Discourses of Diabetes Management in Patient-Physician Interactions

Discussions of diabetes management are challenging for patients and physicians during treatment plan appointments—in large part because “diabetes management” has multiple, competing meanings. Our goal in this study was to examine talk between patients and physicians over multiple visits to: (1) determine the multiple meanings of diabetes management, and (2) determine the specific ways these meanings compete with each other. To accomplish this goal, we gathered data at a family medicine residency clinic in the Midwestern United States, video-recording the interactions of six different patient-physician dyads over multiple visits. Next, we performed in-depth analyses of these interactions using Baxter’s (2011) Relational Dialectics Theory 2.0, which focuses on discourses occurring within interpersonal interactions, rather than on the individuals within interpersonal interactions. Our results reveal meanings associated with two dominant oppositional discourses comprising the meaning of diabetes management: high self-efficacy and low self-efficacy. Additionally, we found that—during conversations between patients and physicians—the central discourse of high self-efficacy competed with the less-central discourse of low self-efficacy. Our results also reveal that both patients and physicians used both discourses. Finally, our results revealed that at times, both patients and physicians mixed these discourses, creating a new “hybrid” meaning for diabetes management: Moderation. Understanding these discourses and how they compete can help physicians focus on the cultural discourses that shape their own and patients’ views of diabetes management and realize the transformational possibilities that can occur in treatment plan discussions through a more moderate discourse

Controller design for bilinear systems with parametric uncertainties

This paper studies the problem of robust control of a class of uncertain bilinear continuous-time systems. The class of uncertain systems is described by a state space model with time-varying norm-bounded parameter uncertainty in the state equation. We address the problem of robust H∞ control in which both robust stability and a prescribed H∞ performance are required to be achieved irrespective of the uncertainties. Both state feedback and output feedback controllers are designed. It has been shown that the above problems can be recast into H∞ syntheses for related bilinear systems without parameter uncertainty, which can be solved via a Riccati inequality approach. Two examples are given to show the potential of the proposed technique

Pine Needle Abortion in Cattle: A Progress Report

Cow and calf loss due to pine needle abortion (PNA) in cattle grazing foothill ranges having stands of ponderosa pine (Pinus ponderosa) continues to cause managerial, as well as economic problems, for many ranchers in South Dakota, Colorado, Idaho and California as well as many areas in Canada

Identifying Inconsistencies and Reporting Deficits in Therapeutic Massage and Bodywork (TMB) Case Reports: A Systematic Review and TMB Adapted CAse REport (CARE) Guidelines Audit

poster abstractIntroduction: Case reports are a fundamental tool through which practitioners in applied disciplines are able to inform research and impact their field by detailing the presentation, treatment, and follow-up of a single individual they’ve encountered in practice. Ideally, published case reports contribute to reductions in the research/practice gap by allowing practitioners to describe current practice situations and outcomes to researchers. Unfortunately, inconsistencies in case reporting across applied disciplines have limited the impact of these fundamental sources of clinical evidence. In 2013, reporting guidelines for case reports (CARE guidelines) were published to standardize the reporting of medical case reports. In recognition of discipline differences and reporting needs, the therapeutic massage and bodywork (TMB) adapted CARE guidelines were published in late 2014 to specifically guide reporting of case reports involving massage therapy applied as a treatment. The TMB adapted CARE guidelines identified 5 primary case report components (pre-manuscript, Introduction, Case Presentation, Results, and Discussion), each with unique subcomponents (e.g., title, keywords, abstract for the pre-manuscript component) ranging in number from 6 - 31. By checking off each component and subcomponent included in any given case report, a summary score for TMB adapted CARE guidelines compliance (range: 0 – 65) can be derived. In order to determine whether the consistency of TMB case reporting is improved after publication of the TMB adapted CARE guidelines, a pre-guideline state of TMB case reports is needed. The current study seeks to provide rich descriptive statistics about the state of TMB related case reports in the literature prior to 2015. Methods: A systematic review using PubMed and CINAHL databases identified 935 unique citations using first the MeSH term “Therapy, Soft Tissue” as the subject heading and publication type “case reports” and then a keyword search in PubMed (acupressure, shiatsu, zhi ya, chih ya, reflexology, rolfing, bodywork, massage, case report, case reports, case study, case studies NOT carotid sinus massage, heart massage, cardiac massage, animals) and CINAHL (subject headings: massage therapists, massage, reflexology, case study). Study inclusion/exclusion criteria required: case report, human, English, peer-reviewed, published prior to 2015. Administered massage treatment(s) had to have been from a professional TMB practitioner who had a role in the case’s reporting and publication. N=34 articles met inclusion criteria and were reviewed by two independent reviewers. Through a REDCap data collection form, components and subcomponents of the TMB adapted CARE reporting guidelines included in each article were identified. Variable coding and descriptive statistics were completed using SAS 9.3 by a non-reviewing team member. TMB adapted CARE reporting compliance scores were determined for each case report. Results: Preliminary results for n=30 (final presentation to include all N=34) indicate mean compliance scores = 40.3 (±9.2) and ranged from 10-50. Article sections with the most robust scoring included pre-manuscript items and introduction with average section scores obtaining 75% and 70% of the possible points, respectively. Case presentation and results sections scored the poorest, obtaining an average of 58% and 53% of the possible points, respectively. Conclusions: Case reports in the TMB field published before possible exposure to the TMB adapted CARE guidelines demonstrate inconsistent and deficient reporting. If case reports in the TMB field are to have an impact, consistent and rigorous reporting must be adopted. In an effort to improve the state and impact of TMB case reports in the literature, TMB practitioners should use the TMB adapted CARE guidelines as a checklist when preparing their case reports for publication

