Development and psychometric testing of a theory-based tool to measure self-care in diabetes patients: the Self-Care of Diabetes Inventory

Background: Self-care is essential for patients with diabetes mellitus. Both clinicians and researchers must be able to assess the quality of that self-care. Available tools have various limitations and none are theoretically based. The aims of this study were to develop and to test the psychometric properties of a new instrument based on the middle range-theory of self-care of chronic illness: the Self-Care of Diabetes Inventory (SCODI). Methods: Forty SCODI items (5 point Likert type scale) were developed based on clinical recommendations and grouped into 4 dimensions: self-care maintenance, self-care monitoring, self-care management and self-care confidence based on the theory. Content validity was assessed by a multidisciplinary panel of experts. A multi-centre cross-sectional study was conducted in a consecutive sample of 200 type 1 and type 2 diabetes patients. Dimensionality was evaluated by exploratory factor analyses. Multidimensional model based reliability was estimated for each scale. Multiple regression models estimating associations between SCODI scores and glycated haemoglobin (HbA1c), body mass index, and diabetes complications, were used for construct validity. Results: Content validity ratio was 100%. A multidimensional structure emerged for the 4 scales. Multidimensional model-based reliabilities were between 0.81 (maintenance) and 0.89 (confidence). Significant associations were found between self-care maintenance and HbA1c (p = 0.02) and between self-care monitoring and diabetes complications (p = 0.04). Self-care management was associated with BMI (p = 0.004) and diabetes complications (p = 0.03). Self-care confidence was a significant predictor of self-care maintenance, monitoring and management (all p < 0.0001). Conclusion: The SCODI is a valid and reliable theoretically-grounded tool to measure self-care in type 1 and type 2 DM patients

Early Paleogene wildfires in peat-forming environments at Schöningen, Germany

AbstractWildfire activity in early Paleogene greenhouse conditions can be used as an analogue to gauge the effect of future warming trends on wildfire in the current climate system. Inertinite (fossil charcoal in coal) from 11 autochthonous early Paleogene lignite seams from the Schöningen mine (Germany) was quantified using macerations, in situ pillars and industry standard crushed samples. A new three transect method was developed to quantify in situ charcoal. The combination of in situ pillars and crushed samples accounts for temporal and spatial variation in charcoal through a stratigraphically oriented pillar, whilst maintaining comparability with industry standards and previous work. Charcoal occurs as a range of randomly distributed particle sizes, indicating that fires were burning locally in the Schöningen peat-forming environment and in the surrounding areas, but according to petrological data, not in an episodic or periodic pattern. Although charcoal abundance is low (relative to previous high fire worlds such as the Cretaceous), three quantitative and semi-quantitative methods show increased wildfire activity (relative to the modern world) in the warmest parts of the early Paleogene. As atmospheric oxygen levels stabilised to modern values and precipitation and humidity became the main control on wildfire, increased rainfall followed by drier intervals would have created an environment rich in dry fuel in which wildfires could easily propagate if humidity was low enough. In the later part of the Early Eocene (Ypresian) charcoal abundance fell to levels similar to those found in modern peats. This indicates that the transition to the modern low fire world occurred within the Early Eocene, earlier than previous records suggest

How Well are Cardiopulmonary Resuscitation and Automated External Defibrillator Skills Retained Over Time? Results from the Public Access Defibrillation (PAD) Trial

Background: The current standard for cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) retraining for laypersons is a four‐hour course every two years. Others have documented substantial skill deterioration during this time period. Objectives: To evaluate 1) the retention of core CPR and AED skills among volunteer laypersons and 2) the time required to retrain laypersons to proficiency as a function of time since initial training. Methods: This was an observational follow‐up study evaluating CPR and AED skill retention and testing/retraining time up through 17 months after initial training. The study took place at 1,260 facilities recruited by 24 North American clinical research centers, and included 6,182 volunteer laypersons participating in the Public Access Defibrillation (PAD) Trial. Training to proficiency in either CPR only (N= 2,426) or CPR+AED (N= 3,756) was followed by testing/retraining provided three to 17 months later. Retraining was done in brief, one‐on‐one, individualized, interactive sessions. The outcome studied was instructors\u27 global assessments of performance of CPR and AED skill adequacy, i.e., whether CPR actions would likely result in perfusion (yes/no) and whether AED actions would result in a shock through the heart (yes/no). Results: For global CPR performance, 79%, 73%, and 71% of volunteers tested for the first time since initial training three to five, six to 11, and 12 to 17 months after initial training, respectively, were judged by their instructors as having adequate performance (p \u3c 0.001, chi‐square for linear trend). For global AED performance, 91%, 86%, and 84% of volunteers, respectively, were judged as having adequate performance (p \u3c 0.001). The mean (± standard deviation) times required to test and retrain volunteers to proficiency were 5.7 (± 4.0) minutes for CPR skills and 7.7 (± 4.6) minutes for CPR+AED skills. Conclusions: Among PAD Trial volunteer laypersons participating in a simulated resuscitation, the proportions of volunteers judged by instructors to have adequate CPR and AED skills demonstrated small declines associated with longer intervals between initial training and subsequent testing. However, based on instructors\u27 judgment, large majorities of volunteers still retained both CPR and AED core skills through 17 months after initial training. Furthermore, individual testing and retraining for CPR and AED skills were usually accomplished in less than 10 minutes per volunteer. Additional research is essential to identify training and evaluation techniques that predict adequate CPR and AED skill performance of laypersons when applied to an actual cardiac arrest

