Effectiveness of group-based self-management education for individuals with Type 2 diabetes:A systematic review with meta-analyses and meta-regression

Aims: Patient education for the management of Type 2 diabetes can be delivered in various forms, with the goal of promoting and supporting positive self-management behaviours. This systematic review aimed to determine the effectiveness of group-based interventions compared with individual interventions or usual care for improving clinical, lifestyle and psychosocial outcomes in people with Type 2 diabetes. Methods: Six electronic databases were searched. Group-based education programmes for adults with Type 2 diabetes that measured glycated haemoglobin (HbA1c) and followed participants for ≥ 6 months were included. The primary outcome was HbA1c, and secondary outcomes included fasting blood glucose, weight, body mass index, waist circumference, blood pressure, blood lipid profiles, diabetes knowledge and self-efficacy. Results: Fifty-three publications describing 47 studies were included (n = 8533 participants). Greater reductions in HbA1c occurred in group-based education compared with controls at 6–10 months [n = 30 studies; mean difference (MD) = 3 mmol/mol (0.3%); 95% confidence interval (CI): −0.48, −0.15; P = 0.0002], 12–14 months [n = 27 studies; MD = 4 mmol/mol (0.3%); 95% CI: −0.49, −0.17; P < 0.0001], 18 months [n = 3 studies; MD = 8 mmol/mol (0.7%); 95% CI: −1.26, −0.18; P = 0.009] and 36–48 months [n = 5 studies; MD = 10 mmol/mol (0.9%); 95% CI: −1.52, −0.34; P = 0.002], but not at 24 months. Outcomes also favoured group-based education for fasting blood glucose, body weight, waist circumference, triglyceride levels and diabetes knowledge, but not at all time points. Interventions facilitated by a single discipline, multidisciplinary teams or health professionals with peer supporters resulted in improved outcomes in HbA1c when compared with peer-led interventions. Conclusions: Group-based education interventions are more effective than usual care, waiting list control and individual education at improving clinical, lifestyle and psychosocial outcomes in people with Type 2 diabetes.No Full Tex

Optimized Large-Scale CMB Likelihood And Quadratic Maximum Likelihood Power Spectrum Estimation

We revisit the problem of exact CMB likelihood and power spectrum estimation with the goal of minimizing computational cost through linear compression. This idea was originally proposed for CMB purposes by Tegmark et al.\ (1997), and here we develop it into a fully working computational framework for large-scale polarization analysis, adopting \WMAP\ as a worked example. We compare five different linear bases (pixel space, harmonic space, noise covariance eigenvectors, signal-to-noise covariance eigenvectors and signal-plus-noise covariance eigenvectors) in terms of compression efficiency, and find that the computationally most efficient basis is the signal-to-noise eigenvector basis, which is closely related to the Karhunen-Loeve and Principal Component transforms, in agreement with previous suggestions. For this basis, the information in 6836 unmasked \WMAP\ sky map pixels can be compressed into a smaller set of 3102 modes, with a maximum error increase of any single multipole of 3.8\% at $\ell\le32$, and a maximum shift in the mean values of a joint distribution of an amplitude--tilt model of 0.006$\sigma$. This compression reduces the computational cost of a single likelihood evaluation by a factor of 5, from 38 to 7.5 CPU seconds, and it also results in a more robust likelihood by implicitly regularizing nearly degenerate modes. Finally, we use the same compression framework to formulate a numerically stable and computationally efficient variation of the Quadratic Maximum Likelihood implementation that requires less than 3 GB of memory and 2 CPU minutes per iteration for $\ell \le 32$, rendering low-$\ell$ QML CMB power spectrum analysis fully tractable on a standard laptop.Comment: 13 pages, 13 figures, accepted by ApJ

Workshop on Structural Dynamics and Control Interaction of Flexible Structures

The Hubble Space Telescope features the most exacting line of sight jitter requirement thus far imposed on a spacecraft pointing system. Consideration of the fine pointing requirements prompted an attempt to isolate the telescope from the low level vibration disturbances generated by the attitude control system reaction wheels. The primary goal was to provide isolation from axial component of wheel disturbance without compromising the control system bandwidth. A passive isolation system employing metal springs in parallel with viscous fluid dampers was designed, fabricated, and space qualified. Stiffness and damping characteristics are deterministic, controlled independently, and were demonstrated to remain constant over at least five orders of input disturbance magnitude. The damping remained purely viscous even at the data collection threshold of .16 x .000001 in input displacement, a level much lower than the anticipated Hubble Space Telescope disturbance amplitude. Vibration attenuation goals were obtained and ground test of the vehicle has demonstrated the isolators are transparent to the attitude control system

