Trust and glycemic control in black patients with diabetic retinopathy: A pilot study

Diabetic retinopathy (DR) is more prevalent in blacks than whites because, compared to whites, blacks on average have worse glycemic control. Both of these racial disparities reflect differences in sociocultural determinants of health, including physician mistrust. This randomized, controlled 6-month pilot trial compared the efficacy of a culturally tailored behavioral health/ophthalmologic intervention called Collaborative Care for Depression and Diabetic Retinopathy (CC-DDR) to enhanced usual care (EUC) for improving glycemic control in black patients with DR (n = 33). The mean age of participants was 68 years (SD 6.1 years), 76% were women, and the mean A1C was 8.7% (SD 1.5%). At baseline, 14 participants (42%) expressed mistrust about ophthalmologic diagnoses. After 6 months, CC-DDR participants had a clinically meaningful decline in A1C of 0.6% (SD 2.1%), whereas EUC participants had an increase of 0.2% (SD 1.1%) (f [1, 28] = 1.9; P = 0.176). Within CC-DDR, participants with trust had a reduction in A1C (1.4% [SD 2.5%]), whereas participants with mistrust had an increase in A1C (0.44% [SD 0.7%]) (f [1, 11] = 2.11; P = 0.177). EUC participants with trust had a reduction in A1C (0.1% [SD 1.1%]), whereas those with mistrust had an increase in A1C (0.70% [SD 1.1%]) (f [1, 16] = 2.01; P = 0.172). Mistrust adversely affected glycemic control independent of treatment. This finding, coupled with the high rate of mistrust, highlights the need to target mistrust in new interventions to improve glycemic control in black patients with DR. © 2019 by the American Diabetes Association

Food Habits of Glaucous Gulls in the Beaufort Sea

During 1973 and 1974, 1877 regurgitated pellets were collected from 15 glaucous gull colonies on inland lakes, river deltas, and coastal reaches of the Beaufort Sea west and east of Tuktoyaktuk, N.W.T. The pellets contained chiefly small rodents, fish, eggs and young of geese and gulls, isopods, berries and grass, and blue mussels. The relative importance of these foods varied among the colonies, both within and between seasons. Predation on young waterfowl was more extensive than predation on eggs. The data show that glaucous gulls are adaptable and opportunistic feeders and that the diversity of foods consumed was high and did not vary within the season.

DEVELOPING AND PRICING PRECIPITATION INSURANCE

Production agriculture and agribusiness are exposed to many weather-related risks. Recent years have seen the emergence of an increased interest in weather-based derivatives as mechanisms for sharing risks due to weather phenomena. In this study, a unique precipitation derivative is proposed that allows the purchaser to specify the parameters of the idemnity function. Pricing methods are presented in the context of a cotton harvest example from Mississippi. Our findings show a potential for weather derivatives to serve niche markets within U.S. agriculture.Risk and Uncertainty,

Functional Outcomes of the Low Vision Depression Prevention Trial in Age-Related Macular Degeneration.

Purpose: To compare the efficacy of behavioral activation (BA) plus low vision rehabilitation with an occupational therapist (OT-LVR) with supportive therapy (ST) on visual function in patients with age-related macular degeneration (AMD). Methods: Single-masked, attention-controlled, randomized clinical trial with AMD patients with subsyndromal depressive symptoms (n = 188). All subjects had two outpatient low vision rehabilitation optometry visits, then were randomized to in-home BA + OT-LVR or ST. Behavioral activation is a structured behavioral treatment aiming to increase adaptive behaviors and achieve valued goals. Supportive therapy is a nondirective, psychological treatment that provides emotional support and controls for attention. Functional vision was assessed with the activity inventory (AI) in which participants rate the difficulty level of goals and corresponding tasks. Participants were assessed at baseline and 4 months. Results: Improvements in functional vision measures were seen in both the BA + OT-LVR and ST groups at the goal level (d = 0.71; d = 0.56 respectively). At the task level, BA + OT-LVR patients showed more improvement in reading, inside-the-home tasks and outside-the-home tasks, when compared to ST patients. The greatest effects were seen in the BA + OT-LVR group in subjects with a visual acuity ≥20/70 (d = 0.360 reading; d = 0.500 inside the home; d = 0.468 outside the home). Conclusions: Based on the trends of the AI data, we suggest that BA + OT-LVR services, provided by an OT in the patient\u27s home following conventional low vision optometry services, are more effective than conventional optometric low vision services alone for those with mild visual impairment. (ClinicalTrials.gov number, NCT00769015.)

