Factors Associated With Integrating Self-Management Support Into Primary Care

Purpose The purpose of this article is to expand the understanding of self-management support by describing factors that contribute to implementing a comprehensive self-management program in primary care. Methods Four rural health centers in medically underserved areas participated in a study to document the implementation of a self-management program. This program consisted of a social marketing plan and decision-making tools to guide patients in making self-management behavior changes. The stages of change constructs of the transtheoretical model were used to design the social marketing plan. Key informant interviews were conducted at 6-month and 9-month intervals to document the implementation process. A standardized set of questions was used in the interviews. The data from the interviews were analyzed using content analysis techniques. Results One of the principle findings is that self-management support requires putting a system in place, not just adding a new component to primary care. The health centers that fully implemented the self-management program made an organizational commitment to keep self-management on the agenda in management meetings, clinical staff set the example by adopting self-management behaviors, and patient self-management support was implemented in multiple patient care venues. Conclusion Primary care centers with limited financial resources are able to integrate self-management support into their system of chronic illness care

STRAP 4 sounding rocket attitude control system

A sounding rocket attitude control system is reported that uses rate integrated gyros operating in both closed loop and open loop modes at very low drift rates. In normal operation the gyros are zeroed on a nearby star and torqued to the proper location in the closed loop mode; rate output is electronically integrated to provide a position displacement signal. Once closed loop torquing is completed, the caging loop is opened and the gyro is operated as angular displacement sensor to provide limit cycle control while viewing the target

Accessing the Functional Capabilities of the Tick Microbiome Through Metagenomics

The black-legged tick Ixodes scapularis is a common ectoparasite of animals and an obligate blood feeder, attaching to a host animal and taking a blood meal once per life stage (i.e. 3 times during its life). Unfortunately for the tick, blood represents a nutrient poor diet largely consisting of lipids and proteins but notably lacking in essential nutrients such a B vitamins (e.g., biotin, riboflavin, niacin) Other exclusive blood feeders such as the tsetse fly harbor symbiotic bacteria that provision B-complex vitamins to their host. I. scapularis harbors Rickettsia buchneri an endoparasitic bacterium that intriguingly possesses two copies of a complete biotin synthesis operon; however, there is no evidence that R. buchneri is required for I. scapularis fitness, or that it provisions biotin to its host. Consequently, it remains an open question how I. scapularis and other ticks without endosymbionts thrive on nutrient-poor blood alone. In the current work, I present a method to isolate the tick microbiome away from host cells to interrogate the complete microbial metagenome for metabolic capabilities related to nutrient supplementation. This method will allow us to analyze the entire microbial metagenome of small arthropods such as ticks – previously inaccessible due to overwhelming amounts of host DNA – and enable characterization of host-microbiome metabolic interdependency, providing novel insight into microbial ecology within ticks and other hematophagous arthropods

Development of an Experiment of Opportunity Test Payload for the Space Transportation System

This paper describes a means for flying existing Sounding Rocket payloads aboard the Space Shuttle by developing small experiment carriers which become detached from the orbiter and are later retrieved and reused. An effort is underway at the Goddard Space Flight Center to develop such a carrier which would be flown as an Experiment of Opportunity Payload (EOP). The activity is viewed as a feasibility test, and success will encourage the construction of similar packages for additional sounding rocket experiments, for eventual evolution of pointed sounding rocket experiments into the Space Shuttle

Experiments of Opportunity Payloads Revisited

A paper entitled Development of an Experiment of Opportunity Test Pay load for the Space Transportation system was presented at the 17th Space Congress in 1980. Over the next 5 years and through the gauntlets of budget crunches, technical snags, administrative reorganizations, and changes in name, the basic concept survived and matured into the Spartan program. Spartan 1 was launched aboard STS 51G in June 1985. The final design and operating concepts are discussed, along with results of its first flight

