Day Re-construction: Understanding How College Students Manage Their Time Through Self-monitoring

With a plethora of possibilities for new social experiences, activities, and other prospects, college students may find it challenging to balance their time. To facilitate their awareness of and reflection upon time expenditures regarding the three pillars of a balanced life: work, personal maintenance and leisure. We designed and evaluated a web app called LifeLogger. This application harnesses semi-automated, self-tracking, and visualization features to support awareness and reflection of time use. We invited 13 participants to interact with the prototype for a week, and followed up with semi-structured interviews to understand their experiences of the application. We find that LifeLogger increases participants awareness and encourages self-reflection on time use, which could facilitate participants in comprehend- ing their time expenditures. We conclude by discussing potential design strategies for time management

Cost-effectiveness of Lifestyle Africa: an adaptation of the diabetes prevention programme for delivery by community health workers in urban South Africa

Background Lifestyle Africa is an adapted version of the Diabetes Prevention Program designed for delivery by community health workers to socioeconomically disadvantaged populations in low- and middle-income countries (LMICs). Results from the Lifestyle Africa trial conducted in an under-resourced community in South Africa indicated that the programme had a significant effect on reducing haemoglobin A1c (HbA1c). Objective To estimate the cost of implementation and the cost-effectiveness (in cost per point reduction in HbA1c) of the Lifestyle Africa programme to inform decision-makers of the resources required and the value of this intervention. Methods Interviews were held with project administrators to identify the activities and resources required to implement the intervention. A direct-measure micro-costing approach was used to determine the number of units and unit cost for each resource. The incremental cost per one point improvement in HbA1c was calculated. Results The intervention equated to 71 United States dollars (USD) in implementation costs per participant and a 0.26 improvement in HbA1c per participant. Conclusions Lifestyle Africa reduced HbA1c for relatively little cost and holds promise for addressing chronic disease in LMIC. Decision-makers should consider the comparative clinical effectiveness and cost-effectiveness of this intervention when making resource allocation decisions

Acceptability and concerns about innovative wearable health sensors in persons with and without chronic disease diagnosis

Advances in biomedical engineering continue to produce innovative wearable health sensors capable of real-time ambulatory assessments (e.g., of physiology, the environment), holding great potential for advancing precision monitoring and interventions through the integration of such devices and data into eHealth systems. As with any novel device, however, user views on acceptability and concerns about the technology must be evaluated to facilitate widespread implementation and user adoption of such devices. One factor that may strongly influence user views is the potential relevance to, and need for, self-care for chronic disease management. We examined if acceptability and concerns regarding innovative wearable devices differed between individuals living with or without chronic disease. A U.S. adult sample (N = 448; 20-70 yrs.; 34 % Female; 60 % White, 35 % Hispanic) completed a web-based survey regarding their thoughts/opinions related to innovative wearable sensors. Two-thirds (67 %, N = 298) reported at least one chronic disease; one-third (33 %, N = 150) reported no chronic health conditions. Participants viewed learning modules about two innovative devices: a watch to detect environmental gases for respiratory health, and a chest-patch monitoring real-time ECG. For each device, participants rated acceptability across multiple dimensions, and then rated potential concerns (including general concerns and specific worries about negative health impacts). Respondents with and without chronic disease differed in education, race, and ethnicity. Controlling for these differences, individuals with chronic disease reported significantly higher acceptability for the watch and for the chest-patch. Healthy participants reported significantly higher general concerns about technology. However, when concern questions were asked specifically about the potential negative impacts of the two study devices on physical health and well-being, participants with chronic disease reported significantly higher concerns. Overall, results show that living with chronic disease influences acceptability and concerns associated with adoption of innovative sensors. These findings suggest it is essential to take potential users' health status into account when studying the design and implementation of innovative wearable sensors. Dissemination strategies may benefit from emphasizing the beneficial features of these devices, addressing hesitations, and customizing implementation approaches by user group

Evaluation of an adapted version of the Diabetes Prevention Program for low- and middle-income countries: A cluster randomized trial to evaluate "Lifestyle Africa" in South Africa.