Loss of intranetwork and internetwork resting state functional connections with Alzheimer\u27s disease progression

Alzheimer\u27s disease (AD) is the most common cause of dementia. Much is known concerning AD pathophysiology but our understanding of the disease at the systems level remains incomplete. Previous AD research has used resting-state functional connectivity magnetic resonance imaging (rs-fcMRI) to assess the integrity of functional networks within the brain. Most studies have focused on the default-mode network (DMN), a primary locus of AD pathology. However, other brain regions are inevitably affected with disease progression. We studied rs-fcMRI in five functionally defined brain networks within a large cohort of human participants of either gender (n = 510) that ranged in AD severity from unaffected [clinical dementia rating (CDR) 0] to very mild (CDR 0.5) to mild (CDR 1). We observed loss of correlations within not only the DMN but other networks at CDR 0.5. Within the salience network (SAL), increases were seen between CDR 0 and CDR 0.5. However, at CDR 1, all networks, including SAL, exhibited reduced correlations. Specific networks were preferentially affected at certain CDR stages. In addition, cross-network relations were consistently lost with increasing AD severity. Our results demonstrate that AD is associated with widespread loss of both intranetwork and internetwork correlations. These results provide insight into AD pathophysiology and reinforce an integrative view of the brain\u27s functional organization

The lived experience of recovery in borderline personality disorder: a qualitative study

BackgroundThe concept of recovery in borderline personality disorder (BPD) is not well defined. Whilst clinical approaches emphasise symptom reduction and functioning, consumers advocate for a holistic approach. The consumer perspective on recovery and comparisons of individuals at varying stages have been minimally explored.MethodFourteen narratives of a community sample of adult women with a self-reported diagnosis of BPD, were analysed using qualitative interpretative phenomenological analysis to understand recovery experiences. Individuals were at opposite ends of the recovery continuum (seven recovered and seven not recovered).ResultsRecovery in BPD occurred across three stages and involved four processes. Stages included; 1) being stuck, 2) diagnosis, and 3) improving experience. Processes included; 1) hope, 2) active engagement in the recovery journey, 3) engagement with treatment services, and 4) engaging in meaningful activities and relationships. Differences between individuals in the recovered and not recovered group were prevalent in the improving experience stage.ConclusionRecovery in BPD is a non-linear, ongoing process, facilitated by the interaction between stages and processes. Whilst clinical aspects are targets of specialist interventions, greater emphasis on fostering individual motivation, hope, engagement in relationships, activities, and treatment, may be required within clinical practice for a holistic recovery approach

Seven-Year Wilkinson Microwave Anisotropy Probe (WMAP) Observations: Power Spectra and WMAP-Derived Parameters

(Abridged) We present the angular power spectra derived from the 7-year maps and discuss the cosmological conclusions that can be inferred from WMAP data alone. The third acoustic peak in the TT spectrum is now well measured by WMAP. In the context of a flat LambdaCDM model, this improvement allows us to place tighter constraints on the matter density from WMAP data alone, and on the epoch of matter-radiation equality, The temperature-polarization (TE) spectrum is detected in the 7-year data with a significance of 20 sigma, compared to 13 sigma with the 5-year data. The low-l EE spectrum, a measure of the optical depth due to reionization, is detected at 5.5 sigma significance when averaged over l = 2-7. The BB spectrum, an important probe of gravitational waves from inflation, remains consistent with zero. The upper limit on tensor modes from polarization data alone is a factor of 2 lower with the 7-year data than it was using the 5-year data (Komatsu et al. 2010). We test the parameter recovery process for bias and find that the scalar spectral index, ns, is biased high, but only by 0.09 sigma, while the remaining parameters are biased by < 0.15 sigma. The improvement in the third peak measurement leads to tighter lower limits from WMAP on the number of relativistic degrees of freedom (e.g., neutrinos) in the early universe: Neff > 2.7 (95% CL). Also, using WMAP data alone, the primordial helium mass fraction is found to be YHe = 0.28+0.14-0.15, and with data from higher-resolution CMB experiments included, we now establish the existence of pre-stellar helium at > 3 sigma (Komatsu et al. 2010).Comment: 22 pages, 14 figures, version accepted to Astrophysical Journal Supplement Series, added high-l EE detection, consolidated parameter recovery simulation

