Body mass index and health care utilization in diabetic and nondiabetic individuals.

BackgroundAlthough controversial, most studies examining the relationship of body mass index (BMI) with mortality in diabetes suggest a paradox: the lowest risk category is above normal weight, versus normal weight in nondiabetic persons. One proposed explanation is greater morbidity of diabetes in normal weight persons. If this were so, it would suggest a health care utilization paradox in diabetes, paralleling the mortality paradox, yet no studies have examined this issue.ObjectiveTo compare the relationship of BMI with health care utilization in diabetic versus nondiabetic persons.DesignPopulation-based cross-sectional study.SubjectsAdults in the 2000-2011 Medical Expenditures Panel Surveys (N=120,389).MeasuresTotal health care expenditures, hospital utilization (≥1 admission), and emergency department utilization (≥1 visit). BMI (kg/m) categories were: <20 (underweight); 20 to <25 (normal); 25 to <30 (overweight); 30 to <35 (obese); and ≥35 (severely obese). Adjustors were age, sex, race/ethnicity, income, health insurance, education, smoking, co-morbidity, urbanicity, region, and year.ResultsAmong diabetic persons, adjusted mean total health care expenditures were significantly lower in obese versus normal weight persons ($1314, 95$513-$2115; P=0.001). By contrast, among nondiabetic persons, total expenditures were nonsignificantly higher in obese versus normal weight persons (-$229, 95% CI, -$460 to$2; P=0.052). Findings for hospital and emergency department utilization exhibited similar patterns.ConclusionsNormal weight diabetic persons used substantially more health care than their overweight and obese counterparts, a difference not observed in nondiabetic persons. These differences support the plausibility of a BMI mortality paradox related to greater morbidity of diabetes in normal weight than in heavier persons

Analyzing Digital Image by Deep Learning for Melanoma Diagnosis

Image classi cation is an important task in many medical applications, in order to achieve an adequate diagnostic of di erent le- sions. Melanoma is a frequent kind of skin cancer, which most of them can be detected by visual exploration. Heterogeneity and database size are the most important di culties to overcome in order to obtain a good classi cation performance. In this work, a deep learning based method for accurate classi cation of wound regions is proposed. Raw images are fed into a Convolutional Neural Network (CNN) producing a probability of being a melanoma or a non-melanoma. Alexnet and GoogLeNet were used due to their well-known e ectiveness. Moreover, data augmentation was used to increase the number of input images. Experiments show that the compared models can achieve high performance in terms of mean ac- curacy with very few data and without any preprocessing.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Political Manipulation: Between the Negative Connotation and the Imperative of Politics

Politična manipulacija je označena z negativno konotacijo, kar predstavlja začetno točko diplomskega dela. Razumeli jo bomo kot upravljanje, programiranje in preusmerjanje množic – javnosti, ki lahko vključuje tudi psihološke vplive za zagotovitev ciljev manipulatorja. Ključna sestavina manipulacije je prikritost. Uporablja jo lahko kdorkoli v političnem prostoru, ki ima sposobnost za njeno izvedbo. To predstavlja oviro pri identifikaciji političnega fenomena v študiji primera, zato smo teoretične nastavke za prepoznavo politične manipulacije iskali v Machiavellijevem delu Vladar, Rikerjevi Herestetiki in teorijah pluralne demokracije. Spoznali smo, da je za identifikacijo politične manipulacije treba ločevati med moralo in politiko ter uveljaviti realistično videnje politike. Realistično gledano politično polje delovanja vidimo v elitno-pluralističnem modelu demokracije, ki temelji na pluralnosti interesov, konfliktih interesov in razpršenosti moči. Prava moč je še vedno v rokah oblasti oz. elit, čeravno obstaja mnogo interesnih skupin in naj bi moč pripadala državljanom. Logika ničelne vsote, ki predstavlja konflikt, je pomembna pri identifikaciji in analizi politične manipulacije, hkrati pa smo zasnovali »makiavelistično« igro moči, ki smo jo aplicirali na konkreten primer. To nam je omogočilo analizo politične manipulacije od njenih ključnih elementov do političnih ciljev. Kot ključno smo raziskovali vlogo politične manipulacije v elitno-pluralističnih demokracijah.Political manipulation is marked with negative connotation, which presents a starting point of this thesis. We will understand it as management, programming, and redirection of the masses – the public, which can also include psychological influences in order to achieve the goal of a manipulator. The key substance of manipulation is covertness. Political manipulation can be used by anyone in a political space that has the ability to carry it out. This poses a barrier at identification of a political phenomenon in a case study. Therefore, we sought theoretical sequences for recognition of political manipulation in Machiavelli\u27s work: The Prince, Riker\u27s Heresthetics and theories of plural democracy. We realised, that one must differentiate between moral and politics for identification of a political manipulation. Politics needs to be seen realistically. As such, we see the political field of action in an elite–pluralistic model of democracy, which is based on the plurality of interests, conflicts of interest, and the dispersal of power. True power is still in the hands of the elites, although many interest groups exist and democracy is all about strengthening the power of the people. The logic of zero-sum, which represents a conflict, is also important for identification of a political manipulation. At the same time, we have designed a »Machiavellian« game of power, which we applied to a concrete case. This allowed us to analyse political manipulation: from its key elements to political goals. The crucial was researching the role of a political manipulation in elite-pluralist democracy