BackgroundLow- and middle-income countries (LMICs) are experiencing major increases in diabetes and cardiovascular conditions linked to overweight and obesity. Lifestyle interventions such as the United States National Diabetes Prevention Program (DPP) developed in high-income countries require adaptation and cultural tailoring for LMICs. The objective of this study was to evaluate the efficacy of "Lifestyle Africa," an adapted version of the DPP tailored for an underresourced community in South Africa compared to usual care.Methods and findingsParticipants were residents of a predominantly Xhosa-speaking urban township of Cape Town, South Africa characterized by high rates of poverty. Participants with body mass index (BMI) ≥ 25 kg/m2 who were members of existing social support groups or "clubs" receiving health services from local nongovernmental organizations (NGOs) were enrolled in a cluster randomized controlled trial that compared Lifestyle Africa (the intervention condition) to usual care (the control condition). The Lifestyle Africa intervention consisted of 17 video-based group sessions delivered by trained community health workers (CHWs). Clusters were randomized using a numbered list of the CHWs and their assigned clubs based on a computer-based random allocation scheme. CHWs, participants, and research team members could not be blinded to condition. Percentage weight loss (primary outcome), hemoglobin A1c (HbA1c), blood pressure, triglycerides, and low-density lipoprotein (LDL) cholesterol were assessed 7 to 9 months after enrollment. An individual-level intention-to-treat analysis was conducted adjusting for clustering within clubs and baseline values. Trial registration is at ClinicalTrials.gov (NCT03342274). Between February 2018 and May 2019, 782 individuals were screened, and 494 were enrolled. Participants were predominantly retired (57% were receiving a pension) and female (89%) with a mean age of 68 years. Participants from 28 clusters were allocated to Lifestyle Africa (15, n = 240) or usual care (13, n = 254). Fidelity assessments indicated that the intervention was generally delivered as intended. The modal number of sessions held across all clubs was 17, and the mean attendance of participants across all sessions was 61%. Outcome assessment was completed by 215 (90%) intervention and 223 (88%) control participants. Intent-to-treat analyses utilizing multilevel modeling included all randomized participants. Mean weight change (primary outcome) was -0.61% (95% confidence interval (CI) = -1.22, -0.01) in Lifestyle Africa and -0.44% (95% CI = -1.06, 0.18) in control with no significant difference (group difference = -0.17%; 95% CI = -1.04, 0.71; p = 0.71). However, HbA1c was significantly lower at follow-up in Lifestyle Africa compared to the usual care group (mean difference = -0.24, 95% CI = -0.39, -0.09, p = 0.001). None of the other secondary outcomes differed at follow-up: systolic blood pressure (group difference = -1.36; 95% CI = -6.92, 4.21; p = 0.63), diastolic blood pressure (group difference = -0.39; 95% CI = -3.25, 2.30; p = 0.78), LDL (group difference = -0.07; 95% CI = -0.19, 0.05; p = 0.26), triglycerides (group difference = -0.02; 95% CI = -0.20, 0.16; p = 0.80). There were no unanticipated problems and serious adverse events were rare, unrelated to the intervention, and similar across groups (11 in Lifestyle Africa versus 13 in usual care). Limitations of the study include the lack of a rigorous dietary intake measure and the high representation of older women.ConclusionsIn this study, we found that Lifestyle Africa was feasible for CHWs to deliver and, although it had no effect on the primary outcome of weight loss or secondary outcomes of blood pressure or triglycerides, it had an apparent small significant effect on HbA1c. The study demonstrates the potential feasibility of CHWs to deliver a program without expert involvement by utilizing video-based sessions. The intervention may hold promise for addressing cardiovascular disease (CVD) and diabetes at scale in LMICs.Trial registrationClinicalTrials.gov NCT03342274

