An Intercultural Study in Health Literacy and Adherence among Patients with Diabetes

poster abstractHealth Literacy is believed to play an essential role in the ability of individuals to effectively manage their own health care. A report by the Institute of Medicine acknowledges that 90 million Americans with low literacy probably also have low health literacy, and that even individuals with adequate health literacy face challenges in the complex demands of health care contexts. This poster presents results of a 3-year study of an interdisciplinary project on health literacy and adherence at the Indiana Center for Intercultural Communication (ICIC) funded by the Eli Lilly & Co. Foundation. The purpose was to examine multiple dimensions of health literacy, based on patients’ perspectives (van Dulmen et al., 2008), with the goal of creating a new conceptualization and way of assessing health literacy in its broader sense that includes processing and acting on information in order to integrate those findings into interventions to improve health regimen adherence. Taking critical studies into account, we developed a model to identify the most important variables of adherence (Nutbeam, D., 2000; Levin-Zamir, D. and Peterburg, Y., 2001; Von Wagner, C., Steptoe, A., Wolf, M., and Wardle, J., 2008). The data consisted of video-taped interviews with 43 English-speakers and 21 Spanish-speakers, all of whom have diabetes. The interviews involved open-ended questions that elicited information about living with diabetes as well as questions on health beliefs, medication adherence, information sources and uses, literacy level and basic demographic information. These narratives were analyzed using grounded theory methodology of the patients’ own words. The quantitative data were analyzed using a multivariate analysis as well as an ordered probit analysis (Connor, U., et al., 2008, 2009, 2010; Lauten, K., et al., 2009, 2010; Lopez-Yunez, A., et al., 2009; Matthias, M.S. & Goering, E., 2008; Rozycki, W. & Connor, U., 2008; Wolf, M.S., et al, 2007). The model that ICIC has built provides practical interventions for patient-centered care. This poster presents examples of linguistic cues and phrases from the interviews, the results of the intercultural comparisons between which information sources were used in the English-speaking and Spanish-speaking subgroups, and the resultant model. Implications are discussed in terms of enhancing the patient-centered tailoring of health information and communication.

Assessing L2 Argumentation in the UAE Context

In this rapidly changing world, argumentation and critical thinking skills are undeniably crucial for new generations of Emirati students. These skills lay the groundwork for a competitive economy, which is a priority for the UAE in its Vision 2021. Specifically, today’s modern workplaces require workers to evaluate different propositions and develop their own after weighing up these various ideas, and thus the ability to defend arguments in English has become increasingly important for UAE university students in English-medium universities as well as their future professional contexts. Despite this importance, research regarding argumentation and the related critical thinking skills is sorely lacking in the UAE. This chapter delineates how written argumentation was assessed in a timed essay in a mandatory argumentative writing course taken by university freshmen in a government university in the UAE, and how the feedback gleaned from this common assessment was mapped to the teaching curriculum to shed light on the teaching effectiveness and to provide directions for future teaching

Correlation length scalings in fusion edge plasma turbulence computations

The effect of changes in plasma parameters, that are characteristic near or at an L-H transition in fusion edge plasmas, on fluctuation correlation lengths are analysed by means of drift-Alfven turbulence computations. Scalings by density gradient length, collisionality, plasma beta, and by an imposed shear flow are considered. It is found that strongly sheared flows lead to the appearence of long-range correlations in electrostatic potential fluctuations parallel and perpendicular to the magnetic field.Comment: Submitted to "Plasma Physics and Controlled Fusion

Value of systematic sampling in an mp-MRI targeted prostate biopsy strategy

The clinical utility of systematic prostate biopsy in addition to multi-parametric magnetic resonance imagining (mp-MRI) targeted biopsy pathways remains unclear. Despite radiological advancements in mp-MRI and utilisation of international standardised reporting systems (i.e., PI-RADS, LIKERT), undetected clinically significant prostate cancer (csPCa) on imaging persists. This has prevented the widespread adoption of an exclusively targeted biopsy approach. The current evidence on csPCa cancer detection rates in mp-MRI targeted alone and combined with a non-targeted systematic sampling is presented. Arguments for and against routine limited systematic sampling as an adjunct to an mp-MRI targeted biopsy are discussed. Our review will report the clinical utility of a combined sampling strategy on csPCa detection rate. The available evidence suggests that we are yet to reach a stage where non-targeted systematic prostate biopsy can be routinely omitted in mp-MRI targeted prostate biopsy pathways. Research should focus on improving the accuracy of mp-MRI, prostate biopsy techniques, and in identifying those men that will most benefit from a combined prostate biopsy. Such strategies may help future urologists reduce the burden of non-targeted cores in modern mp-MRI prostate biopsy pathways

Measurement and physical interpretation of the mean motion of turbulent density patterns detected by the BES system on MAST