Expression of CAP2 during early Xenopus embryogenesis

We have cloned and characterized a second member of the Xenopus CAP (cyclase associated protein) gene family. xCAP2 demonstrates greater restriction of expression than its homolog, xCAP1, and is differentially expressed throughout early embryogenesis. Although present as a maternal transcript, CAP2 comes to be expressed in the anterior-most mesoderm/endoderm during late gastrulation, in paraxial mesoderm during late neurula stages, and later expresses in lens, cardiac primordia, somites, otic vesicles, retina,and in the optic and craniofacial musculature. The gene is also expressed in the leading edge of myotome

Training Residents to Employ Self-efficacy-enhancing Interviewing Techniques: Randomized Controlled Trial of a Standardized Patient Intervention

Current interventions to enhance patient self-efficacy, a key mediator of health behavior, have limited primary care application. To explore the effectiveness of an office-based intervention for training resident physicians to use self-efficacy-enhancing interviewing techniques (SEE IT). Randomized controlled trial. Family medicine and internal medicine resident physicians (N = 64) at an academic medical center. Resident use of SEE IT (a count of ten possible behaviors) was coded from audio recordings of the physician-patient portion of two standardized patient (SP) instructor training visits and two unannounced post-training SP visits, all involving common physical and mental health conditions and behavior change issues. One post-training SP visit involved health conditions similar to those experienced in training, while the other involved new conditions. Experimental group residents demonstrated significantly greater use of SEE IT than controls, starting after the first training visit and sustained through the final post-training visit. The mean effect of the intervention was significant [adjusted incidence rate ratio for increased use of SEE IT = 1.94 (95% confidence interval = 1.34, 2.79; p < 0.001)]. There were no significant effects of resident gender, race/ethnicity, specialty, training level, or SP health conditions. SP instructors can teach resident physicians to apply SEE IT during SP office visits, and the effects extend to health conditions beyond those used for training. Future studies should explore the effects of the intervention on practicing physicians, physician use of SEE IT during actual patient visits, and its influence on patient health behaviors and outcomes

Telemonitoring for Patients With Chronic Heart Failure: A Systematic Review

Background Telemonitoring, the use of communication technology to remotely monitor health status, is an appealing strategy for improving disease management. Methods and Results We searched Medline databases, bibliographies, and spoke with experts to review the evidence on telemonitoring in heart failure patients. Interventions included: telephone-based symptom monitoring (n = 5), automated monitoring of signs and symptoms (n = 1), and automated physiologic monitoring (n = 1). Two studies directly compared effectiveness of 2 or more forms of telemonitoring. Study quality and intervention type varied considerably. Six studies suggested reduction in all-cause and heart failure hospitalizations (14% to 55% and 29% to 43%, respectively) or mortality (40% to 56%) with telemonitoring. Of the 3 negative studies, 2 enrolled low-risk patients and patients with access to high quality care, whereas 1 enrolled a very high-risk Hispanic population. Studies comparing forms of telemonitoring demonstrated similar effectiveness. However, intervention costs were higher with more complex programs ($8383 per patient per year) versus less complex programs ($1695 per patient per year). Conclusion The evidence base for telemonitoring in heart failure is currently quite limited. Based on the available data, telemonitoring may be an effective strategy for disease management in high-risk heart failure patients

Hybrid copula mixed models for combining case-control and cohort studies in meta-analysis of diagnostic tests

