Efficacy of Various Interventions for Achieving Target HbA1C Levels for Patients with Type II Diabetes Mellitus and on Exogenous Insulin

Objective: To learn the rates at which patients at UT Family Medicine–St. Francis (UTFM–SF) with type II diabetes mellitus are being prescribed recommended medications—namely metformin, sodium-glucose cotransporter 2 (SGLT2) inhibitors, and glucagon-like peptide 1 receptor agonists (GLP1RAs)—whether these rates correspond to the severity of hyperglycemia (as indicated by HbA1C level). A secondary goal of the study was to investigate if HbA1C levels are being checked at recommended intervals. Methods: A retrospective chart review was conducted using records of patients seen at the clinic in the previous four years between the ages of 18 and 65 who had visits with ICD 10 codes for type II diabetes mellitus (E11) and long term insulin use (Z79.4). Patients with an HbA1C result from January 1, 2018 or later and a chart history of an insulin prescription were selected for further analysis. Results: 234 patients met the search criteria and were divided into three groups based on an average of the three most recent HbA1C labs: Below the American Diabetes Association (ADA) recommended HbA1C of 7% (n=40), between 7% and the insurance quality metric goal of 9% (n=66), and above 9% (n=128). A chi-square test revealed there was no significant association between HbA1C group and the rate of prescription of metformin (2-sided, p=.631), SGLT2 inhibitors (P=.221), or GLP1RAs (P=.223); a chi-square test also showed there was no association between group and the number of medications prescribed (P=.236). A one-way ANOVA revealed no statistically significant differences between group with regards to frequency of HbA1C checks (P=.295). Conclusion: Patients at UTFM–SF with lower levels of glycemic control are not receiving significantly different treatment from patients who demonstrate better glycemic control—they are not being prescribed recommended medication classes at a different rate, they are not having medications combined at a different rate, and their HbA1Cs are not being monitored differently. Increased utilization of metformin, SGLT2 inhibitors, and GLP1Ras, as well as quarterly HbA1C checks, are necessary to bring diabetic care at UTFM–SF more in line with ADA recommendations

Economic Impacts of Ethanol Production in Georgia

Capital costs to construct a conventional ethanol plant producing 100 million gallons per year are $170.593 million. Average annual net returns average$59.216 million with a 1% chance of annual net returns less than $0. Ethanol production stimulates total economic output of$314.221 million in the Georgia economy. Wages and benefits total $20.181 million for 408 jobs in Georgia. State and local governments derive a total of$4.572 million in tax revenues from ethanol production.Resource /Energy Economics and Policy,

Dear Pal Of My Dreams

https://digitalcommons.library.umaine.edu/mmb-vp/1288/thumbnail.jp

Discrimination, Mental Health, and Coping Among Mexican-American Adults: Exploring Gender Differences

In collaboration with the University of California, Davis, we will analyze existing data from the California Families Project, an ongoing longitudinal study of Mexican origin adults living in Northern California (N = 674). Our first objective is to investigate associations between ethnic discrimination and distress over time. Second, we explore protective factors or sources of support (ethnic pride, perceived support, neighborhood cohesion) that may moderate the association between discrimination and distress over time. Third, we investigate whether there are significant gender differences in levels of discrimination and distress, as well as the associations between discrimination and distress over time. Participant data come from home interviews (survey) over a ten-year period. Our statistical analyses include measurement invariance tests and equality constraints between males and females in structural equation models and testing interaction effects between levels of discrimination and the three hypothesized protective factors. Findings will advance understanding about the mental health outcomes associated with discrimination as well as the factors that promote wellbeing among Mexican origin adults. Data analyses are currently underway and will be completed in early April. Findings may inform future research and theory development, practice, and policy so that the mental health of Mexican origin families can be improved

A meta-analysis of ethnic differences in pathways to care at the first episode of psychosis

Objective: We sought to systematically review the literature on ethnic differences in the likelihood of general practitioner (GP) involvement, police involvement, and involuntary admission on the pathway to care of patients with first-episode psychosis (FEP). Method: We searched electronic databases and conducted forward and backward tracking to identify relevant studies. We calculated pooled odds ratios (OR) to examine the variation between aggregated ethnic groups in the indicators of the pathway to care. Results: We identified seven studies from Canada and England that looked at ethnic differences in GP involvement (n = 7), police involvement (n = 7), or involuntary admission (n = 5). Aggregated ethnic groups were most often compared. The pooled ORs suggest that Black patients have a decreased likelihood of GP involvement (OR = 0.70, 0.57-0.86) and an increased likelihood of police involvement (OR = 2.11, 1.67-2.66), relative to White patients. The pooled ORs were not statistically significant for patients with Asian backgrounds (GP involvement OR = 1.23, 0.87-1.75; police involvement OR = 0.86, 0.57-1.30). There is also evidence to suggest that there may be ethnic differences in the likelihood of involuntary admission; however, effect modification by several sociodemographic factors precluded a pooling of these data. Conclusion: Ethnic differences in pathways to care are present at the first episode of psychosis

Convergent learning algorithms for potential games with unknown noisy rewards

In this paper, we address the problem of convergence to Nash equilibria in games with rewards that are initially unknown and which must be estimated over time from noisy observations. These games arise in many real-world applications, whenever rewards for actions cannot be prespecified and must be learned on-line. Standard results in game theory, however, do not consider such settings. Specifically, using results from stochastic approximation and differential inclusions, we prove the convergence of variants of fictitious play and adaptive play to Nash equilibria in potential games and weakly acyclic games, respectively. These variants all use a multi-agent version of Q-learning to estimate the reward functions and a novel form of the e-greedy decision rule to select an action. Furthermore, we derive e-greedy decision rules that exploit the sparse interaction structure encoded in two compact graphical representations of games, known as graphical and hypergraphical normal form, to improve the convergence rate of the learning algorithms. The structure captured in these representations naturally occurs in many distributed optimisation and control applications. Finally, we demonstrate the efficacy of the algorithms in a simulated ad hoc wireless sensor network management problem

Bereavement, Level Stress and Coping Mechanism Among Teacher Education Students of Samar State University: College Bereavement Study

Bereavement is a severe stressor that should be addressed properly. The study of Teacher education is very tight as it prepares soon to educator that will light the future of other young children. This study sought to determine the Level of Stress and Coping Mechanism on Bereavement among Teacher Education Students of Samar State University. It tested some assumption using the descriptive survey method on 76 identified students who experienced bereavement. It shows that respondent manifested highly emotional and physical stress rather than behavioral stress. It shows that social support is coping mechanism. The said study being the first bereavement research in the city could provide baseline information in the field of bereavement