The mean motion of turbulent patterns detected by a two-dimensional (2D) beam emission spectroscopy (BES) diagnostic on the Mega Amp Spherical Tokamak (MAST) is determined using a cross-correlation time delay (CCTD) method. Statistical reliability of the method is studied by means of synthetic data analysis. The experimental measurements on MAST indicate that the apparent mean poloidal motion of the turbulent density patterns in the lab frame arises because the longest correlation direction of the patterns (parallel to the local background magnetic fields) is not parallel to the direction of the fastest mean plasma flows (usually toroidal when strong neutral beam injection is present). The experimental measurements are consistent with the mean motion of plasma being toroidal. The sum of all other contributions (mean poloidal plasma flow, phase velocity of the density patterns in the plasma frame, non-linear effects, etc.) to the apparent mean poloidal velocity of the density patterns is found to be negligible. These results hold in all investigated L-mode, H-mode and internal transport barrier (ITB) discharges. The one exception is a high-poloidal-beta (the ratio of the plasma pressure to the poloidal magnetic field energy density) discharge, where a large magnetic island exists. In this case BES detects very little motion. This effect is currently theoretically unexplained.Comment: 28 pages, 15 figures, submitted to PPC

The effect of pulmonary rehabilitation on mortality, balance, and risk of fall in stable patients with chronic obstructive pulmonary disease: a systematic review

Objectives: To evaluate the impact of pulmonary rehabilitation on survival and fall (including balance) in patients with chronic obstructive pulmonary disease (COPD) at stability. Design: Systematic Review. Methods: OVID, MEDLINE, EMBASE, and Cochrane Collaboration Library were searched for literature dating from January 1980 up to November 2014 as well as an update in October 2015. Two reviewers screened titles, abstracts and full text records, extracted data and assessed studies for risk of bias; any disagreements were resolved by a third member of the team, and consensus was always sought. Results: Initial searches yielded 3216 records but after review, only 7 studies were included and no studies focused solely on falls. Two cohort studies found some positive benefits of pulmonary rehabilitation on balance but the results were inconsistent across the studies. Regarding survival, two randomised controlled trials were conducted; one study showed significant survival benefit at 1 year while the other one showed non-significant survival benefit at 3 years. Neither were adequately powered and in both, survival was a secondary outcome. Conclusions: There was only limited inconclusive evidence to show that pulmonary rehabilitation has a significant beneficial effect on balance or survival

Diagnostic accuracy of magnetic resonance imaging targeted biopsy techniques compared to transrectal ultrasound guided biopsy of the prostate: a systematic review and meta-analysis

Background: Multiparametric MRI localizes cancer in the prostate, allowing for MRI guided biopsy (MRI-GB) 43 alongside transrectal ultrasound-guided systematic biopsy (TRUS-GB). Three MRI-GB approaches exist; visual estimation (COG-TB); fusion software-assisted (FUS-TB) and MRI ‘in-bore’ biopsy (IB-TB). It is unknown whether any of these are superior. We conducted a systematic review and meta-analysis to address three questions. First, whether MRI-GB is superior to TRUS-GB at detecting clinically significant PCa (csPCa). Second, whether MRI-GB is superior to TRUS-GB at avoiding detection of insignificant PCa. Third, whether any MRI-GB strategy is superior at detecting csPCa. Methods: A systematic literature review from 2015 to 2019 was performed in accordance with the START recommendations. Studies reporting PCa detection rates, employing MRI-GB and TRUS-GB were included and evaluated using the QUADAS-2 checklist. 1553 studies were found, of which 43 were included in the meta-analysis. Results: For csPCa, MRI-GB was superior in detection to TRUS-GB (0.83 vs. 0.63 [p = 0.02]). MRI-GB was superior in detection to TRUS-GB at avoiding detection of insignificant PCa. No MRI-GB technique was superior at detecting csPCa (IB-TB 0.87; COG TB 0.81; FUS-TB 0.81, [p = 0.55]). There was significant heterogeneity observed between the included studies. Conclusions: In patients with suspected PCa on MRI, MRI-GB offers superior rates of csPCa detection and reduces detection of insignificant PCa compared to TRUS-GB. No individual MRI-GB technique was found to be better in csPCa detection. Prospective adequately powered randomized controlled trials are required

Molecular Genetic Approaches to Disease of Neural Development

This study utilized novel genetic techniques in order to find causative gene mutations that underlie diseases of neural development. Our laboratory has collected 175 cases of malformations of cortical development (MCD) from the United States and Europe. Four of these cases are the focus of this manuscript: two familial cases of infantile neuroaxonal dystrophy (INAD), a familial case of hereditary spastic paraparesis (HSP), and a sporadic case of Greig cephalopolysyndactyly (GCPS) and cerebral cavernous malformations (CCMs). The techniques utilized to study the affected patients include microarray-based single nucleotide polymorphism (SNP) genotyping and copy number variation (CNV) analysis, both of which are powerful tools in the hunt for disease-causing gene mutations. In the familial cases of INAD, we report two novel mutations in the PLA2G6 gene, previously shown to cause INAD when mutated. In the familial case of HSP, we demonstrate linkage to the SPG11 locus on chromosome 15q. Finally, in the sporadic case of GCPS and CCM, we published the first report on this novel syndrome along with a genetic analysis that demonstrates a microdeletion on chromosome 7p, resulting in heterozygous loss of both the GLI3 and CCM2 genes. The three studies presented in this manuscript demonstrate the utility of SNP genotyping and CNV analysis in revealing the genetic mutations that underlie diseases of neural development