Self-care research: How to grow the evidence base?

Background and objective: The number of studies in the area of self-care is growing and international researchers are increasingly developing self-care interventions to improve outcomes of individual patients and communities. However, growth of the evidence is still slow due to challenges with designing and testing self-care interventions. In this article we address major methodological challenges with regard to the definition of self-care, use of theory, and research design, intended to provide guidance to researchers in this field.Method: During the inaugural conference of the International Center for Self-Care Research held in Rome, Italy in June 2019 we identified important issues in existing self-care research. Discussion and literature review lead to eight recommendation for future self-care research.Results: In preparation, begin with a theoretically sound definition of self-care. In planning the intervention, build on and extend previous studies. Use theory to develop self-care interventions and consider translational models to guide development, evaluation and implementation of complex self-care interventions. Employ a study design that fits the current phase and objectives of the research and measure self-care and related factors carefully. In reporting, describe the sample and setting sufficiently so that others can draw conclusions about generalizability and applicability to their practice and patient population. In interpretation, describe how the intervention is assumed to work (causal assumptions) and its key components.Conclusion: Our review of existing self-care research clearly illustrates that the recommendations we provide are needed if we are to substantially grow the evidence base supporting self-care. Embracing a core set of principles will allow us to build on each other's work.Tweetable abstract: A core set of methodological principles is needed to substantially grow the evidence base supporting self-care. (C) 2020 The Authors. Published by Elsevier Ltd

An Automated Method for the Detection and Extraction of HI Self-Absorption in High-Resolution 21cm Line Surveys

We describe algorithms that detect 21cm line HI self-absorption (HISA) in large data sets and extract it for analysis. Our search method identifies HISA as spatially and spectrally confined dark HI features that appear as negative residuals after removing larger-scale emission components with a modified CLEAN algorithm. Adjacent HISA volume-pixels (voxels) are grouped into features in (l,b,v) space, and the HI brightness of voxels outside the 3-D feature boundaries is smoothly interpolated to estimate the absorption amplitude and the unabsorbed HI emission brightness. The reliability and completeness of our HISA detection scheme have been tested extensively with model data. We detect most features over a wide range of sizes, linewidths, amplitudes, and background levels, with poor detection only where the absorption brightness temperature amplitude is weak, the absorption scale approaches that of the correlated noise, or the background level is too faint for HISA to be distinguished reliably from emission gaps. False detection rates are very low in all parts of the parameter space except at sizes and amplitudes approaching those of noise fluctuations. Absorption measurement biases introduced by the method are generally small and appear to arise from cases of incomplete HISA detection. This paper is the third in a series examining HISA at high angular resolution. A companion paper (Paper II) uses our HISA search and extraction method to investigate the cold atomic gas distribution in the Canadian Galactic Plane Survey.Comment: 39 pages, including 14 figure pages; to appear in June 10 ApJ, volume 626; figure quality significantly reduced for astro-ph; for full resolution, please see http://www.ras.ucalgary.ca/~gibson/hisa/cgps1_survey

Perinatal death by bile acid levels in intrahepatic cholestasis of pregnancy: a systematic review

