Racial/Ethnic Disparities in Diabetes Care and Outcomes: A Mixed Methods Study

Limited research has examined racial/ethnic differences in diabetes care and outcomes among primary care patients. This study examined racial/ethnic differences in diabetes care and outcomes among an ambulatory patient population and explored patient perceptions of the patient-provider relationship to inform strategies to improve care delivery. Using data from 62,149 adults with diabetes who received care within Atrium Health in 2013, regression models assessed associations between race/ethnicity and the following outcomes: glycated hemoglobin (HbA1c) tests, low density lipoprotein (LDL) and blood pressure (BP) screening, foot and eye exams, and HbA1c, LDL, and BP control. Eleven patients with diabetes and uncontrolled hypertension participated in three focus groups about their perceptions of the patient-provider relationship. Compared to non-Hispanic Whites, non-Hispanic Blacks had 22% to 73% higher odds of receiving screenings (HbA1c, LDL, BP, foot and eye exams;

Metalanguage in L1 English-speaking 12-year-olds: which aspects of writing do they talk about?

Traditional psycholinguistic approaches to metalinguistic awareness in L1 learners elicit responses containing metalanguage that demonstrates metalinguistic awareness of pre-determined aspects of language knowledge. This paper, which takes a more ethnographic approach, demonstrates how pupils are able to engage their own focus of metalanguage when reflecting on their everyday learning activities involving written language. What is equally significant is what their metalanguage choices reveal about their understanding and application of written language concepts

Microbial Growth and Biofilm Formation in Geologic Media Is Detected with Complex Conductivity Measurements

Complex conductivity measurements (0.1-1000 Hz) were obtained from biostimulated sand-packed columns to investigate the effect of microbial growth and biofilm formation on the electrical properties of porous media. Microbial growth was verified by direct microbial counts, pH measurements, and environmental scanning electron microscope imaging. Peaks in imaginary (interfacial) conductivity in the biostimulated columns were coincident with peaks in the microbial cell concentrations extracted from sands. However, the real conductivity component showed no discernible relationship to microbial cell concentration. We suggest that the observed dynamic changes in the imaginary conductivity (σ″) arise from the growth and attachment of microbial cells and biofilms to sand surfaces. We conclude that complex conductivity techniques, specifically imaginary conductivity measurements are a proxy indicator for microbial growth and biofilm formation in porous media. Our results have implications for microbial enhanced oil recovery, CO2 sequestration, bioremediation, and astrobiology studies

Unconfined Specimens

ABSTRACT: Effective diffusion coefficients, D*, of chloride and zinc diffusing in saturated, unconfined specimens of a compacted sandclay mixture are measured for three specimen lengths, L (2.91, 5.83, and 11.60 cm) and three test durations (7, 14, and 21 days). For a specimen length of 2.91 cm, both the chloride and zinc D* values tend to decrease with increasing test duration, possibly due to the measurement of concentration-dependent D* values. For a 14-day test duration, no consistent trend in D* with specimen length is observed, but the overall effect of specimen length on D* is minor relative to the range of measured D* values. A 21-day test duration provides the best correlation between the D* values based on reservoir concentrations, DiScs, and the D* values based on soil concentrations, D~oil, for chloride for a given test regardless of the specimen length. The effect of test duration on the correlation between D~cs and D~oit for zinc is minor based on the relatively narrow range of measured zinc D* values. The observed effects of specimen length on the correlation between D~¢s and D~oil for a given test are consistent with the more uniform final porosity distributions in the shorter specimens and the contrasting effects of the non-linear distributions in porosity and dry density that become less significant as the specimen length increases. KEYWORDS: adsorption, attapulgite clay, batch equilibrium, chloride diffusion, contaminant transport, diffusion testing, Freundlich isotherm, sand-clay mixture, swelling, zinc diffusion Over the past -30 years, diffusion testing has been performed in several different disciplines (e.g., soil science, geology, oceanography, geotechnical engineering) for several different purposes, including diffusion of nutrients to plant roots (Olsen and Kemper 1968), characterization of pore water in geologic deposits Several different types of diffusion testing procedures can be used, test durations have ranged from a few hours to several months, and the specimen volumes have ranged from as small as 10 cm 3 to more than 944 cm 3 (Shacketford 1991). Practical limitations to some, if not all, of the different test methods undoubtedly exist, and variability in test duration and specimen size may have an effect on determination of the measured diffusion coefficients. As a result, an evaluation of the factors potentially affecting the measurement of effective diffusion coefficients is needed. Such an evaluation is particularly of interest to geotechnical engineers associated with the design and evaluation of waste containment barriers because of the increasing importance placed on contaminant transport, in general, and diffusive transport, in particular, in such applications. The primary objective of this study is to evaluate the potential influence of test duration and specimen length on the diffusion of chloride and zinc in compacted, unconfined specimens of a sandclay mixture. The evaluation is based on the single reservoir, decreasing source concentration method that has been used extensively in the measurement of effective diffusion coefficients associated with waste disposal applications Materials and Methods Soil The soil used in this study is a mixture of 75% sand and 25% attapulgite clay (dry weight basis). Physical and chemical properties of the sand and attapulgite clay are provided i

The MASSIVE Survey. VI. The spatial sistribution and kinematics of warm ionized gas in the most massive local early-type galaxies

