Diabetes Education With a Focus on Blood Glucose Self-Management: Impacting the Frequency of Glucose Monitoring

This quality improvement project was conducted to evaluate whether a focused educational session on self-management of blood glucose monitoring increased the frequency of monitoring for adult type II diabetics who were not taking insulin therapy. The purpose of this improvement project was to add to the body of research from this project. Currently, there are no recommendations for people with type II diabetes who are not taking insulin therapy regarding monitoring their blood glucose. This quantitative project was conducted online to reduce face-to-face contact during the COVID-19 pandemic. It was conducted online through diabetes support groups found on Facebook. Permission was obtained through the group administrators to post in the diabetes support groups and obtain participants. Participants were given information for the quality improvement project and were given a consent form. A pre- and postquestionnaire were utilized. These questionnaires were designed identically for statistical purposes. An educational video provided a focused educational session on self-monitoring blood glucose. There was a total of five participants utilized. A Wilcoxon signed-rank test was utilized for statistical analysis. The data was found to be not statistically significant except for one question. Question 15 was noted to be statistically significant in that participants were noted to have a decrease in physical activity to obtain optimal blood glucose levels after viewing the focused educational session

Disrupting Norms to Increase Diversity of Teacher Candidates: Restraining Forces for Junior Faculty

Research in teacher preparation programs in Institutes of Higher Education (IHE) suggests that diverse and non-traditional students face barriers and challenges within teacher preparation programs (Widiputers et al., 2017). Diverse students include non-traditional students, first-generation students, students who have work responsibilities, who may have family or other care-giving responsibilities, students with disabilities, students living in poverty, and may also include culturally and linguistically diverse students. Issues such as unpaid practicum hours (similar to an internship), conflicting course and work schedules, attendance policies, due dates/late work policies, course expectations that value verbal participation, office hours not available when students are available, and how often courses are offered (e.g., yearly vs every semester) negatively impact diverse student populations. Many of these decisions are made at the preference of administration and tenured and established faculty while others are left-over from a time when students did not have to balance the work and family requirements many students face today. As we attempt to increase representation of students in teacher prep programs, the policies and practices to meet their unique situations have not been equitably incorporated into the daily practices in higher education. This continues to maintain of the status quo rather than increasing the diversity of teachers in the workforce as the diversity of teacher candidates has not increased to represent the diversifying population despite efforts (United States Department of Education, 2016). Many junior faculty may engage or attempt to engage in disrupting the status quo to create and implement policies that respond to students' needs that result in increased support for students from backgrounds that are disproportionately impacted by traditional practices. Junior faculty can serve as change agents if IHE can recognize the tremendous time and effort that goes into making sustainable change within the college and surrounding educational systems. Recognizing the barriers to junior faculty and providing support to do this challenging work and remain on target for promotion and tenure is critical. Tenure protections ensure faculty can be leaders in sustained change and establishes them as leaders within IHE and in their professional fields and disciplines. Establishing support systems, especially from administration, within the university and community can support junior faculty and accelerate the timeline or target systems open and more responsive to change

Curated Collections for Educators: Five Key Papers on Clinical Teaching

The ability to teach in the clinical setting is of paramount importance. Clinical teaching is at the heart of medical education, irrespective of the learner’s level of training. Learners desire and need effective, competent, and thoughtful clinical teaching from their instructors. However, many clinician-educators lack formal training on this important skill and thus may provide a variable experience to their learners. Although formal training of clinician-educators is standard and required in many other countries, the United States has yet to follow suit, leaving many faculty members to fend for themselves to learn these important skills. In September 2018, the Academic Life in Emergency Medicine (ALiEM) 2018-2019 Faculty Incubator program discussed the topic of clinical teaching techniques. We gathered the titles of papers that were cited, shared, and recommended within our online discussion forum and compiled the articles pertaining to the topic of clinical teaching techniques. To augment the list, the authors did a formal literature search using the search terms “teaching techniques", "clinical teaching", "medical education", "medical students", and "residents” on Google Scholar and PubMed. Finally, we posted a call for important papers on the topic of clinical teaching techniques on Twitter. Through this process, we identified 48 core articles on the topic of clinical teaching. We conducted a modified Delphi methodology to identify the key papers on the topic. In this paper, we present the five highest-rated articles based on the relevance to junior faculty and faculty developers. This article will review and summarize the articles we found to be the most impactful to improve one’s clinical teaching skills

Route of administration for illicit prescription opioids: a comparison of rural and urban drug users