Age at Diagnosis of Diabetes in Appalachia

Background Appalachia is a region of the United States noted for the poverty and poor health outcomes of its residents. Residents of the poorest Appalachian counties have a high prevalence of diabetes and risk factors (obesity, low income, low education, etc.) for type 2 diabetes. However, diabetes prevalence exceeds what these risk factors alone explain. Based on this, the history of poor health outcomes in Appalachia, and personally observed high rates of childhood obesity and lack of concern about prediabetes, we speculated that people in Appalachia with diagnosed diabetes might tend to be diagnosed younger than their non-Appalachian counterparts. Methods We used data from the Behavioral Risk Factor Surveillance System (2006-2008). We compared age at diagnosis among counties by Appalachian Regional Commission-defined level of economic development. To account for risk differences, we constructed a model for average age at diagnosis of diabetes, adjusting for county economic development, obesity, income, sedentary lifestyle, and other covariates. Findings After adjustment for risk factors for diabetes, people in distressed or at-risk counties (the least economically developed) had their diabetes diagnosed two to three years younger than comparable people in non-Appalachian counties. No significant differences between non-Appalachian counties and Appalachian counties at higher levels of economic development remained after adjusting. Conclusions People in distressed and at-risk counties have poor access to care, and are unlikely to develop diabetes at the same age as their non-Appalachian counterparts but be diagnosed sooner. Therefore, people in distressed and at-risk counties are likely developing diabetes at younger ages. We recommend that steps to reduce health disparities between the poorest Appalachian counties and non-Appalachian counties be considered

High Potassium Intake on Sheep and Rabbits

Chemistr

Appalachian Regional Model for Organizing and Sustaining County-Level Diabetes Coalitions

This article describes a model for developing diabetes coalitions in rural Appalachian counties and presents evidence of their sustainability. The rural Appalachian coalition model was developed through a partnership between two federal agencies and a regional university. Coalitions go through a competitive application process to apply for one-time $10,000 grants. The project has funded 7 to 9 coalitions annually since 2001, reaching 66 total coalitions in 2008. Sustainability of the coalitions is defined by the number of coalitions that voluntarily report on their programs and services. In 2008, 58 of 66 (87%) coalitions in the Appalachian region continue to function and voluntarily submit reports even after their grant funds have been depleted. The factors that may contribute to sustainability are discussed in the article. This model for organizing coalitions has demonstrated that it is possible for coalitions to be maintained over time in rural underserved areas in Appalachia

Residence in a Distressed County in Appalachia as a Risk Factor for Diabetes, Behavioral Risk Factor Surveillance System, 2006-2007

Introduction We compared the risk of diabetes for residents of Appalachian counties to that of residents of non-Appalachian counties after controlling for selected risk factors in states containing at least 1 Appalachian county. Methods We combined Behavioral Risk Factor Surveillance System data from 2006 and 2007 and conducted a logistic regression analysis, with self-reported diabetes as the dependent variable. We considered county of residence (5 classifications for Appalachian counties, based on economic development, and 1 for non-Appalachian counties), age, sex, race/ethnicity, education, household income, smoking status, physical activity level, and obesity to be independent variables. The classification “distressed” refers to counties in the worst 10%, compared with the nation as a whole, in terms of 3-year unemployment rate, per capita income, and poverty. Results Controlling for covariates, residents in distressed Appalachian counties had 33% higher odds (95% confidence interval, 1.10-1.60) of reporting diabetes than residents of non-Appalachian counties. We found no significant differences between other classifications of Appalachian counties and non-Appalachian counties. Conclusions Residents of distressed Appalachian counties are at higher risk of diabetes than are residents of other counties. States with distressed Appalachian counties should implement culturally sensitive programs to prevent diabetes

The Spartan 1 mission

The first Spartan mission is documented. The Spartan program, an outgrowth of a joint Naval Research Laboratory (NRL)/National Aeronautics and Space Administration (NASA)-Goddard Space Flight Center (GSFC) development effort, was instituted by NASA for launching autonomous, recoverable payloads from the space shuttle. These payloads have a precise pointing system and are intended to support a wide range of space-science observations and experiments. The first Spartan, carrying an NRL X-ray astronomy instrument, was launched by the orbiter Discovery (STS51G) on June 20, 1985 and recovered successfully 45 h later, on June 22. During this period, Spartan 1 conducted a preprogrammed series of observations of two X-ray sources: the Perseus cluster of galaxies and the center of our galaxy. The mission was successful from both on engineering and a scientific viewpoint. Only one problem was encountered, the attitude control system (ACS) shut down earlier than planned because of high attitude control system gas consumption. A preplanned emergency mode then placed Spartan 1 into a stable, safe condition and allowed a safe recovery. The events are described of the mission and presents X-ray maps of the two observed sources, which were produced from the flight data