Diabetes and the socioeconomic and built environment: geovisualization of disease prevalence and potential contextual associations using ring maps

<p>Abstract</p> <p>Background</p> <p>Efforts to stem the diabetes epidemic in the United States and other countries must take into account a complex array of individual, social, economic, and built environmental factors. Increasingly, scientists use information visualization tools to "make sense" of large multivariate data sets. Recently, ring map visualization has been explored as a means of depicting spatially referenced, multivariate data in a single information graphic. A ring map shows multiple attribute data sets as separate rings of information surrounding a base map of a particular geographic region of interest. In this study, ring maps were used to evaluate diabetes prevalence among adult South Carolina Medicaid recipients. In particular, county-level ring maps were used to evaluate disparities in diabetes prevalence among adult African Americans and Whites and to explore potential county-level associations between diabetes prevalence among adult African Americans and five measures of the socioeconomic and built environment—persistent poverty, unemployment, rurality, number of fast food restaurants per capita, and number of convenience stores per capita. Although Medicaid pays for the health care of approximately 15 percent of all diabetics, few studies have examined diabetes in adult Medicaid recipients at the county level. The present study thus addresses a critical information gap, while illustrating the utility of ring maps in multivariate investigations of population health and environmental context.</p> <p>Results</p> <p>Ring maps showed substantial racial disparity in diabetes prevalence among adult Medicaid recipients and suggested an association between adult African American diabetes prevalence and rurality. Rurality was significantly positively associated with diabetes prevalence among adult African American Medicaid recipients in a multivariate statistical model.</p> <p>Conclusions</p> <p>Efforts to reduce diabetes among adult African American Medicaid recipients must extend to rural African Americans. Ring maps can be used to integrate diverse data sets, explore attribute associations, and achieve insights critical to the promotion of population health.</p

Using the Plan-Do-Study-Act (PDSA) Model for Continuous Quality Improvement of an Established Simulated Patient Program

Objective: To describe the use of a continuous quality improvement process for strengthening our simulated patient (SP) program and the initial steps that have been implemented.&nbsp; Innovation: A workgroup that included five clinical faculty with significant experience working with SPs and a strong interest in improving the SP program was developed.&nbsp; The Plan-Do-Study-Act model was used as it allowed for incremental quality improvement changes, in order to ensure a high-quality SP program designed to optimize student learning.&nbsp; Data were gathered from students, SPs, and faculty. Opportunities for improvement were prioritized based on anticipated benefits and available resources.&nbsp; Changes related to planning, implementation, and evaluation and feedback have been executed. Critical Analysis: Changes related to planning that were implemented included developing handbooks for SPs, faculty, and graduate student instructors, as well as material for students in order to better describe the program.&nbsp; SPs are now referred to as “simulated” as opposed to “standardized” as part of a broader effort to clarify the purpose of SP interactions to students.&nbsp; Streamlined rubrics have been piloted, including electronic rubrics for first year students.&nbsp; SPs are being trained on fewer cases, in order to improve the training program.&nbsp; When possible, activities now take place in one large classroom instead of many small classrooms to improve oversight.&nbsp; Finally, additional feedback has been obtained from SPs via a retreat.&nbsp; These changes have been well received by students, SPs, and faculty.&nbsp;&nbsp;&nbsp; Next Steps: The collection of this data and initial quality improvement changes provided a basis for hiring a full-time employee who will: dedicate 50% of their time to programmatic assessment of the SP program, support faculty with logistics and training, and be the face of our program to the students and SPs. Further, formal quantitative and qualitative assessment of the SP program has begun. &nbsp; Type:&nbsp; Not

Nonisentropic Release of a Shocked Solid

We present molecular dynamics (MD) simulations of shock and release in micron-scale tantalum crystals that exhibit post-breakout temperatures far exceeding those expected under the standard assumption of isentropic release. We show via an energy-budget analysis that this is due to plastic-work heating from material strength that largely counters thermoelastic cooling. The simulations are corroborated by experiments where the release temperatures of laser-shocked tantalum foils are deduced from their thermal strains via in situ x-ray diffraction, and are found to be close to those behind the shock

'Support our networking and help us belong!': listening to beginning secondary school science teachers

