Cognitive appraisal of perceived threat of diabetes and adherence to self -management behaviors

Background. Within adherence research, health beliefs have been identified as being significant predictors of adherence. Specifically, perceived threat as a health belief has received considerable attention. However, a gap in current knowledge exists in terms of understanding perceived threat of illness as an event that is appraised by the patient.;Aim. The purpose of this exploratory, descriptive study was to examine cognitive appraisal of perceived threat of illness in relation to adherence to self-management behaviors in uninsured/under-insured persons with type 2 diabetes.;Method. A convenience sample consisted of 80 subjects being treated for type 2 diabetes mellitus at a free clinic in West Virginia between January 2008 and May 2008 meeting the following inclusion criteria: (1) age \u3e 18 years, (2) diagnosis of type 2 diabetes, (3) the ability to read, write, or understand English, and (4) uninsured/under-insured and receiving care at a free clinic. Subjects were administered the Summary of Diabetes Self Care Activities and the Cognitive Appraisal of Health Scale.;Results. Characteristics of the study sample included a mean age of 50.4 years (range 23 to 64 years), with 27.4% men and 72.4% women. The majority of subjects were white (94.7%), had diabetes for less than 10 years (82.9%), and reported having one to two co-morbidities. The sample followed recommendations for taking prescribed oral medications an average of 6.6 days/week, for general diet an average of 4.1 days/week, for specific diet 3.7 days/week, and for exercise an average of 2.9 days/week. The mean HbA1c = 7.56. HbA1c levels of 7% or greater were found in 49.4% of the subjects. Several significant relationships were found between cognitive appraisal variables and self-management variables. Persons with diabetes in this study perceived their diabetes as more of a challenge than as threatening or causing harm or loss. Cognitive appraisal did predict variance in adherence to diet and HbA1c level. Cognitive appraisal did not predict adherence to oral medication taking or exercise recommendations.;Conclusion. The persons with diabetes receiving care at the free clinic from this study did not differ in their levels of adherence to self-management behaviors from other types of patients reported in the literature. This study highlights the need for more research exploring the issues that persons with diabetes have with adherence to self-management behaviors, especially diet and exercise recommendations

Fuel consumption of gasoline and diesel tractors when used with selected implements in West Tennessee

The rate of fuel consumption was measured for both gasoline and diesel tractors in size classes for use with two-, four-, and six-row implements. Tractors were operated at four different speeds with various sizes of the following implements: moldboard plow, tandem disc, planter, and cultivator. Fuel meters were designed and constructed to measure the amount of fuel consumed for gasoline and diesel tractors during field opera-tions. The fuel consumption was measured volumetrically by using systems of electrically-actuated solenoid valves to control the flow of fuel into and out of graduated cylinders. The moldboard plows in almost every instance required the most energy both per hour and per unit area with each tractor type. As a rule, the moldboard plow was followed in fuel consumption by the tandem disc, the cultivator, and the planter. As implement size increased fuel consumption per hour increased as did field capacities. An increase in operating speed resulted in an increase in fuel consumption per hour. However, the fuel consumed per unit area decreased as speed increased from 3.2 to 8.1 kilometers per hour (2.0 to 5.0 miles per hour). This suggests that certain implements with high field capacities plus high operating speeds may result in substantial energy savings

The importance of understanding computer analyses in civil engineering

Sophisticated computer modelling systems are widely used in civil engineering analysis. This paper takes examples from structural engineering, environmental engineering, flood management and geotechnical engineering to illustrate the need for civil engineers to be competent in the use of computer tools. An understanding of a model's scientific basis, appropriateness, numerical limitations, validation, verification and propagation of uncertainty is required before applying its results. A review of education and training is also suggested to ensure engineers are competent at using computer modelling systems, particularly in the context of risk management. 1. Introductio

Strategies for recruiting a sample of adults with type 2 diabetes from primary care clinics in rural Appalachia: Incorporating cultural competence

Background: Recruiting research participants from primary care in rural Appalachia is a major challenge and can be influenced by cultural characteristics, making it critically important to incorporate strategies of cultural competence in the overall design of clinical research. Objectives: The purpose of this paper is to describe culturally competent strategies used for recruitment and data collection with a sample of adults with type 2 diabetes from primary care settings in Appalachia. Design: The Purnell model of cultural competence and relevant literature served as a framework for study design. Four overarching approaches informed the organization of recruitment strategies and development of the data collection plan. Procedures: The approaches included selection of research sites, establishing collaborations, sustaining collaborative relationships, and enhancing understanding of benefits of participation. Four recruitment sites were selected based on potential to enhance diversification of participants; multiple steps were included in each of the three remaining approaches to build relationships and gain participation. A study log was maintained to provide evaluation data. Results: Recruitment took 14 months and a sample of 102 subjects provided consent with 101 partici- pants providing complete data. Demographics were representative of the region except that African American participation was higher (6.9%) compared to current north central Appalachia (3%). Over 72% of participants indicated they would be interested in participating in future studies. Conclusions: These findings emphasize the importance of employing strategies for cultural competence in study design. Use of concepts from the Purnell model led to enhanced representativeness and po- tential for subsequent generalizability