We present the first systematic investigation of the existence, spatial distribution, and kinematics of warm ionized gas as traced by the [O ii] 3727 Å emission line in 74 of the most massive galaxies in the local universe. All of our galaxies have deep integral-field spectroscopy from the volume- and magnitude-limited MASSIVE survey of early-type galaxies with stellar mass $\mathrm{log}({M}_{* }/{M}_{\odot })\gt 11.5$ (M K < −25.3 mag) and distance D < 108 Mpc. Of the 74 galaxies in our sample, we detect warm ionized gas in 28, which yields a global detection fraction of 38 ± 6% down to a typical [O ii] equivalent width limit of 2 Å. MASSIVE fast rotators are more likely to have gas than MASSIVE slow rotators with detection fractions of 80 ± 10% and 28 ± 6%, respectively. The spatial extents span a wide range of radii (0.6–18.2 kpc; 0.1–4R e ), and the gas morphologies are diverse, with 17/28 ≈ 61 ± 9% being centrally concentrated, 8/28 ≈ 29 ± 9% exhibiting clear rotation out to several kiloparsecs, and 3/28 ≈ 11 ± 6% being extended but patchy. Three out of four fast rotators show kinematic alignment between the stars and gas, whereas the two slow rotators with robust kinematic measurements available exhibit kinematic misalignment. Our inferred warm ionized gas masses are roughly ~105 M ⊙. The emission line ratios and radial equivalent width profiles are generally consistent with excitation of the gas by the old underlying stellar population. We explore different gas origin scenarios for MASSIVE galaxies and find that a variety of physical processes are likely at play, including internal gas recycling, cooling out of the hot gaseous halo, and gas acquired via mergers

Computer skills and internet use in adults aged 50-74 years: influence of hearing difficulties

BACKGROUND The use of personal computers (PCs) and the Internet to provide health care information and interventions has increased substantially over the past decade. Yet the effectiveness of such an approach is highly dependent upon whether the target population has both access and the skill set required to use this technology. This is particularly relevant in the delivery of hearing health care because most people with hearing loss are over 50 years (average age for initial hearing aid fitting is 74 years). Although PC skill and Internet use by demographic factors have been examined previously, data do not currently exist that examine the effects of hearing difficulties on PC skill or Internet use in older adults. OBJECTIVE To explore the effect that hearing difficulty has on PC skill and Internet use in an opportunistic sample of adults aged 50-74 years. METHODS Postal questionnaires about hearing difficulty, PC skill, and Internet use (n=3629) were distributed to adults aged 50-74 years through three family physician practices in Nottingham, United Kingdom. A subsample of 84 respondents completed a second detailed questionnaire on confidence in using a keyboard, mouse, and track pad. Summed scores were termed the "PC confidence index." The PC confidence index was used to verify the PC skill categories in the postal questionnaire (ie, never used a computer, beginner, and competent). RESULTS The postal questionnaire response rate was 36.78% (1298/3529) and 95.15% (1235/1298) of these contained complete information. There was a significant between-category difference for PC skill by PC confidence index (P<.001), thus verifying the three-category PC skill scale. PC and Internet use was greater in the younger respondents (50-62 years) than in the older respondents (63-74 years). The younger group's PC and Internet use was 81.0% and 60.9%, respectively; the older group's PC and Internet use was 54.0% and 29.8%, respectively. Those with slight hearing difficulties in the older group had significantly greater odds of PC use compared to those with no hearing difficulties (odds ratio [OR]=1.57, 95% confidence interval [CI] 1.06-2.30, P=.02). Those with moderate+ hearing difficulties had lower odds of PC use compared with those with no hearing difficulties, both overall (OR=0.58, 95% CI 0.39-0.87, P=.008) and in the younger group (OR=0.49, 95% CI 0.26-0.86, P=.008). Similar results were demonstrated for Internet use by age group (older: OR=1.57, 95% CI 0.99-2.47, P=.05; younger: OR=0.32, 95% CI 0.16-0.62, P=.001). CONCLUSIONS Hearing health care is of particular relevance to older adults because of the prevalence of age-related hearing loss. Our data show that older adults experiencing slight hearing difficulty have increased odds of greater PC skill and Internet use than those reporting no difficulty. These findings suggest that PC and Internet delivery of hearing screening, information, and intervention is feasible for people between 50-74 years who have hearing loss, but who would not typically present to an audiologist

Hyaluronan turnover and hypoxic brown adipocytic differentiation are co-localized with ossification in calcified human aortic valves

The calcification process in aortic stenosis has garnered considerable interest but only limited investigation into selected signaling pathways. This study investigated mechanisms related to hypoxia, hyaluronan homeostasis, brown adipocytic differentiation, and ossification within calcified valves. Surgically explanted calcified aortic valves (nﾠ=ﾠ14) were immunostained for markers relevant to these mechanisms and evaluated in the center (NodCtr) and edge (NodEdge) of the calcified nodule (NodCtr), tissue directly surrounding nodule (NodSurr); center and tissue surrounding small ﾓprenodulesﾔ (PreNod, PreNodSurr); and normal fibrosa layer (CollFibr). Pearson correlations were determined between staining intensities of markers within regions. Ossification markers primarily localized to NodCtr and NodEdge, along with markers related to hyaluronan turnover and hypoxia. Markers of brown adipocytic differentiation were frequently co-localized with markers of hypoxia. In NodCtr and NodSurr, brown fat and ossification markers correlated with hyaluronidase-1, whereas these markers, as well as hypoxia, correlated with hyaluronan synthases in NodEdge. The protein product of tumor necrosis factor-? stimulated gene-6 strongly correlated with ossification markers and hyaluronidase in the regions surrounding the nodules (NodSurr, PreNodSurr). In conclusion, this study suggests roles for hyaluronan homeostasis and the promotion of hypoxia by cells demonstrating brown fat markers in calcific aortic valve disease