<p>Abstract</p> <p>Background</p> <p>Nonmedical prescription opioid use has emerged as a major public health concern in recent years, particularly in rural Appalachia. Little is known about the routes of administration (ROA) involved in nonmedical prescription opioid use among rural and urban drug users. The purpose of this study was to describe rural-urban differences in ROA for nonmedical prescription opioid use.</p> <p>Methods</p> <p>A purposive sample of 212 prescription drug users was recruited from a rural Appalachian county (n = 101) and a major metropolitan area (n = 111) in Kentucky. Consenting participants were given an interviewer-administered questionnaire examining sociodemographics, psychiatric disorders, and self-reported nonmedical use and ROA (swallowing, snorting, injecting) for the following prescription drugs: buprenorphine, fentanyl, hydrocodone, hydromorphone, methadone, morphine, OxyContin^®and other oxycodone.</p> <p>Results</p> <p>Among urban participants, swallowing was the most common ROA, contrasting sharply with substance-specific variation in ROA among rural participants. Among rural participants, snorting was the most frequent ROA for hydrocodone, methadone, OxyContin^®, and oxycodone, while injection was most common for hydromorphone and morphine. In age-, gender-, and race-adjusted analyses, rural participants had significantly higher odds of snorting hydrocodone, OxyContin^®, and oxycodone than urban participants. Urban participants had significantly higher odds of swallowing hydrocodone and oxycodone than did rural participants. Notably, among rural participants, 67% of hydromorphone users and 63% of morphine users had injected the drugs.</p> <p>Conclusions</p> <p>Alternative ROA are common among rural drug users. This finding has implications for rural substance abuse treatment and harm reduction, in which interventions should incorporate methods to prevent and reduce route-specific health complications of drug use.</p

Bobcat Predation on Quail, Birds, and Mesomammals

We reviewed 54 scientific articles about bobcat (Lynx rufus) food habits to determine the occurrence of quail, birds, and mesopredators including red (Vulpes vulpes) and gray fox (Urocyon cinereoargenteus), raccoon (Procyon lotor), skunk (Mephitis spp.), and opossum (Didelphis virginianus). Quail (Colinus virginianus, Cyrtonyx montezumae, Callipepla squamata, C. gambelii, C. californica, Oreortyx pictus) were found in 9 diet studies and constituted 3% of the bobcat diet in only 2 of 54 studies. Birds occurred in 47 studies, but were also a minor dietary component in most studies. Although mesopredators were represented as bobcat prey in 33 of 47 studies, their percent occurrence within bobcat diets was low and showed regional patterns of occurrence. Bobcats are a minor quail predator, but felid effects on mesopredators and secondary impacts on quail need to be studied

A Rural/Urban Comparison of Privacy and Confidentiality Concerns Associated with Providing Sensitive Location Information in Epidemiologic Research Involving Persons Who Use Drugs

Background—Analyses that link contextual factors with individual-level data can improve our understanding of the risk environment ; however, the accuracy of information provided by participants about locations where illegal/stigmatized behaviors occur may be influenced by privacy/confidentiality concerns that may vary by setting and/or data collection approach. Methods—We recruited thirty-five persons who use drugs from a rural Appalachian town and a Mid-Atlantic city to participate in in-depth interviews. Through thematic analyses, we identified and compared privacy/confidentiality concerns associated with two survey methods that (1) collect self-reported addresses/cross-streets and (2) use an interactive web-based map to find/confirm locations in rural and urban settings. Results—Concerns differed more by setting than between methods. For example, (1) rural participants valued interviewer rapport and protections provided by the Certificate of Confidentiality more; (2) locations considered to be sensitive differed in rural (i.e., others\u27 homes) and urban (i.e., where drugs were used) settings; and (3) urban participants were more likely to view providing cross-streets as an acceptable alternative to providing exact addresses for sensitive locations and to prefer the web-based map approach. Conclusion—Rural-urban differences in privacy/confidentiality concerns reflect contextual differences (i.e., where drugs are used/purchased, population density, and prior drug-related arrests). Strategies to alleviate concerns include: (1) obtain a Certificate of Confidentiality, (2) collect geographic data at the scale necessary for proposed analyses, and (3) permit participants to provide intersections/landmarks in close proximity to actual locations rather than exact addresses or to skip questions where providing an intersection/landmark would not obfuscate the actual address

Healthcare Contact and Treatment Uptake Following Hepatitis C Virus Screening and Counseling Among Rural Appalachian People Who Use Drugs