Copula mixed models for trivariate (or bivariate) meta-analysis of diagnostic test accuracy studies accounting (or not) for disease prevalence have been proposed in the biostatistics literature to synthesize information. However, many systematic reviews often include case-control and cohort studies, so one can either focus on the bivariate meta-analysis of the case-control studies or the trivariate meta-analysis of the cohort studies, as only the latter contains information on disease prevalence. In order to remedy this situation of wasting data we propose a hybrid copula mixed model via a combination of the bivariate and trivariate copula mixed model for the data from the case-control studies and cohort studies, respectively. Hence, this hybrid model can account for study design and also due to its generality can deal with dependence in the joint tails. We apply the proposed hybrid copula mixed model to a review of the performance of contemporary diagnostic imaging modalities for detecting metastases in patients with melanoma

Effects of increase in temperature and open water on transmigration and access to health care by the Nenets reindeer herders in northern Russia

Background . The indigenous Nenets reindeer herders in northern Russia annually migrate several hundred kilometers between summer and winter pastures. In the warming climate, ice-rich permafrost and glaciers are being significantly reduced and will eventually disappear from parts of the Arctic. The emergent changes in hydrological cycles have already led to substantial increases in open water that stays unfrozen for longer periods of time. This environmental change has been reported to compromise the nomadic Nenets’ traditional way of life because the presence of new water in the tundra reduces the Nenets’ ability to travel by foot, sled, or motor vehicle from the summer transitory tundra campsites in order to access healthcare centers in villages. New water can also impede their access to family and community at other herder camps and in the villages. Although regional and global models predicting hydrologic changes due to climate changes exist, the spatial resolution of these models is too coarse for studying how increases in open water affect health and livelihoods. To anticipate the full health impact of hydrologic changes, the current gap between globally forecasted scenarios and locally forecasted hydrologic scenarios needs to be bridged. Objectives . We studied the effects of the autumn temperature anomalies and increases in open water on health care access and transmigration of reindeer herders on the Kanin Peninsula. Design . Correlational and time series analyses were completed. Methods . The study population consisted of 370 full-time, nomadic reindeer herders. We utilized clinical visit records, studied surface temperature anomalies during autumn migrations, and used remotely sensed imagery to detect water bodies. Spearman correlation was used to measure the relationship between temperature anomalies and the annual arrival of the herders at the Nes clinic for preventive and primary care. Piecewise regression was used to model change in mean autumnal temperature anomalies over time. We also created a water body product to detect inter-annual changes in water area. Results . Correlation between arrivals to the Nes clinic and temperature anomalies during the fall transmigration (1979–2011) was r = 0.64, p = 0.0004; 95% CI (0.31; 0.82). Regression analysis estimated that mean temperature anomalies during the fall migration in September–December were stochastically stationary pre-1991 and have been rising significantly (p < 0.001) since then. The rate of change was estimated at +0.1351°C/year, SE = 0.0328, 95% CI (+0.0694, +0.2007). The amount of detected water fluctuated significantly interannually (620–800 km2). Conclusions . Later arrival of freezing temperatures in the autumn followed by the earlier spring thaws and more open water delay transmigration and reduce herders’ access to health care. The recently observed delays in arrival to the clinic are likely related to the warming trend and to concomitant hydrologic changes

Exploring cancer survivors’ views of health behavior change: "Where do you start, where do you stop with everything?"

International audienceObjective: Physical activity (PA) and a healthy diet can improve the well‐being of cancer survivors. However, cancer survivors often do not engage in these behaviours. This study aimed to explore barriers and facilitators to engaging in these behaviours following cancer treatment.Methods: During the development of a web‐based intervention to enhance health‐related quality of life in cancer survivors, 32 people who had completed treatment for breast, colon or prostate cancer were presented with an intervention for PA and healthy eating. In‐depth think‐aloud and semi‐structured interviewing techniques were used to elicit perceptions of both behaviours. Data were analysed using thematic analysis.Results: Some individuals reported implementing positive health behaviour changes to maintain health and prevent recurrence, or to help them to move forward after cancer. However, others reported feeling abandoned, and many did not report an intention to engage in lifestyle changes. Individuals discussed contextual and health‐related barriers that were specifically linked to their situation as post‐treatment cancer survivors: individuals described uncertainty about how to implement adaptive changes and perceived a lack of support from healthcare providers. Others viewed behaviour change as unnecessary or undesirable, with some arguing that non‐modifiable factors contributed more to their cancer diagnosis than lifestyle‐related factors.Conclusions: For many participants in this study, the period that follows treatment for cancer did not represent a ‘teachable moment’. A variety of complex and heterogeneous factors appeared to impact motivation, and may limit cancer survivors from engaging with diet and PA changes