The relationship of individual comorbid chronic conditions to diabetes care quality.

ObjectiveMultimorbidity affects 26 million persons with diabetes, and care for comorbid chronic conditions may impact diabetes care quality. The aim of this study was to determine which chronic conditions were related to lack of achievement or achievement of diabetes care quality goals to determine potential targets for future interventions.Research design and methodsThis is an exploratory retrospective analysis of electronic health record data for 23 430 adults, aged 18-75, with diabetes who were seen at seven Midwestern US health systems. The main outcome measures were achievement of six diabetes quality metrics in the reporting year, 2011 (glycated haemoglobin (HbA1c) control and testing, low-density lipoprotein control and testing, blood pressure control, kidney testing). Explanatory variables were 62 chronic condition indicators. Analyses were adjusted for baseline patient sociodemographic and healthcare utilization factors.ResultsThe 62 chronic conditions varied in their relationships to diabetes care goal achievement for specific care goals. Congestive heart failure was related to lack of achievement of cholesterol management goals. Obesity was related to lack of HbA1c and BP control. Mental health conditions were related to both lack of achievement and achievement of different care goals. Three conditions were related to lack of cholesterol testing, including congestive heart failure and substance-use disorders. Of 17 conditions related to achieving control goals, 16 were related to achieving HbA1c control. One-half of the comorbid conditions did not predict diabetes care quality.ConclusionsFuture interventions could target patients at risk for not achieving diabetes care for specific care goals based on their individual comorbidities

Teachers\u27 Read-Aloud Preferences: Perpetuating Sex-Role Stereotypes

Just what influence does children\u27s literature, sexist or not, have upon socialization of children

The Deepwater Horizon Oil Spill And Gulf Of Mexico Shelf Hypoxia

The oil/water/dispersant mixture from the 2010 Deepwater Horizon oil spill was juxtaposed on the Louisiana continental shelf with the annual development of oxygen-depleted bottom waters. There was uncertainty whether the oil from the spill might worsen the extent or severity of the seasonal hypoxic area formation in 2010. The surface and bottom water hydrocarbons in May were elevated compared to in June and July, while the bottom-water dissolved oxygen concentrations were higher in May and June compared to in July. The degradation of oil in the water column or sediments was not known. The results of an empirical orthogonal functions (EOF) analysis of the progression of hypoxia development in May, June and July 2010, and an analysis of conditions in July compared to a 27-year background database, indicated no difference in oxygen concentrations for May, June or July 2010, with or without oil data included, nor any difference in July 2010 compared to other years. The analysis instead indicated that, in all years compared, the hypoxic area increased with higher river discharge, higher nitrate-N load, an easterly (westward) wind and reduced wind speed. Although the analyses did not demonstrate that the oil spill affected, or did not affect, the size of the 2010 hypoxic zone, there was evidence that the 2010 hypoxia season did not differ from the long-term record

NMFS / Interagency Working Group Evaluation of CITES Criteria and Guidelines.

EXECUTIVE SUMMARY: At present, the Convention on International Trade in Endangered Species of Wild Fauna and Flora (CITES) criteria used to assess whether a population qualifies for inclusion in the CITES Appendices relate to (A) size of the population, (B) area of distribution of the population, and (C) declines in the size of the population. Numeric guidelines are provided as indicators of a small population (less than 5,000 individuals), a small subpopulation (less than 500 individuals), a restricted area of distribution for a population (less than 10,000 km2), a restricted area of distribution for a subpopula-tion (less than 500 km2), a high rate of decline (a decrease of 50% or more in total within 5 years or two generations whichever is longer or, for a small wild population, a decline of 20% or more in total within ten years or three generations whichever is longer), large fluctuations (population size or area of distribution varies widely, rapidly and frequently, with a variation greater than one order of magnitude), and a short-term fluctuation (one of two years or less). The Working Group discussed several broad issues of relevance to the CITES criteria and guidelines. These included the importance of the historical extent of decline versus the recent rate of decline; the utility and validity of incorporating relative population productivity into decline criteria; the utility of absolute numbers for defining small populations or small areas; the appropriateness of generation times as time frames for examining declines; the importance of the magnitude and frequency of fluctuations as factors affecting risk of extinction; and the overall utility of numeric thresh-olds or guidelines