Background—Hepatitis C virus (HCV) remains a major contributor to morbidity and mortality worldwide. Since 2009, Kentucky has led the United States in cases of acute HCV, driven largely by injection drug use in rural areas. Improved treatment regimens hold promise of mitigating the impact and transmission of HCV, but numerous barriers obstruct people who inject drugs (PWID) from receiving care, particularly in medically underserved settings. Methods—503 rural people who use drugs were recruited using respondent-driven sampling and received HCV screening and post-test counseling. Presence of HCV antibodies was assessed using enzyme immunoassay of dried blood samples. Sociodemographic and behavioral data were collected using computer-based questionnaires. Predictors of contacting a healthcare provider for follow-up following HCV-positive serotest and counseling were determined using discrete-time survival analysis. Results—150 (59%) of 254 participants reported contacting a healthcare provider within 18 months of positive serotest and counseling; the highest probability occurred within six months of serotesting. 35 participants (14%) reported they were seeking treatment, and 21 (8%) reported receiving treatment. In multivariate time-dependent modeling, health insurance, internet access, prior substance use treatment, meeting DSM-IV criteria for generalized anxiety disorder, and recent marijuana use increased the odds of making contact for follow-up. Participants meeting criteria for major depressive disorder and reporting prior methadone use, whether legal or illegal, were less likely to contact a provider. Conclusion—While only 8% received treatment after HCV-positive screening, contacting a healthcare provider was frequent in this sample of rural PWID, suggesting that the major barriers to care are likely further downstream. These findings offer insight into the determinants of engaging the cascade of medical treatment for HCV and ultimately, treatment-as-prevention. Further study and increased resources to support integrated interventions with effectiveness in other settings are recommended to mitigate the impact of HCV in this resource-deprived setting

Carbon-enhanced Metal-poor Stars in SDSS/SEGUE. I. Carbon Abundance Estimation and Frequency of CEMP Stars

We describe a method for the determination of stellar [C/Fe] abundance ratios using low-resolution (R = 2000) stellar spectra from the SDSS and SEGUE. By means of a star-by-star comparison with a set of SDSS/SEGUE spectra with available estimates of [C/Fe] based on published high-resolution analyses, we demonstrate that we can measure [C/Fe] from SDSS/SEGUE spectra with S/N > 15 to a precision better than 0.35 dex. Using the measured carbon-to-iron abundance ratios obtained by this technique, we derive the frequency of carbon-enhanced stars ([C/Fe] > +0.7) as a function of [Fe/H], for both the SDSS/SEGUE stars and other samples from the literature. We find that the differential frequency slowly rises from almost zero to about 14% at [Fe/H] ~ -2.4, followed by a sudden increase, by about a factor of three, to 39% from [Fe/H] ~ -2.4 to [Fe/H] ~ -3.7. We also examine how the cumulative frequency of CEMP stars varies across different luminosity classes. The giant sample exhibits a cumulative CEMP frequency of 32% for [Fe/H] < -2.5, 31% for [Fe/H] < -3.0, and 33% for [Fe/H] < -3.5. For the main-sequence turnoff stars, we obtain a lower cumulative CEMP frequency, around 10% for [Fe/H] < -2.5. The dwarf population displays a large change in the cumulative frequency for CEMP stars below [Fe/H] = -2.5, jumping from 15% for [Fe/H] < -2.5 to about 75% for [Fe/H] < -3.0. When we impose a restriction with respect to distance from the Galactic mid-plane (|Z| < 5 kpc), the frequency of the CEMP giants does not increase at low metallicity ([Fe/H] < -2.5), but rather, decreases, due to the dilution of C-rich material in stars that have undergone mixing with CNO-processed material from their interiors. The frequency of CEMP stars near the main-sequence turnoff, which are not expected to have experienced mixing, increases for [Fe/H] < -3.0. [abridged]Comment: 19 pages, 10 figures, 6 tables, accepted for publication in AJ on August 20, 201

Metallicity Mapping with gri Photometry: The Virgo Overdensity and the Halos of the Galaxy

We describe the methodology required for estimation of photometric estimates of metallicity based on the SDSS gri passbands, which can be used to probe the properties of main-sequence stars beyond ~ 10 kpc, complementing studies of nearby stars from more metallicity-sensitive color indices that involve the u passband. As a first application of this approach, we determine photometric metal abundance estimates for individual main-sequence stars in the Virgo Overdensity, which covers almost 1000 square degrees on the sky, based on a calibration of the metallicity sensitivity of stellar isochrones in the gri filter passbands using field stars with well-determined spectroscopic metal abundances. Despite the low precision of the method for individual stars, internal errors of in [Fe/H] ~ +/- 0.1 dex can be achieved for bulk stellar populations. The global metal abundance of the Virgo Overdensity determined in this way is = -2.0 +/- 0.1 (internal) +/- 0.5 (systematic), from photometric measurements of 0.7 million stars with heliocentric distances from ~ 10 kpc to ~ 20 kpc. A preliminary metallicity map, based on results for 2.9 million stars in the northern SDSS DR-7 footprint, exhibits a shift to lower metallicities as one proceeds from the inner- to the outer-halo population, consistent with recent interpretation of the kinematics of local samples of stars with spectroscopically available metallicity estimates and full space motions.Comment: 4 pages, 2 figures, to appear in IAU Symp. 26