Self-management support for chronic disease in primary care: frequency of patient self-management problems and patient reported priorities, and alignment with ultimate behavior goal selection.

BackgroundTo enable delivery of high quality patient-centered care, as well as to allow primary care health systems to allocate appropriate resources that align with patients' identified self-management problems (SM-Problems) and priorities (SM-Priorities), a practical, systematic method for assessing self-management needs and priorities is needed. In the current report, we present patient reported data generated from Connection to Health (CTH), to identify the frequency of patients' reported SM-Problems and SM-Priorities; and examine the degree of alignment between patient SM-Priorities and the ultimate Patient-Healthcare team member selected Behavioral Goal.MethodsCTH, an electronic self-management support system, was embedded into the flow of existing primary care visits in 25 primary care clinics and was used to assess patient-reported SM-Problems across 12 areas, patient identified SM-Priorities, and guide the selection of a Patient-Healthcare team member selected Behavioral Goal. SM-Problems included: BMI, diet (fruits and vegetables, salt, fat, sugar sweetened beverages), physical activity, missed medications, tobacco and alcohol use, health-related distress, general life stress, and depression symptoms. Descriptive analyses documented SM-Problems and SM-Priorities, and alignment between SM-Priorities and Goal Selection, followed by mixed models adjusting for clinic.Results446 participants with ≥ one chronic diseases (mean age 55.4 ± 12.6; 58.5% female) participated. On average, participants reported experiencing challenges in 7 out of the 12 SM-Problems areas; with the most frequent problems including: BMI, aspects of diet, and physical activity. Patient SM-Priorities were variable across the self-management areas. Patient- Healthcare team member Goal selection aligned well with patient SM-Priorities when patients prioritized weight loss or physical activity, but not in other self-management areas.ConclusionParticipants reported experiencing multiple SM-Problems. While patients show great variability in their SM-Priorities, the resulting action plan goals that patients create with their healthcare team member show a lack of diversity, with a disproportionate focus on weight loss and physical activity with missed opportunities for using goal setting to create targeted patient-centered plans focused in other SM-Priority areas. Aggregated results can assist with the identification of high frequency patient SM-Problems and SM-Priority areas, and in turn inform resource allocation to meet patient needs.Trial registrationClinicalTrials.gov ID: NCT01945918

Prospectus, April 9, 1997

https://spark.parkland.edu/prospectus_1997/1011/thumbnail.jp

Binary Neutron Stars with Arbitrary Spins in Numerical Relativity

We present a code to construct initial data for binary neutron star systems in which the stars are rotating. Our code, based on a formalism developed by Tichy, allows for arbitrary rotation axes of the neutron stars and is able to achieve rotation rates near rotational breakup. We compute the neutron star angular momentum through quasi-local angular momentum integrals. When constructing irrotational binary neutron stars, we find a very small residual dimensionless spin of $\sim 2\times 10^{-4}$. Evolutions of rotating neutron star binaries show that the magnitude of the stars' angular momentum is conserved, and that the spin- and orbit-precession of the stars is well described by post-Newtonian approximation. We demonstrate that orbital eccentricity of the binary neutron stars can be controlled to $\sim 0.1\%$. The neutron stars show quasi-normal mode oscillations at an amplitude which increases with the rotation rate of the stars.Comment: 20 pages, 22 figure

A Preliminary Analysis of Precipitation Properties and Processes during NASA GPM IFloodS

The Iowa Flood Studies (IFloodS) is a NASA Global Precipitation Measurement (GPM) ground measurement campaign, which took place in eastern Iowa from May 1 to June 15, 2013. The goals of the field campaign were to collect detailed measurements of surface precipitation using ground instruments and advanced weather radars while simultaneously collecting data from satellites passing overhead. Data collected by the radars and other ground instruments, such as disdrometers and rain gauges, will be used to characterize precipitation properties throughout the vertical column, including the precipitation type (e.g., rain, graupel, hail, aggregates, ice crystals), precipitation amounts (e.g., rain rate), and the size and shape of raindrops. The impact of physical processes, such as aggregation, melting, breakup and coalescence on the measured liquid and ice precipitation properties will be investigated. These ground observations will ultimately be used to improve rainfall estimates from satellites and in particular the algorithms that interpret raw data for the upcoming GPM mission's Core Observatory satellite, which launches in 2014. The various precipitation data collected will eventually be used as input to flood forecasting models in an effort to improve capabilities and test the utility and limitations of satellite precipitation data for flood forecasting. In this preliminary study, the focus will be on analysis of NASA NPOL (Sband, polarimetric) radar (e.g., radar reflectivity, differential reflectivity, differential phase, correlation coefficient) and NASA 2D Video Disdrometers (2DVDs) measurements. Quality control and processing of the radar and disdrometer data sets will be outlined. In analyzing preliminary cases, particular emphasis will be placed on 1) documenting the evolution of the rain drop size distribution (DSD) as a function of column melting processes and 2) assessing the impact of range on groundbased polarimetric radar estimates of DSD properties

Magnetic Transition State Searching : Beyond the Static Ion Approximation

The effect of structural relaxations on the magnetocrystalline anisotropy energy (MAE) was investigated by using density functional theory (DFT). The theory of the impact of magnetostructural coupling on the MAE was discussed, including the effects on attempt frequency. The MAE for ferromagnetic FePt (3.45 meV/formula unit) and antiferromagnetic PtMn (0.41 meV/formula unit) were calculated within the local density approximation (LDA). The effects of the structural relaxation were calculated and found to give

An Experimental Study of the Rainfall Variability Within TRMM/GPM Precipitation Radar and Microwave Sensor Instantaneous Field of View During MC3E

Dual tipping bucket gauges were operated at 16 sites in support of ground based precipitation measurements during Mid-latitude Continental Convective Clouds Experiment (MC3E). The experiment is conducted in North Central Oklahoma from April 22 through June 6, 2011. The gauge sites were distributed around Atmospheric Radiation Measurement (ARM) Climate Research facility where the minimum and maximum separation distances ranged from 1 to 12 km. This study investigates the rainfall variability by employing the stretched exponential function. It will focus on the quantitative assessment of the partial beam of the experiment area in both convective and stratiform rain. The parameters of the exponential function will also be determined for various events. This study is unique for two reasons. First is the existing gauge setup and the second is the highly convective nature of the events with rain rates well above 100 mm h-1 for 20 minutes. We will compare the findings with previous studies