Linearized large signal modeling, analysis, and control design of phase-controlled series-parallel resonant converters using state feedback

This paper proposes a linearized large signal state-space model for the fixed-frequency phase-controlled series-parallel resonant converter. The proposed model utilizes state feedback of the output filter inductor current to perform linearization. The model combines multiple-frequency and average state-space modeling techniques to generate an aggregate model with dc state variables that are relatively easier to control and slower than the fast resonant tank dynamics. The main objective of the linearized model is to provide a linear representation of the converter behavior under large signal variation which is suitable for faster simulation and large signal estimation/calculation of the converter state variables. The model also provides insight into converter dynamics as well as a simplified reduced order transfer function for PI closed-loop design. Experimental and simulation results from a detailed switched converter model are compared with the proposed state-space model output to verify its accuracy and robustness

Manual of Criminal Law and Procedure

Intended to aid to Alaska law enforcement officers in the performance of their duties in the field, this manual was designed to provide brief, quick access to major points of substantive and procedural criminal law. The manual contained discussion and procedural guidelines for investigatory stops, identification procedures including line-ups, arrest, search and seizure, interrogation, as well as discussion of justification for the use of nondeadly and deadly force whether by peace officers or civilians, culpability, entrapment, trial preparation, and media relations. The section on substantive criminal law deals with a selection of crimes most likely to be encountered by "street" officers as defined with the recently enacted Revised Alaska Criminal Code (effective January 1, 1980), desribing elements of each crime, investigative hints, and differences with previous provisions of the criminal code, where relevant.Alaska Department of Law Grant No. 78-A-014Introduction / Criminal Procedures / Substantive Criminal Law / Justification / Culpability / Entrapment / Trial Preparation / Media Relations / Appendice

Determinants of Activity Levels in African Americans With Mild Cognitive Impairment.

Engaging in cognitive, social, and physical activities may prevent cognitive decline. In a sample of older African Americans with mild cognitive impairment (MCI; N=221), we investigated the cross-sectional relationships between activity levels and participants\u27 demographic, clinical, and neuropsychological characteristics. The average age of participants was 75.4 years (SD, 7.0); 177 (80.1%) were women. Participation in cognitive/social activities was positively associated with education, depression, literacy, mobility, instrumental activities of daily living (IADL), verbal learning, and subcomponents of executive function. A linear regression identified IADLs, education, depression, and verbal learning as independent predictors. Participation in physical activities was positively associated with sex, depression, IADLs, and subcomponents of executive function. An ordinal regression identified executive function and depression as independent correlates. These data suggest that unique characteristics are associated with cognitive/social and physical activities in older African Americans with MCI. These characteristics, coupled with low activity levels, may increase the risk of progression from MCI to dementia. Culturally relevant behavioral interventions to reduce cognitive decline in this high-risk population are needed

Relationships between synoptic-scale transport and interannual variability of inorganic cations in surface snow at Summit, Greenland: 1992-1996

To fully utilize the long-term chemical records retrieved from central Greenland ice cores, specific relationships between atmospheric circulation and the variability of chemical species in the records need to be better understood. This research examines associations between the variability of surface snow inorganic cation chemistry at Summit, Greenland (collected during 1992–1996 summer field seasons) and changes in air mass transport pathways and source regions, as well as variations in aerosol source strength. Transport patterns and source regions are determined through 10-day isentropic backward air mass trajectories during a 1 month (late May to late June) common season over the 5 years. Changes in the extent of exposed continental surfaces in source regions are evaluated to estimate aerosol-associated calcium and magnesium ion source strength, while forest fire activity in the circumpolar north is investigated to estimate aerosol ammonium ion source strength. During the 1995 common season, 3 times more calcium and magnesium accumulated in the snowpack than the other study years. Also, an increasing trend of ammonium concentration was noted throughout the 5 years. Anomalous transport pathways and velocities were observed during 1995, which likely contributed to the high levels of calcium and magnesium. Increased forest fire activity in North America was concurrent with increased levels of ammonium and potassium, except for 1996, when ion levels were above average and forest fire activity was below average. Because of the ubiquitous nature of soluble ions, we conclude that it is very difficult to establish a quantitative link between the ion content of snow and firn at Summit and changes in aerosol source regions and source strength