Towards Universal Screening for Colon Cancer: A Cheap, Reliable, Noninvasive Test Using Gene Expression Analysis of Rectal Swabs

Though colon cancer is the second leading cause of cancer deaths in the US, it is entirely preventable through early screening to detect and remove adenomatous polyps. Colonoscopy has long been regarded as the “gold standard” but is expensive, invasive, and uncomfortable, and only about half those considered at risk for colon cancer currently submit to colonoscopy or to less reliable alternatives such as fecal occult blood test. Here we describe the use of gene expression analysis to detect altered expression of certain genes associated with not only colon cancer but also polyps. The analysis can be performed on rectal swabs, with specimens provided in a routine doctor's office visit. The existence of this cheap and simple test, together with an active program to encourage individuals to submit to screening, could help eradicate colon cancer

Meeting Expanding Needs to Collect Food Intake Specificity: The Nutrition Data System for Research (NDS-R)

Food and nutrient databases are populated with data obtained from a variety of sources including USDA Reference Tables, scientific journals, food manufacturers and foreign food tables. The food and nutrient database maintained by the Nutrition Coordinating Center (NCC) at the University of Minnesota is continually updated with current nutrient data and continues to be expanded with additional nutrient fields to meet diverse research endeavors. Data are strictly evaluated for reliability and relevance before incorporation into the database; however, the values are obtained from various sources and food samples rather than from direct chemical analysis of specific foods. Precise nutrient values for specific foods are essential to the nutrition program at the National Aeronautics and Space Administration (NASA). Specific foods to be included in the menus of astronauts are chemically analyzed at the Johnson Space Center for selected nutrients. A request from NASA for a method to enter the chemically analyzed nutrient values for these space flight food items into the Nutrition Data System for Research (NDS-R) software resulted in modification of the database and interview system for use by NASA, with further modification to extend the method for related uses by more typical research studies

A Novel Application of TMA to Converging Runway Operations in a Simulated NextGen Environment

In 2013, the Airspace Operations Laboratory at NASA Ames Research Center conducted a human-in-the-loop simulation that examined the feasibility of applying a number of Next Generation Air Transportation System (NextGen) solutions to complex arrival operations in and around the New York metroplex. The delivery of arrivals to Newark Liberty International Airport (EWR) was the focus of this simulation, which involved extending the Terminal Sequencing and Spacing (TSS) scheduling capability to precisely schedule arrivals to intersecting runways 22 Left and 11. An important enabler for the concept was the availability of a dependent runway scheduler that was able to coordinate arrival times between aircraft landing on intersecting runways. At the time of the study, there was no functionality within the TSS scheduler to automatically create the dependent runway schedules. Instead, a Traffic Management Coordinator (TMC) manually created a de-conflicted schedule, which allowed for the concept to be tested as well as provided valuable insight into the tool requirements for a dependent runway scheduler. Throughout the course of preparations for the simulation, the individual serving as the TMC developed a number of strategies and procedures for manually adjusting the Scheduled Time of Arrival (STA) of the EWR arrivals in order to ensure that adequate spacing was provided between runway 22L and 11 arrival pairs. This paper describes the strategies and procedures that were developed and details how they were successfully applied during the simulation. Results will also be presented that shed additional light on exactly how the schedules were manipulated and their impact on delivery performance and safety. Ideas for additional TSS enhancements and next steps, based on participant feedback, will also be presented

Ground-Ground Data Communication-Assisted Planning and Coordination: Shorter Verbal Communications

A human-in-the-loop simulation was conducted to investigate the operational feasibility, technical requirements, and potential improvement in airspace efficiency of adding a Multi-Sector Planner position. A subset of the data from that simulation is analyzed here to determine the impact, if any, of ground-ground data communication (Data Comm) on verbal communication and coordination for multi-sector air traffic management. The results suggest that the use of Data Comm significantly decreases the duration of individual verbal communications. The results also suggest that the use of Data Comm, as instantiated in the current simulation, does not obviate the need for accompanying voice calls