycling cadence and workrate are simultaneously well controlled and contemporary physiological measures of exercise performance derived. A second aim was to investigate the possible benefits of the approach for mobile, recreational cycling. METHODS: A recumbent tricycle with an auxiliary electric motor is used, which is adapted for paraplegic users, and instrumented for stimulation control. We propose a novel integrated control strategy which simultaneously provides feedback control of leg power output (via automatic adjustment of stimulation intensity) and cycling cadence (via electric motor control). Both loops are designed using system identification and analytical (model-based) feedback design methods. Ventilatory and pulmonary gas exchange response profiles are derived using a portable system for real-time breath-by-breath acquisition. RESULTS:We provide indicative results from one paraplegic subject in which a series of feedback-control tests illustrate accurate control of cycling cadence, leg power control, and external disturbance rejection. We also provide physiological response profiles from a submaximal exercise step test and a maximal incremental exercise test, as facilitated by the control strategy. CONCLUSION: The integrated control strategy is effective in facilitating exercise testing under conditions of well-controlled cadence and power output. Our control approach significantly extends the achievable workrate range and enhances exercise-test sensitivity for FES cycling, thus allowing a more stringent characterization of physiological response profiles and estimation of key parameters of aerobic function.We further conclude that the control approach can significantly improve the overall performance of mobile recreational cycling

Prodigious submarine landslides during the inception and early growth of volcanic islands

Volcanic island inception applies large stresses as the ocean crust domes in response to magma ascension and is loaded by eruption of lavas. There is currently limited information on when volcanic islands are initiated on the seafloor, and no information regarding the seafloor instabilities island inception may cause. The deep sea Madeira Abyssal Plain contains a 43 million year history of turbidites among which many originate from mass movements in the Canary Islands. Here, we investigate the composition and timing of a distinctive group of turbidites that we suggest represent a new unique record of large-volume submarine landslides triggered during the inception, submarine shield growth, and final subaerial emergence of the Canary Islands. These slides are predominantly multi-stage and yet represent among the largest mass movements on the Earth’s surface up to three or more-times larger than subaerial Canary Islands flank collapses. Thus whilst these deposits provide invaluable information on ocean island geodynamics they also represent a significant, and as yet unaccounted, marine geohazard

Stratigraphy and chronology of a 15ka sequence of multi-sourced silicic tephras in a montane peat bog, eastern North Island, New Zealand.

We document the stratigraphy, composition, and chronology of a succession of 16 distal, silicic tephra layers interbedded with lateglacial and Holocene peats and muds up to c. 15 000 radiocarbon years (c. 18 000 calendar years) old at a montane site (Kaipo Bog) in eastern North Island, New Zealand. Aged from 665 +/- 15 to 14 700 +/- 95 14C yr BP, the tephras are derived from six volcanic centres in North Island, three of which are rhyolitic (Okataina, Taupo, Maroa), one peralkaline (Tuhua), and two andesitic (Tongariro, Egmont). Correlations are based on multiple criteria: field properties and stratigraphic interrelationships, ferromagnesian silicate mineral assemblages, glass-shard major element composition (from electron microprobe analysis), and radiocarbon dating. We extend the known distribution of tephras in eastern North Island and provide compositional data that add to their potential usefulness as isochronous markers. The chronostratigraphic framework established for the Kaipo sequence, based on both site-specific and independently derived tephra-based radiocarbon ages, provides the basis for fine-resolution paleoenvironmental studies at a climatically sensitive terrestrial site from the mid latitudes of the Southern Hemisphere. Tephras identified as especially useful paleoenvironmental markers include Rerewhakaaitu and Waiohau (lateglacial), Konini (lateglacial-early Holocene), Tuhua (middle Holocene), and Taupo and Kaharoa (late Holocene)

Mrk 609: resolving the circum-nuclear structure with near-infrared integral field spectroscopy

We present first results of near infrared J and H+K ESO-SINFONI integral field spectroscopy of the composite starburst/Seyfert 1.8 galaxy Mrk 609. The data were taken during the science verification period of SINFONI. We aim to investigate the morphology and excitation conditions within the central 2 kpc. Additional Nobeyama 45 m CO(1-0) data are presented, which we used to estimate the molecular gas mass. The source was selected from a sample of adaptive optics suitable, SDSS/ROSAT based, X-ray bright AGN with redshifts of 0.03 < z < 1. This sample allows for a detailed study of the NIR properties of the nuclear and host environments with high spectral and spatial resolution. Our NIR data reveal a complex emission-line morphology, possibly associated with a nuclear bar seen in the reconstructed continuum images. The detections of [SiVI] and a broad Pa alpha component are clear indicators for the presence of an accreting super-massive black hole at the center of Mrk 609. In agreement with previous observations we find that the circum-nuclear emission is not significantly extincted. The analysis of the high angular resolution rotational-vibrational molecular hydrogen and forbidden [FeII] emission reveals a LINER character of the nucleus. The large H_2 gas mass deduced from the CO(1-0) observation provides the fuel needed to feed the starburst and Seyfert activity in Mrk 609. High angular resolution imaging spectroscopy provides an ideal tool to resolve the nuclear and starburst contribution in active galaxies. We show that Mrk 609 exhibits LINER features, that appear to be hidden in larger aperture visible/NIR spectra.Comment: published by A&A, 19 pages, 16 figures, version with high resolution figures is available via http://www.ph1.uni-koeln.de/~zuther/mrk609.pd