Toward a Conceptual Framework of Culturally Relevant Pedagogy: An Overview of the Conceptual and Theoretical Literature

The United States is a diverse country with constantly changing demographics. The noticeable shift in demographics is even more phenomenal among the school-aged population. The increase of ethnic-minority student presence is largely credited to the national growth of the Hispanic population, which exceeded the growth of all other ethnic minority group students in public schools. Scholars have pondered over strategies to assist teachers in teaching about diversity (multiculturalism, racism, etc.) as well as interacting with the diversity found within their classrooms in order to ameliorate the effects of cultural discontinuity. One area that has developed in multicultural education literature is culturally relevant pedagogy (CRP). CRP maintains that teachers need to be non-judgmental and inclusive of the cultural backgrounds of their students in order to be effective facilitators of learning in the classroom. The plethora of literature on CRP, however, has not been presented as a testable theoretical model nor has it been systematically viewed through the lens of critical race theory (CRT). By examining the evolution of CRP among some of the leading scholars, the authors broaden this work through a CRT infusion which includes race and indeed racism as normal parts of American society that have been integrated into the educational system and the systematic aspects of school relationships. Their purpose is to infuse the tenets of CRT into an overview of the literature that supports a conceptual framework for understanding and studying culturally relevant pedagogy. They present a conceptual framework of culturally relevant pedagogy that is grounded in over a quarter of a century of research scholarship. By synthesizing the literature into the five areas and infusing it with the tenets of CRT, the authors have developed a collection of principles that represents culturally relevant pedagogy

Nano-Imprinted Thin Films of Reactive, Azlactone-Containing Polymers: Combining Methods for the Topographic Patterning of Cell Substrates with Opportunities for Facile Post-Fabrication Chemical Functionalization

Laser scanning confocal microscopy (LSCM) and atomic force microscopy (AFM) were used to characterize changes in nanoscale structure that occur when ultrathin polyelectrolyte multilayers (PEMs) are incubated in aqueous media. The PEMs investigated here were fabricated by the deposition of alternating layers of plasmid DNA and a hydrolytically degradable polyamine onto a precursor film composed of alternating layers of linear poly(ethylene imine) (LPEI) and sodium poly(styrene sulfonate) (SPS). Past studies of these materials in the context of gene delivery revealed transformations from a morphology that is smooth and uniform to one characterized by the formation of nanometer-scale particulate structures. We demonstrate that in-plane registration of LSCM and AFM images acquired from the same locations of films fabricated using fluorescently labeled polyelectrolytes allows the spatial distribution of individual polyelectrolyte species to be determined relative to the locations of topographic features that form during this transformation. Our results suggest that this physical transformation leads to a morphology consisting of a relatively less disturbed portion of film composed of polyamine and DNA juxtaposed over an array of particulate structures composed predominantly of LPEI and SPS. Characterization by scanning electron microscopy and energy-dispersive X-ray microanalysis provides additional support for this interpretation. The combination of these different microscopy techniques provides insight into the structures and dynamics of these multicomponent thin films that cannot be achieved using any one method alone, and could prove useful for the further development of these assemblies as platforms for the surface-mediated delivery of DNA

A Review of the Properties of Nb3Sn and Their Variation with A15 Composition, Morphology and Strain State

This article gives an overview of the available literature on simplified, well defined (quasi-)homogeneous laboratory samples. After more than 50 years of research on superconductivity in Nb3Sn, a significant amount of results are available, but these are scattered over a multitude of publications. Two reviews exist on the basic properties of A15 materials in general, but no specific review for Nb3Sn is available. This article is intended to provide such an overview. It starts with a basic description of the Niobium-Tin intermetallic. After this it maps the influence of Sn content on the the electron-phonon interaction strength and on the field-temperature phase boundary. The literature on the influence of Cu, Ti and Ta additions will then be briefly summarized. This is followed by a review on the effects of grain size and strain. The article is concluded with a summary of the main results.Comment: Invited Topical Review for Superconductor, Science and Technology. Provisionally scheduled for July 200