Blood Sugar, Your Pancreas, and Unicorns: The Development of Health Education Materials for Youth With Prediabetes

Background. The obesity epidemic has led to an increase in prediabetes in youth, causing a serious public health concern. Education on diabetes risk and initiation of lifestyle change are the primary treatment modalities. There are few existing age-appropriate health education tools to address diabetes prevention for high-risk youth. Aim. To develop an age-appropriate health education tool(s) to help youth better understand type 2 diabetes risk factors and the reversibility of risk. Method. Health education tool development took place in five phases: exploration, design, analysis, refinement, and process evaluation. Results. The project resulted in (1) booklet designed to increase knowledge of risk, (2) meme generator that mirrors the booklet graphics and allows youth to create their own meme based on their pancreas’ current mood, (3) environmental posters for clinic, and (4) brief self-assessment that acts as a conversation starter for the health educators. Conclusion. Patients reported high likability and satisfaction with the health education tools, with the majority of patients giving the materials an “A” rating. The process evaluation indicated a high level of fidelity and related measures regarding how the health education tools were intended to be used and how they were actually used in the clinic setting

A stratified transect approach captures reef complexity with canopy-forming organisms

On the Great Barrier Reef (GBR), persistent changes to reef communities have begun to be documented, and on inshore reefs these shifts may favour the proliferation of macroalgae. Critical to understanding changes to reef community structure in response to anthropogenic impacts is developing effective methods to accurately document the abundance of different reef organisms. Effective monitoring must be time and cost efficient, replicable, and able to sufficiently and accurately detect disturbances to allow development of strategies to mitigate their impacts. Traditional techniques to document coral reef communities (i.e. photo-quadrats, benthic intercept transects) rely on planar views, which tend to either over- or under-represent canopy-forming organisms. As canopy-forming organisms are likely to be affected by anthropogenic influences (corals negatively, algae positively), it is essential for monitoring programs to implement methods sufficient to document changes to the vertical dimension of coral reefs. Here we build on previous work to document the canopy effect in coral-dominated ecosystems and propose a new survey approach suitable for implementation in algal-dominated systems. A vertically stratified transect, modified from a traditional point intercept transect, captures benthic and canopy-forming members of reef communities and provides information on three-dimensional complexity. To test the capability of the new method to detect changes in vertical reef structure, seaweed was removed from experimental quadrats and monitoring techniques were applied before and after four months of regrowth. A stratified method more accurately captured the three-dimensional change resulting from algal canopy growth, while resolving the over- and under-representation of algal biomass in two traditional techniques. We propose that a stratified transect method improves abundance estimates of canopy-forming organisms whilst maintaining data compatibility with traditional methods

Obstacle Avoidance in Collective Robotic Search Using Particle Swarm Optimization

Particle Swarm Optimization (PSO) has been demonstrated to be a useful technique in target search applications such as Collective Robotic Search (CRS). A group of unmanned mobile robots are able to locate a specified target in a high risk environment with extreme efficiency when driven by an optimized PSO algorithm. This paper presents an algorithm for obstacle avoidance with the PSO approach applied to navigate robots in collective search applications. Obstacles represented by basic geometric shapes to simulate perilous ground terrain are introduced to the search area. Results are presented to show that PSO algorithm based CRS is able to locate targets avoiding hazardous pathways