Identifying Inconsistencies and Reporting Deficits in Therapeutic Massage and Bodywork (TMB) Case Reports Authored by TMB Practitioners: a TMB-Adapted CAse REport (CARE) Guidelines Audit Through 2014

INTRODUCTION: Case reports are a fundamental tool through which therapeutic massage and bodywork (TMB) practitioners can inform research and impact their field by detailing the presentation, treatment, and follow-up of a single individual encountered in practice. Inconsistencies in case reporting limit their impact as fundamental sources of clinical evidence. Using the TMB-adapted CAse REport (CARE) guidelines, the current study sought to provide a rich description regarding the reporting quality of TMB practitioner authored TMB case reports in the literature. METHODS: 1) Systematic identification of published, peer-reviewed TMB case reports authored by TMB practitioners following PRISMA recommendations; 2) audit development based on TMB-adapted CARE guidelines; 3) audit implementation; and 4) descriptive analysis of audit scores. RESULTS: Our search identified 977 articles and 35 met study inclusion criteria. On average, TMB case reports included approximately 58% of the total items identified as necessary by the TMB-adapted CARE guidelines. Introduction sections of case reports had the best item reporting (80% on average), while Case Presentation (54%) and Results (52%) sections scored moderately overall, with only 20% of necessary Practitioner Description items included on average. Audit scores revealed inconsistent abstract reporting and few audited case reports including client race (20%), perspective (26%), and occupation/activities (40%); practitioner practice setting (12%), training (12%), scope-of-practice (29%), and credentialing (20%); adverse events or lack thereof (17%); and some aspect of informed consent (34%). Treatment descriptor item reporting varied from high to low. Various implications of concern are discussed. CONCLUSION: The current audit and descriptive analysis highlight several reporting inconsistencies in TMB case reports prior to 2015. Reporting guidelines for case reports are important if standards for, and impact of, TMB case reports are desired. Adherence to reporting specifications outlined by the TMB-adapted CARE guidelines could improve the impact and usability of TMB case reports in research, education, and practice

Pressure balance at the magnetopause: Experimental studies

The pressure balance at the magnetopause is formed by magnetic field and plasma in the magnetosheath, on one side, and inside the magnetosphere, on the other side. In the approach of dipole earth's magnetic field configuration and gas-dynamics solar wind flowing around the magnetosphere, the pressure balance predicts that the magnetopause distance R depends on solar wind dynamic pressure Pd as a power low R ~ Pd^alpha, where the exponent alpha=-1/6. In the real magnetosphere the magnetic filed is contributed by additional sources: Chapman-Ferraro current system, field-aligned currents, tail current, and storm-time ring current. Net contribution of those sources depends on particular magnetospheric region and varies with solar wind conditions and geomagnetic activity. As a result, the parameters of pressure balance, including power index alpha, depend on both the local position at the magnetopause and geomagnetic activity. In addition, the pressure balance can be affected by a non-linear transfer of the solar wind energy to the magnetosheath, especially for quasi-radial regime of the subsolar bow shock formation proper for the interplanetary magnetic field vector aligned with the solar wind plasma flow.Comment: 8 pages, 2 figure