Background: Intrahepatic cholestasis of pregnancy (ICP) is characterized by the elevation of total bile acids (TBAs). The primary concern in women with ICP is the increased risk of stillbirth. ICP is generally considered as “mild” when TBA levels range from 10 to 39 µmol/L and “severe” with levels greater than 40 µmol/L, although levels of TBA ≥100 µmol/L have been also considered as a further threshold of severity. Objective: To quantify the association between different severities of ICP (TBA 10–39, 40–99, and ≥100 µmol/L) and perinatal death. Data sources: Medline, Embase, Scopus, Web of Sciences, and ClinicalTrial.gov were searched from the inception of each database to February 2019. Methods of study selection: Randomized, cohort, case-control, or case series studies reporting maternal and perinatal outcomes on women with ICP by the three prespecified TBA levels (10–39, 40–99, and ≥100 µmol/L) were included. We excluded multiple gestations and trials which included an intervention. The analysis was performed with Pearson chi-square and Fisher’s exact test as appropriate. Continuous outcomes were compared using metaregression with inverse variance weighting using reported sample sizes and standard deviations. Pairwise comparisons used a Bonferroni correction to control for multiple testing. Tabulation, integration, and results: Six articles including 1280 singleton pregnancies affected by ICP were included in the systematic review. Out of the 1280 singleton pregnancies affected by ICP included, 118 had ICP with TBA ≥100 µmol/L. Perinatal death was more common in women with TBA ≥100 µmol/L (0.4% for TBA 10-39 μmol/L versus 0.3% for TBA 40-99 μmol/L versus 6.8% for TBA ≥ 100 μmol/L, p <.0001). Of the 8 perinatal deaths in the TBA ≥100 µmol/L group, 3 occurred ≥34 weeks. TBA ≥100 µmol/L increased the risk of spontaneous preterm birth (PTB) (5.4% versus 8.6% versus 18.2% respectively, p <.0001) and iatrogenic PTB (10.8% versus 21.6% versus 35.8% respectively, p<.0001) as well as meconium-stained amniotic fluid (9.0% versus 18.4% versus 31.6% respectively, p <.0001). Conclusions: Maternal TBA ≥100 µmol/L is associated with a 6.8% incidence of perinatal death, most of which (5.9% overall) are stillbirths, while TBA <100 µmol/L are associated with an incidence of perinatal death of 0.3%. It may be reasonable to consider late preterm delivery (at about 35–36 weeks) in women with TBA ≥100 µmol/L

HI Narrow Line Absorption in Dark Clouds

We have used the Arecibo telescope to carry out an survey of 31 dark clouds in the Taurus/Perseus region for narrow absorption features in HI ($\lambda$ 21cm) and OH (1667 and 1665 MHz) emission. We detected HI narrow self--absorption (HINSA) in 77% of the clouds that we observed. HINSA and OH emission, observed simultaneously are remarkably well correlated. Spectrally, they have the same nonthermal line width and the same line centroid velocity. Spatially, they both peak at the optically--selected central position of each cloud, and both fall off toward the cloud edges. Sources with clear HINSA feature have also been observed in transitions of CO, \13co, \c18o, and CI. HINSA exhibits better correlation with molecular tracers than with CI. The line width of the absorption feature, together with analyses of the relevant radiative transfer provide upper limits to the kinetic temperature of the gas producing the HINSA. Some sources must have a temperature close to or lower than 10 K. The correlation of column densities and line widths of HINSA with those characteristics of molecular tracers suggest that a significant fraction of the atomic hydrogen is located in the cold, well--shielded portions of molecular clouds, and is mixed with the molecular gas. The average number density ratio [HI]/[\h2] is $1.5\times10^{-3}$. The inferred HI density appears consistent with but is slightly higher than the value expected in steady state equilibrium between formation of HI via cosmic ray destruction of H$_2$ and destruction via formation of H$_2$ on grain surfaces. The distribution and abundance of atomic hydrogen in molecular clouds is a critical test of dark cloud chemistry and structure, including the issues of grain surface reaction rates, PDRs, circulation, and turbulent diffusion.Comment: 40 pages, 10 figures, accepted by Ap

Search for Interstellar Water in the Translucent Molecular Cloud toward HD 154368

We report an upper limit of 9 x 10^{12} cm-2 on the column density of water in the translucent cloud along the line of sight toward HD 154368. This result is based upon a search for the C-X band of water near 1240 \AA carried out using the Goddard High Resolution Spectrograph of the Hubble Space Telescope. Our observational limit on the water abundance together with detailed chemical models of translucent clouds and previous measurements of OH along the line of sight constrain the branching ratio in the dissociative recombination of H_3O+ to form water. We find at the $3\sigma$ level that no more than 30% of dissociative recombinations of H_3O+ can lead to H_2O. The observed spectrum also yielded high-resolution observations of the Mg II doublet at 1239.9 \AA and 1240.4 \AA, allowing the velocity structure of the dominant ionization state of magnesium to be studied along the line of sight. The Mg II spectrum is consistent with GHRS observations at lower spectral resolution that were obtained previously but allow an additional velocity component to be identified.Comment: Accepted by ApJ, uses aasp