Center for Pediatric Obesity and Diabetes Prevention Research

poster abstractBackground To facilitate both research and treatment of obesity in youth who are at especially high risk for diabetes, we have created the Center for Pediatric Obesity and Diabetes Prevention Research. The mission of the center is to advance the health of vulnerable populations through obesity and diabetes prevention research focusing on mechanisms of progression from obesity to type 2 diabetes, defining best practices for obesity/diabetes prevention among youth, and cost-effective translation of the research to the community. Specific Aims 1. To promote the clinical investigation of pathophysiologic mechanisms, diagnosis, and primary prevention of type 2 diabetes among vulnerable youth 2. Foster collaboration and facilitate interdisciplinary research between investigators interested in childhood obesity and diabetes prevention 3. Participate in community-based diabetes prevention research Key Ongoing Collaborative Research Projects Youth Diabetes Prevention Clinic (YDPC) – Patient-Centered Outcomes Project This program is designed to evaluate and assess the needs of adolescents (ages 10 – 21) who have evidence of prediabetes. Our goal is to successfully intervene in the trajectory toward the development of diabetes, and to promote healthy weight-control and improved well-being through an individualized treatment plan. Not only has this allowed us to address a significant unmet clinical need, but also to advance pediatric obesity patient-centered outcomes research and comparative effectiveness research in adolescent obesity / diabetes prevention. Dietary Intervention for Glucose Intolerance in Teens (DIG-IT Study) The objective of this study is to determine the impact on glycemic control, in adolescents who have prediabetes, of an individually-tailored wellness coaching strategy used to modify lifestyle habits. Additionally, the study aims to identify lifestyle factors that drive glycemic control, independent of changes in weight. We are conducting this study in in the Youth Diabetes Prevention Clinic via a collaboration with Dr. Gletsu-Miller (Purdue University). ENCOURAGE Healthy Families Study This is a randomized trial evaluating the comparative effectiveness and costs of an adaptation of the Diabetes Prevention Program (DPP) directed at mothers and their children. The intervention is a group based lifestyle program which we developed and implemented in partnership with the YMCA. We are comparing the ENCOURAGE intervention targeted to 1) mothers who have had gestational diabetes or prediabetes, and 2) mothers who have had GDM or prediabetes along with their school-aged children

Testing Whether Camera Presence Influences Habitat Specific Predation Pressure on Artificial Shorebird Nests in the Arctic

When monitoring the breeding ecology of birds, the causes and times of nest failure can be difficult to determine. Cameras placed near nests allow for accurate monitoring of nest fate, but their presence may increase the risk of predation by attracting predators, leading to biased results. The relative influence of cameras on nest predation risk may also depend on habitat because predator numbers or behaviour can change in response to the availability or accessibility of nests. We evaluated the impact of camera presence on the predation rate of artificial nests placed within mesic tundra habitats used by Arctic-breeding shorebirds. We deployed 94 artificial nests, half with cameras and half without, during the shorebird-nesting season of 2015 in the East Bay Migratory Bird Sanctuary, Nunavut. Artificial nests were distributed evenly across sedge meadow and supratidal habitats typically used by nesting shorebirds. We used the Cox proportional hazards model to assess differential nest survival in relation to camera presence, habitat type, placement date, and all potential interactions. Artificial nests with cameras did not experience higher predation risk than those without cameras. Predation risk of artificial nests was related to an interaction between habitat type and placement date. Nests deployed in sedge meadows and in supratidal habitats later in the season were subject to a higher risk of predation than those deployed in supratidal habitats early in the season. These differences in predation risk are likely driven by the foraging behaviour of Arctic fox (Vulpes lagopus), a species that accounted for 81% of observed predation events in this study. Arctic fox prey primarily on Arvicoline prey and goose eggs at this site and take shorebird nests opportunistically, perhaps more often later in the season when their preferred prey becomes scarcer. This study demonstrates that, at this site, cameras used for nest monitoring do not influence predation risk. Evaluating the impact of cameras on predation risk is critical prior to their use, as individual study areas may differ in terms of predator species and behaviour.Lors de la surveillance de l’écologie de reproduction des oiseaux, les causes et les périodes de défaillance des nids peuvent être difficiles à déterminer. Des caméras placées près des nids permettent une surveillance précise du sort des nids, mais leur présence peut augmenter le risque de prédation en attirant les prédateurs, ce qui entraîne des résultats biaisés. L’influence relative des caméras sur le risque de prédation des nids peut également dépendre de l’habitat, car le nombre ou le comportement des prédateurs peut changer en fonction de la disponibilité ou de l’accessibilité des nids. Nous avons évalué l’impact de la présence de caméras sur le taux de prédation des nids artificiels placés dans les habitats de la toundra mésique utilisés par les limicoles se reproduisant dans l’Arctique. Nous avons installé 94 nids artificiels, la moitié avec des caméras et l’autre moitié sans caméras, pendant la saison de nidification des limicoles de 2015 dans le Refuge d’oiseaux migrateurs de la baie Est, au Nunavut. Les nids artificiels étaient répartis uniformément dans les cariçaies et les habitats supratidaux généralement utilisés par les limicoles nicheurs. Nous avons utilisé le modèle à risques proportionnels de Cox pour évaluer la survie différentielle des nids en fonction de la présence de caméras, du type d’habitat, de la date d’installation des caméras et de toutes les interactions potentielles. Les nids artificiels équipés de caméras ne présentaient pas de risque de prédation plus élevé que ceux sans caméras. Le risque de prédation des nids artificiels était lié à une interaction entre le type d’habitat et la date d’installation des caméras. Plus tard dans la saison, les nids placés dans les cariçaies et dans les habitats supratidaux ont fait l’objet d’un risque de prédation plus élevé que ceux des habitats supratidaux en début de saison. Ces différences de risque de prédation sont probablement attribuables au comportement d’alimentation du renard arctique (Vulpes lagopus), une espèce qui représentait 81 % des événements de prédation observés dans cette étude. Le renard arctique se nourrit principalement d’arvicolinés et d’oeufs d’oie sur ce site, et s’empare des nids de limicoles de manière opportuniste, peut-être plus souvent plus tard dans la saison, lorsque ses proies préférées se font plus rares. Cette étude démontre que, sur ce site, les caméras servant à la surveillance des nids n’influencent pas le risque de prédation. Il est essentiel d’évaluer l’impact des caméras sur le risque de prédation avant leur utilisation, car chacune des zones étudiées peut différer sur le plan des espèces de prédateurs et des comportements