Analysis of Downlink Connectivity in NB-IoT Networks Employing NOMA with Imperfect SIC

International audienceWe study the problem of maximizing the number of served devices in a non-orthogonal multiple access (NOMA) based Narrowband Internet of Things (NB-IoT) network for supporting massive connectivity in the downlink. We analyze this problem under practical system limitations of imperfect successive interference cancellation (SIC) at the receiver along with data rate, power and bandwidth constraints. We propose a strategy for joint device and power allocation through an iterative solution for a system of linear equations on each sub-carrier that maximizes the number of connected devices. We evaluate the performance of the proposed solution over a wide range of service scenarios through extensive computer simulations and demonstrate the sensitivity of connectivity in power domain NOMA based NB-IoT systems to the residual interference resulting from imperfect SIC

Allocating the Burdens of Climate Action: Consumption-Based Carbon Accounting and the Polluter-Pays Principle

Action must be taken to combat climate change. Yet, how the costs of climate action should be allocated among states remains a question. One popular answer—the polluter-pays principle (PPP)—stipulates that those responsible for causing the problem should pay to address it. While intuitively plausible, the PPP has been subjected to withering criticism in recent years. It is timely, following the Paris Agreement, to develop a new version: one that does not focus on historical production-based emissions but rather allocates climate burdens in proportion to each state’s annual consumption-based emissions. This change in carbon accounting results in a fairer and more environmentally effective principle for distributing climate duties

Viperin is an important host restriction factor in control of Zika virus infection

Published online 30 June 2017Zika virus (ZIKV) infection has emerged as a global health threat and infection of pregnant women causes intrauterine growth restriction, spontaneous abortion and microcephaly in newborns. Here we show using biologically relevant cells of neural and placental origin that following ZIKV infection, there is attenuation of the cellular innate response characterised by reduced expression of IFN-β and associated interferon stimulated genes (ISGs). One such ISG is viperin that has well documented antiviral activity against a wide range of viruses. Expression of viperin in cultured cells resulted in significant impairment of ZIKV replication, while MEFs derived from CRISPR/Cas9 derived viperin-/- mice replicated ZIKV to higher titers compared to their WT counterparts. These results suggest that ZIKV can attenuate ISG expression to avoid the cellular antiviral innate response, thus allowing the virus to replicate unchecked. Moreover, we have identified that the ISG viperin has significant anti-ZIKV activity. Further understanding of how ZIKV perturbs the ISG response and the molecular mechanisms utilised by viperin to suppress ZIKV replication will aid in our understanding of ZIKV biology, pathogenesis and possible design of novel antiviral strategies.Kylie H. Van der Hoek, Nicholas S. Eyre, Byron Shue, Onruedee Khantisitthiporn, Kittirat Glab-Ampi, Jillian M. Carr, Matthew J. Gartner, Lachlan A. Jolly, Paul Q. Thomas, Fatwa Adikusuma, Tanja Jankovic-Karasoulos, Claire T. Roberts, Karla J. Helbig and Michael R. Bear

Information Sources

Since passage of the Affordable Care Act (ACA) was signed into law by President Barrack Obama, little is known about statelevel perceptions of residents on the ACA. Perceptions about the act could potentially affect implementation of the law to the fullest extent. This 3-year survey study explored attitudes about the ACA, the types of information sources that individuals rely on when creating those attitudes, and the predictors of these attitudes among state of Indiana residents. The respondents were split between favorable and unfavorable views of the ACA, yet the majority of respondents strongly supported individual components of the act. National TV news, websites, family members, and individuals' own reading of the ACA legislation were identified as the most influential information sources. After controlling for potential confounders, the respondent's political affiliation, age, sex, and obtaining ACA information from watching national television news were the most important predictors of attitudes about the ACA and its components. These results mirror national-level findings. Implications for implementing health care reform at the state-level are discussed