The Intentional Use of Service Recovery Strategies to Influence Consumer Emotion, Cognition and Behaviour

Service recovery strategies have been identified as a critical factor in the success of. service organizations. This study develops a conceptual frame work to investigate how specific service recovery strategies influence the emotional, cognitive and negative behavioural responses of . consumers., as well as how emotion and cognition influence negative behavior. Understanding the impact of specific service recovery strategies will allow service providers' to more deliberately and intentionally engage in strategies that result in positive organizational outcomes. This study was conducted using a 2 x 2 between-subjects quasi-experimental design. The results suggest that service recovery has a significant impact on emotion, cognition and negative behavior. Similarly, satisfaction, negative emotion and positive emotion all influence negative behavior but distributive justice has no effect

A multi-decade record of high quality fCO2 data in version 3 of the Surface Ocean CO2 Atlas (SOCAT)

The Surface Ocean CO2 Atlas (SOCAT) is a synthesis of quality-controlled fCO2 (fugacity of carbon dioxide) values for the global surface oceans and coastal seas with regular updates. Version 3 of SOCAT has 14.7 million fCO2 values from 3646 data sets covering the years 1957 to 2014. This latest version has an additional 4.6 million fCO2 values relative to version 2 and extends the record from 2011 to 2014. Version 3 also significantly increases the data availability for 2005 to 2013. SOCAT has an average of approximately 1.2 million surface water fCO2 values per year for the years 2006 to 2012. Quality and documentation of the data has improved. A new feature is the data set quality control (QC) flag of E for data from alternative sensors and platforms. The accuracy of surface water fCO2 has been defined for all data set QC flags. Automated range checking has been carried out for all data sets during their upload into SOCAT. The upgrade of the interactive Data Set Viewer (previously known as the Cruise Data Viewer) allows better interrogation of the SOCAT data collection and rapid creation of high-quality figures for scientific presentations. Automated data upload has been launched for version 4 and will enable more frequent SOCAT releases in the future. High-profile scientific applications of SOCAT include quantification of the ocean sink for atmospheric carbon dioxide and its long-term variation, detection of ocean acidification, as well as evaluation of coupled-climate and ocean-only biogeochemical models. Users of SOCAT data products are urged to acknowledge the contribution of data providers, as stated in the SOCAT Fair Data Use Statement. This ESSD (Earth System Science Data) “living data” publication documents the methods and data sets used for the assembly of this new version of the SOCAT data collection and compares these with those used for earlier versions of the data collection (Pfeil et al., 2013; Sabine et al., 2013; Bakker et al., 2014). Individual data set files, included in the synthesis product, can be downloaded here: doi:10.1594/PANGAEA.849770. The gridded products are available here: doi:10.3334/CDIAC/OTG.SOCAT_V3_GRID

Differential branching fraction and angular analysis of the decay B0→K∗0μ+μ−

The angular distribution and differential branching fraction of the decay B 0→ K ∗0 μ + μ − are studied using a data sample, collected by the LHCb experiment in pp collisions at s√=7 TeV, corresponding to an integrated luminosity of 1.0 fb−1. Several angular observables are measured in bins of the dimuon invariant mass squared, q 2. A first measurement of the zero-crossing point of the forward-backward asymmetry of the dimuon system is also presented. The zero-crossing point is measured to be q20=4.9±0.9GeV2/c4 , where the uncertainty is the sum of statistical and systematic uncertainties. The results are consistent with the Standard Model predictions

Measurement of the relative rate of prompt χc0, χc1 and χc2 production at √s=7TeV

Prompt production of charmonium χc0, χc1 and χc2 mesons is studied using proton-proton collisions at the LHC at a centre-of-mass energy of √s=7TeV. The χc mesons are identified through their decay to J/ψγ, with J/ψ→μ+mu− using photons that converted in the detector. A data sample, corresponding to an integrated luminosity of 1.0fb−1 collected by the LHCb detector, is used to measure the relative prompt production rate of χc1 and χc2 in the rapidity range 2.0<y<4.5 as a function of the J/ψ transverse momentum from 3 to 20 GeV/c. First evidence for χc0 meson production at a hadron collider is also presented