Codesigned Shared Decision-Making Diabetes Management Plan Tool for Adolescents With Type 1 Diabetes Mellitus and Their Parents: Prototype Development and Pilot Test

Background: Adolescents with type 1 diabetes mellitus have difficulty achieving optimal glycemic control, partly due to competing priorities that interfere with diabetes self-care. Often, significant diabetes-related family conflict occurs, and adolescents’ thoughts and feelings about diabetes management may be disregarded. Patient-centered diabetes outcomes may be better when adolescents feel engaged in the decision-making process. Objective: The objective of our study was to codesign a clinic intervention using shared decision making for addressing diabetes self-care with an adolescent patient and parent advisory board. Methods: The patient and parent advisory board consisted of 6 adolescents (teens) between the ages 12 and 18 years with type 1 diabetes mellitus and their parents recruited through our institution’s Pediatric Diabetes Program. Teens and parents provided informed consent and participated in 1 or both of 2 patient and parent advisory board sessions, lasting 3 to 4 hours each. Session 1 topics were (1) patient-centered outcomes related to quality of life, parent-teen shared diabetes management, and shared family experiences; and (2) implementation and acceptability of a patient-centered diabetes care plan intervention where shared decision making was used. We analyzed audio recordings, notes, and other materials to identify and extract ideas relevant to the development of a patient-centered diabetes management plan. These data were visually coded into similar themes. We used the information to develop a prototype for a diabetes management plan tool that we pilot tested during session 2. Results: Session 1 identified 6 principal patient-centered quality-of-life measurement domains: stress, fear and worry, mealtime struggles, assumptions and judgments, feeling abnormal, and conflict. We determined 2 objectives to be principally important for a diabetes management plan intervention: (1) focusing the intervention on diabetes distress and conflict resolution strategies, and (2) working toward a verbalized common goal. In session 2, we created the diabetes management plan tool according to these findings and will use it in a clinical trial with the aim of assisting with patient-centered goal setting. Conclusions: Patients with type 1 diabetes mellitus can be effectively engaged and involved in patient-centered research design. Teens with type 1 diabetes mellitus prioritize reducing family conflict and fitting into their social milieu over health outcomes at this time in their lives. It is important to acknowledge this when designing interventions to improve health outcomes in teens with type 1 diabetes mellitus

Learning from innovative practitioners: Evidence for the sustainability and resilience of pasture fed livestock systems

There is an urgent need for transformational change in agriculture to address current and future issues caused by climate change, biodiversity loss and socio-ecological disruption. But change is slow to come and is hindered by a lack of transdisciplinary evidence on potential approaches which take a systems approach. The research described here was co-developed with the Pasture Fed Livestock Association in the UK to objectively evidence their practices. These include producing pasture-based meat from livestock fed on pasture and pasture-based forages alone. This approach sits alongside wider aims of fitting their practices with the ecological conditions on each individual farm to facilitate optimal production and working collaboratively through a forum for sharing knowledge. The research provides strong indications that the PFLA approach to livestock production is resilient and viable, as well as contributing to wider public goods delivery, despite variability within and between farms. It also reveals that learning and adaption of practice (through farmer experience) is central to farming using agro-ecological approaches. This fluidity of practice presents challenges for reductionist approaches to "measuring" agricultural innovations