Interventions for self-management of type 2 diabetes: An integrative review

Background Type 2 diabetes mellitus has been identified as one of the most challenging chronic illnesses to manage. Since the management of diabetes is mainly accomplished by patients and families, self-management has become the mainstay of diabetes care. However, a significant proportion of patients fail to engage in adequate self-management. A priority research question is how do interventions affect the self-management behaviors of persons with Type 2 diabetes? Purpose/Objectives The purpose of this integrative review is to provide a summary and critique of interventions that support diabetes self-management in the patient with Type II diabetes mellitus. Design An integrative review design, with a comprehensive methodological approach of reviews, allowing inclusion of experimental and non-experimental studies. Procedures A comprehensive search was conducted via Ebscohost using databases of Academic Search Complete, CINAHL, Health Source: Nursing/Academic Edition, MEDLINE, PsycArtiCLES, and PsycInfo. The final number of papers used for this review were: motivational interviewing (6), peer support/coaching (10), problem solving therapy (3), technology-based interventions (30), lifestyle modification programs (7), patient education (11), mindfulness (3), and cognitive behavioral therapy (5). Results Studies were examined from seventeen countries including a broad range of cultures and ethnicities. While interventions have shown mixed results in all interventional categories, many studies do support small to modest improvements in physiologic, behavioral, and psychological outcome measures. Considerable heterogeneity of interventions exists. The most commonly reported physiologic measure was HbA1c level. Outcome measures were collected mostly at 6 and 12 months. Duration of most research was limited to one year. Conclusions Research exploring the impact of interventions for self-management has made major contributions to the care of persons with type 2 diabetes, from offering suggestions for improving care, to stimulating new questions for research. However, implications for clinical practice remain inconclusive, and limitations in existing research suggest caution in interpreting results of studies

Developing a conformance methodology for clinically-defined medical record headings:a preliminary report.

Background: The Professional Records Standards Body for health and social care (PRSB) was formed in 2013 to develop and assure professional standards for the content and structure of patient records across all care disciplines in the UK. Although the PRSB work is aimed at Electronic Health Record (EHR) adoption and interoperability to support continuity of care, the current technical guidance is limited and ambiguous. Objectives: This project was initiated as a proof-ofconcept to demonstrate whether, and if so, how, conformance methods can be developed based on the professional standards. Methods: An expert group was convened, comprising clinical and technical representatives. A constrained data set was defined for an outpatient letter, using the subset of outpatient headings that are also present in the ep-SOS patient summary. A mind map was produced for the main sections and sub-sections. An openEHR archetype model was produced as the basis for creating HL7 and IHE implementation artefacts. Results: Several issues about data definition and representation were identified when attempting to map the outpatient headings to the epSOS patient summary, partly due to the difference between process and static viewpoints. Mind maps have been a simple and helpful way to visualize the logical information model and expose and resolve disagreements about which headings are purely for human navigation and which, if any, have intrinsic meaning. Conclusions: Conformance testing is feasible but nontrivial. In contrast to traditional standards-development timescales, PRSB needs an agile standards development process with EHR vendor and integrator collaboration to ensure implementability and widespread adoption. This will require significant clinical and technical resources

Multi-modales Biofeedback System zur Vorbeugung von Stürzen Multi-modal Biofeedback System for the Prevention of Falls

Das Biofeedback des Körperschwankens stellt eine Möglichkeit dar, Patienten mit statischen und dynamischen Gleichgewichtsproblemen alternative Sinnesreize zur Erlangung eines stabilen Gleichgewichts zur Verfügung zu stellen, was zu einer Verbesserung ihrer Lebensqualität führt. Das Biofeedback-System erzeugt mittels am Kopf befestigter Signalwandler auditive, vibro-taktile und vibro-vestibuläre Sinneseindrücke. Die Ergebnisse sowohl an jungen als auch an älteren Probanden ergaben, dass mit Hilfe des Biofeedbacks eine bemerkenswerte 40-60%ige Reduktion des Körperschwankens erzielt werden konnt

Stellar contents and Star formation in the young cluster Stock 18

We have carried out deep (V$\sim$21 mag) \ubvri photometric study of the star cluster Stock 18. These along with archival Infrared data have been used to derive the basic cluster parameters and also to study the star formation processes in and around the cluster region. The distance to the cluster is derived as 2.8$\pm$0.2 kpc while its age is estimated as $6.0\pm2.0$ Myr. Present study indicates that interstellar reddening is normal in the direction of the cluster. The mass function slope is found to be -1.37$\pm$0.27 for the mass range 1$<M/M_\odot<$11.9. There is no evidence found for the effect of mass segregation in main-sequence stars of the cluster. A young stellar population with age between 1-2 Myr have been found in and around the cluster region. The presence of IRAS and AKARI sources with MSX intensity map also show the youth of the Sh2-170 region.Comment: 25 pages, 11 figures, 3 tables (Accepted for publication in New Astronomy