Access and Barriers to Care During Transition from Active Duty to Veteran Status in Veterans with Diabetes: A Look at Health Literacy, Change, and Ongoing Diabetes Self-Management Education

Background and Rationale: Transition from active duty to veteran status may be a challenging time, especially for veterans with diabetes. These veterans face multiple changes that can cause distress. Most veterans with diabetes have type 2 diabetes, however a diagnosis of type 1 diabetes on active duty is cause for discharge for active duty. Purposes and Aims: The purpose of this study was to describe the transition experience of veterans diagnosed with diabetes while on active duty from active duty to veteran status. The study describes barriers and facilitators to healthcare and diabetes self-care management. The four aims of the veterans with diabetes transition study of veterans were to 1) Describe the experience of veterans with diabetes during their transition from active duty to veteran status, 2) Describe barriers and facilitators to healthcare access, 3) Describe diabetes self-management and veterans’ diabetes self-management education, and 4) To note veteran’s health literacy and diabetes distress. Methods: A qualitative, descriptive study was conducted of the transition experience from active duty to veteran status using a sample of 10 veterans with diabetes. Veterans access and barriers to care and use of diabetes self-management resources were measured by a qualitative questionnaire. Health literacy was measured by S-TOFHLA, and distress during by the DDS. Data were collected in the US southwest. Qualitative data analysis was done by uncovering themes and keywords. Quantitative instruments analysis was per instrument instructions. Results: Two major and four additional themes were uncovered. Major themes included feeling loss due to undesired end of a military career and feeling prepared to leave the military. Participants were compliant with diabetes management and had received diabetes education. Conclusions and Implications: Transition is an inevitable part of military service. The veterans with diabetes transition study provides data regarding transition of healthcare in veterans from active duty healthcare to healthcare in another system previously absent in the literature. Data gathered during the study contains themes indicating veterans have the potential to be extremely compliant participants in their diabetes self-management. The study serves as a starting point for study of the active duty to veteran transition process

Journeying Home through the Body: An Introduction to Resource, Resilience, and Resistance in Relationship (R4)

This paper will explore the connections to Black cultural reclamation, liberatory healing, and future building through a framework of cultivating a sense of home in contemplative body-based Resource, Resilience, and Resistance in Relationship (R4). Home is a concept that has been historically disrupted for Black and Brown bodies across generations. As people of African descent, we carry stories of homegoing, stolen histories, and politicized futures. Displaced from our motherlands and separated from our resources, home is lost. In a society where we are racialized and subjectively treated and mistreated by the rigidity of white cisheteropatriarchal supremacy, home is needed. Through the reflective experiencing of deep commitment to invest in our individual and collective bodies through intentional practice, home is found. The “R4” approach is offered as a conceptual framework that proposes an embodied lens to contemplation as a lineage practice that connects historical memory and resilience across the sequence of lineal descents from ancestry to the present experience of the body and informs creative responses for the next generation. When practiced as an expression of Black liberation, R4 in contemplative practice has the power to reclaim, heal, and build. While the physical location of home is complicated within a broader cultural context, this exploration will support a conceptual framework and practical strategies for home as an inner embodied resource to facilitate individual and collective liberation. Future directions for research and practice are discussed

The influence of the framework core residues on the biophysical properties of immunoglobulin heavy chain variable domains

Antibody variable domains differ considerably in stability. Single-chain Fv (scFv) fragments derived from natural repertoires frequently lack the high stability needed for therapeutic application, necessitating reengineering not only to humanize their sequence, but also to improve their biophysical properties. The human VH3 domain has been identified as having the best biophysical properties among human subtypes. However, complementarity determining region (CDR) grafts from highly divergent VH domains to huVH3 frequently fail to reach its superior stability. In previous experiments involving a CDR graft from a murine VH9 domain of very poor stability to huVH3, a hybrid VH framework was obtained which combines the lower core residues of muVH9 with the surface residues of huVH3. It resulted in a scFv with far better biophysical properties than the corresponding grafts to the consensus huVH3 framework. To better understand the origin of the superior properties of the hybrid framework, we constructed further hybrids, but now in the context of the consensus CDR-H1 and -H2 of the original human VH3 domain. The new hybrids included elements from either murine VH9, human VH1 or human VH5 domains. From guanidinium chloride-induced equilibrium denaturation measurements, kinetic denaturation experiments, measurements of heat-induced aggregation and comparison of soluble expression yield in Escherichia coli, we conclude that the optimal VH framework is CDR-dependent. The present work pinpoints structural features responsible for this dependency and helps to explain why the immune system uses more than one framework with different structural subtypes in framework 1 to optimally support widely different CDR

Reconciling Epidemiology and Social Justice in the Public Health Discourse Around the Sexual Networks of Black Men Who Have Sex With Men

Several studies have implicated the sexual networks of Black men who have sex with men (MSM) as facilitating disproportionally high rates of new HIV infections within this community. Although structural disparities place these networks at heightened risk for infection, HIV prevention science continues to describe networks as the cause for HIV disparities, rather than an effect of structures that pattern infection. We explore the historical relationship between public health and Black MSM, arguing that the current articulation of Black MSM networks is too often incomplete and counterproductive. Public health can offer a counternarrative that reconciles epidemiology with the social justice that informs our discipline, and that is required for an effective response to the epidemic among Black MSM

A TEORIA DE GOFFMAN E O GERENCIAMENTO DE IMPRESSÕES

Este estudo trata das práticas de gerenciamento de impressões realizadas nas entrevistas de seleção. O referencial teórico do nosso trabalho é o livro de Erving Goffman A Representação do Eu na Vida Cotidiana. 

Primary Care-Led Transition Clinics Hold Promise in Improving Care Transitions for Cancer Patients Facing Social Disparities: A Commentary.

Transitions in care are key junctions during which care coordination, communication, and individualized support are required to ensure optimal health outcomes for patients. This is particularly true for patients who face social disparities, such as poverty, limited health literacy, or belonging to a racial or ethnic minority, who are particularly at risk for experiencing poor care transitions. Interdisciplinary primary care-led transition clinics are an intervention that have shown promise in improving care transitions for diverse patient populations, including those that face social disparities, but their role in improving transitions in cancer care remains largely untapped. In this commentary we highlight why the time-limited support of an interdisciplinary primary care-led transition clinic that targets socially vulnerable cancer patients holds the promise of achieving more equitable healthcare access, healthcare quality, and ultimately more equitable health outcomes for cancer patients

Revisiting the Early Modern Philosophical Canon

I reflect critically on the early modern philosophical canon in light of the entrenchment and homogeneity of the line up of seven core figures: Descartes, Spinoza, Leibniz, Locke, Berkeley, Hume, Kant. After distinguishing three elements of a philosophical canon -- a causal story, a set of core philosophical questions and a set of distinctively philosophical works -- I argue that recent efforts contextualizing the history of philosophy within the history of science subtly shift the central philosophical questions and allow for a greater range of figures to be philosophically central. However, the history of science is but one context in which to situate philosophical works. Looking at the historical context of 17th century philosophy of mind, one that weaves together questions of consciousness, rationality, and education, does more than shift the central questions -- it brings new ones to light. It also shows that a range of genres can to be properly philosophical, and seamlessly diversifies the central philosophers of the period