Contrasting Effects of Errorless Naming Treatment and Gestural Facilitation for Word Retrieval in Aphasia

Purpose- We compared the effects of two treatments for aphasic word retrieval impairments, errorless naming treatment (ENT) and gestural facilitation of naming (GES), within the same individuals, anticipating that the use of gesture would enhance the effect of treatment over errorless treatment alone. In addition to picture naming, we evaluated results for other outcome measures that were largely untested in earlier ENT studies. Methods- In a single participant crossover treatment design, we examined the effects of ENT and GES in eight individuals with stroke-induced aphasia and word retrieval impairments (three semantic anomia, five phonological anomia) in counterbalanced phases across participants. We evaluated effects of the two treatments for a daily picture naming/gesture production probe measure and in standardised aphasia tests and communication rating scales administered across phases of the experiment. Results- Both treatments led to improvements in naming of trained words (small-to-large effect sizes) in individuals with semantic and phonological anomia. Small generalised naming improvements were noted for three individuals with phonological anomia. GES improved use of corresponding gestures for trained words (large effect sizes). Results were largely maintained at one month post-treatment completion. Increases in scores on standardised aphasia testing also occurred for both ENT and GES training. Discussion- Both ENT and GES led to improvements in naming measures, with no clear difference between treatments. Increased use of gestures following GES provided a potential compensatory means of communication for those who did not improve verbal skills. Both treatments are considered to be effective methods to promote recovery of word retrieval and verbal production skills in individuals with aphasia

A Test of the Standard Hypothesis for the Origin of the HI Holes in Holmberg II

The nearby irregular galaxy Holmberg II has been extensively mapped in HI using the Very Large Array (VLA), revealing intricate structure in its interstellar gas component (Puche et al. 1992). An analysis of these structures shows the neutral gas to contain a number of expanding HI holes. The formation of the HI holes has been attributed to multiple supernova events occurring within wind-blown shells around young, massive star clusters, with as many as 10-200 supernovae required to produce many of the holes. From the sizes and expansion velocities of the holes, Puche et al. assigned ages of ~10^7 to 10^8 years. If the supernova scenario for the formation of the HI holes is correct, it implies the existence of star clusters with a substantial population of late-B, A and F main sequence stars at the centers of the holes. Many of these clusters should be detectable in deep ground-based CCD images of the galaxy. In order to test the supernova hypothesis for the formation of the HI holes, we have obtained and analyzed deep broad-band BVR and narrow-band H-alpha images of Ho II. We compare the optical and HI data and search for evidence of the expected star clusters in and around the HI holes. We also use the HI data to constrain models of the expected remnant stellar population. We show that in several of the holes the observed upper limits for the remnant cluster brightness are strongly inconsistent with the SNe hypothesis described in Puche et al. Moreover, many of the HI holes are located in regions of very low optical surface brightness which show no indication of recent star formation. Here we present our findings and explore possible alternative explanations for the existence of the HI holes in Ho II, including the suggestion that some of the holes were produced by Gamma-ray burst events.Comment: 30 pages, including 6 tables and 3 images. To appear in Astron. Journal (June 1999

Estimating Development Cost of an Interactive Website Based Cancer Screening Promotion Program

Author's manuscript made available in accordance with the publisher's policy.Objectives The aim of this study was to estimate the initial development costs for an innovative talk show format tailored intervention delivered via the interactive web, for increasing cancer screening in women 50–75 who were non-adherent to screening guidelines for colorectal cancer and/or breast cancer. Methods The cost of the intervention development was estimated from a societal perspective. Micro costing methods plus vendor contract costs were used to estimate cost. Staff logs were used to track personnel time. Non-personnel costs include all additional resources used to produce the intervention. Results Development cost of the interactive web based intervention was $.39 million, of which 77% was direct cost. About 98% of the cost was incurred in personnel time cost, contract cost and overhead cost. Conclusions The new web-based disease prevention medium required substantial investment in health promotion and media specialist time. The development cost was primarily driven by the high level of human capital required. The cost of intervention development is important information for assessing and planning future public and private investments in web-based health promotion interventions