This study, drawing on the voice of beginning teachers, seeks to illuminate their experiences of building professional relationships as they become part of the teaching profession. A networking perspective was taken to expose and explore the use of others during the first three years of a teacher’s workplace experience. Three case studies, set within a wider sample of 11 secondary school science teachers leaving one UK university’s PostGraduate Certificate in Education, were studied. The project set out to determine the nature of the networks used by teachers in terms of both how they were being used for their own professional development and perceptions of how they were being used by others in school. Affordances and barriers to networking were explored using notions of identity formation through social participation. The focus of the paper is on how the teachers used others to help shape their sense of belonging to this, their new workplace. The paper develops ideas from network theories to argue that membership of the communities are a subset of the professional inter‐relationships teachers utilise for their professional development. During their first year of teaching, eight teachers were interviewed, completing 13 semi‐structured interviews. This was supplemented in Year 2 by a questionnaire survey of their experiences. In the third year of the programme, 11 teachers (including the original sample of eight) were surveyed using a network mapping tool in which they represented their communications with people, groups and resources. Finally, three of the teachers (common to both samples) were then interviewed specifically about their networking practices and experiences using the generation of their network map as a stimulated recall focus. The implications of the analysis of these accounts are that these beginning teachers did not perceive of themselves wholly as novices and that their personal aspirations to increase participation in practical science, develop a career or work for pupils holistically did not always sit comfortably with the school communities into which they were being accommodated. While highlighting the importance of trust and respect in establishing relationships, these teachers’ accounts highlight the importance of finding ‘peers’ from whom they can find support and with whom they can reflect and potentially collaborate towards developing practice. They also raise questions about who these ‘peers’ might be and where they might be found

Photometric and Spectroscopic Observations of SN 1990E in NGC 1035: Observational Constraints for Models of Type II Supernovae

We present 126 photometric and 30 spectral observation of SN 1990E spanning from 12 days before B maximum to 600 days past discovery. These observations show that SN 1990E was of type II-P, displaying hydrogen in its spectrum, and the characteristic plateau in its light curve. SN 1990E is one of the few SNe II which has been well observed before maximum light, and we present evidence that this SN was discovered very soon after its explosion. In the earliest spectra we identify, for the first time, several N II lines. We present a new technique for measuring extinction to SNe II based on the evolution of absorption lines, and use this method to estimate the extinction to SN 1990E, Av=1.5+/-0.3 mag. From our photometric data we have constructed a bolometric light curve for SN 1990E and show that, even at the earliest times, the bolometric luminosity was falling rapidly. We use the late-time bolometric light curve to show that SN 1990E trapped a majority of the gamma rays produced by the radioactive decay of 56Co, and estimate that SN 1990E ejected 0.073 Mo of 56Ni, an amount virtually identical to that of SN 1987A. [excerpt

Interprofessional education through shadowing experiences in multi-disciplinary clinical settings

The World Health Organization has recently added Interprofessional Education (IPE) to its global health agenda recognizing it as a necessary component of all health professionals' education. We suggest mandatory interprofessional shadowing experiences as a mechanism to be used by chiropractic institutions to address this agenda. IPE initiatives of other professions (pharmacy and medicine) are described along with chiropractic. This relative comparison of professions local to our jurisdiction in Ontario, Canada is made so that the chiropractic profession may take note that they are behind other health care providers in implementing IPE

Consumer Attitudes and Use of Antibiotics

Recent antibiotic use is a risk factor for infection or colonization with resistant bacterial pathogens. Demand for antibiotics can be affected by consumers’ knowledge, attitudes, and practices. In 1998–1999, the Foodborne Diseases Active Surveillance Network (FoodNet) conducted a population-based, random-digit dialing telephone survey, including questions regarding respondents’ knowledge, attitudes, and practices of antibiotic use. Twelve percent had recently taken antibiotics; 27% believed that taking antibiotics when they had a cold made them better more quickly, 32% believed that taking antibiotics when they had a cold prevented more serious illness, and 48% expected a prescription for antibiotics when they were ill enough from a cold to seek medical attention. These misguided beliefs and expectations were associated with a lack of awareness of the dangers of antibiotic use; 58% of patients were not aware of the possible health dangers. National educational efforts are needed to address these issues if patient demand for antibiotics is to be reduced

Search for the standard model Higgs boson in the H to ZZ to 2l 2nu channel in pp collisions at sqrt(s) = 7 TeV

A search for the standard model Higgs boson in the H to ZZ to 2l 2nu decay channel, where l = e or mu, in pp collisions at a center-of-mass energy of 7 TeV is presented. The data were collected at the LHC, with the CMS detector, and correspond to an integrated luminosity of 4.6 inverse femtobarns. No significant excess is observed above the background expectation, and upper limits are set on the Higgs boson production cross section. The presence of the standard model Higgs boson with a mass in the 270-440 GeV range is excluded at 95% confidence level.Comment: Submitted to JHE