Comparing large-scale hydrological model simulations to observed runoff percentiles in Europe

Large-scale hydrological models describing the terrestrial water balance at continental and global scales are increasingly being used in earth system modeling and climate impact assessments. However, because of incomplete process understanding and limits of the forcing data, model simulations remain uncertain. To quantify this uncertainty a multimodel ensemble of nine large-scale hydrological models was compared to observed runoff from 426 small catchments in Europe. The ensemble was built within the framework of the European Union Water and Global Change (WATCH) project. The models were driven with the same atmospheric forcing data. Models were evaluated with respect to their ability to capture the interannual variability of spatially aggregated annual time series of five runoff percentiles—derived from daily time series—including annual low and high flows. Overall, the models capture the interannual variability of low, mean, and high flows well. However, errors in the mean and standard deviation, as well as differences in performance between the models, became increasingly pronounced for low runoff percentiles, reflecting the uncertainty associated with the representation of hydrological processes, such as the depletion of soil moisture stores. The large spread in model performance implies that any single model should be applied with caution as there is a great risk of biased conclusions. However, this large spread is contrasted by the good overall performance of the ensemble mean. It is concluded that the ensemble mean is a pragmatic and reliable estimator of spatially aggregated time series of annual low, mean, and high flows across Europe

Pamphlets - homoeopathic.

-- Work of the National Association of Homoeopathic Members of Examining and Licensing Boards / H.M. Paine -- Pabula Neonatorum, a guide to the feeding of infants / G.B. Peck -- Treatment of scarlatina and measles / G.B. Peck -- Flotsam and jetsam / O.S. Runnels -- Constitution and by-laws, code of ethics, officers and members / Southern Homoeopathic Medical Association -- Science and homoeopathy / F.P. WebsterLetter to the members of the American Institute from A.B. Norton / American Institute of Homeopathy -- Important notice to the members of the American Institute of Homoeopathy in relation to the repertory of the Cyclopaedia of Drug Pathogenesy / R. Hughes -- Constitution and by-laws / American Institute of Homeopathy -- Code of medical ethics, constitution, by-laws, and list of members of the American Institute of Homoeopathy / American Institute of Homeopathy -- Homoeopathy in the public service / B.F.Bailey -- Proof of the law of similia from the electro-chemico-physiological standpoint / E.H.S. Bailey -- Two cases of brain tumor : a contribution to cerebral surgery / C. Bartlett -- Concerning Hensel's Tonicum... / Boericke & Tafel -- Homoeopathy : some observations in regard to its progress for forty years / G.W. Bowen -- Tubercular cystitis / B.G. Carleton -- Proving of the Apis Mellifica / Central New-York Homoeopathic Society -- On supra-pubic cystotomy and catheterization as a guide in perineal section for obliterative urethritis / H. Crutcher -- Test at the bed-side / P. Dudley -- Dietetic, climatic and hygienic treatment of tuberculosis / F.A. Faust -- Concordance repertory, of the well proven and most reliable symptoms of the homoeopathic Materia Medica / W.D. Gentry -- Sanitation on the farm / W.B. Hinsdale -- June number of the New England Medical Gazette...contains a paper... / Editor of Homoeopathic Recorder -- Samuel Hahnemann : a lecture / H.P. Holmes -- Urine of uro-genital tuberculosis / G.F. Laidlaw -- Plea for homeopathic solidarity and independent work / S. Leavitt -- Ups and downs of a doctor's life, being the closing lecture of the course delivered in the Hahnemann Medical College for the session of 1863-64 / R. Ludlam -- Study of Materia Medica / C. Mohr -- Twentieth century homoeopathy / J.H. Moore -- Spinal Affections / E.A. Murphy, M.D. -- Yellow fever, its treatment and prevention / E.A. Murphy, M.D.Mode of access: Internet