Effectiveness-implementation trial comparing a family model of diabetes self-management education and support with a standard model

BACKGROUND

Diabetes self-management education and support (DSMES) is an effective approach for improving diabetes self-care behaviors to achieve improved glycemic management and other health outcomes. Engaging family members may improve outcomes, both for the person with diabetes (PWD) and for the family members. However, family models of DSMES have been inconsistently defined and delivered. We operationalize Family-DSMES to be generalizable and replicable, detail our protocol for a comparative effectiveness trial comparing Standard-DSMES with Family-DSMES on outcomes for PWDs and family members, and detail our mixed-methods implementation evaluation plan.

METHODS

We will examine Family-DSMES relative to Standard-DSMES using a Hybrid Type 1 effectiveness-implementation design. Participants are ≥18 years old with type 2 diabetes mellitus and hemoglobin A1c ≥7.0%, recruited from rural and urban primary care clinics that are part of an academic medical center. Each participant invites a family member. Dyads are randomly assigned to Family- or Standard-DSMES, delivered in a small-group format via telehealth. Data are collected at baseline, immediately post-intervention, and 6-, 12-, and 18-months post-intervention. Outcomes include PWDs' hemoglobin A1c (primary), other biometric, behavioral, and psychosocial outcomes (secondary), and family members' diabetes-related distress, involvement in the PWD's diabetes management, self-efficacy for providing support, and biometric outcomes (exploratory). Our mixed-methods implementation evaluation will include process data collected during the trial and stakeholder interviews guided by the Consolidated Framework for Implementation Research.

CONCLUSION

Results will fill knowledge gaps about which type of DSMES may be most effective and guide Family-DSMES implementation efforts.

REGISTRATION

The trial is pre-registered at clinicaltrials.gov (#NCT04334109).

Integrating wearables and modelling for monitoring rehabilitation following total knee joint replacement

BACKGROUND AND OBJECTIVE

Wearable inertial devices integrated with modelling and cloud computing have been widely adopted in the sports sector, however, their use in the health and medical field has yet to be fully realised. To date, there have been no reported studies concerning the use of wearables as a surrogate tool to monitor knee joint loading during recovery following a total knee joint replacement. The objective of this study is to firstly evaluate if peak tibial acceleration from wearables during gait is a good surrogate metric for computer modelling predicted functional knee loading; and secondly evaluate if traditional clinical patient related outcomes measures are consistent with wearable predictions.

METHODS

Following ethical approval, four healthy participants were used to establish the relationship between computer modelling predicted knee joint loading and wearable measured tibial acceleration. Following this, ten patients who had total knee joint replacements were then followed during their 6-week rehabilitation. Gait analysis, wearable acceleration, computer models of knee joint loading, and patient related outcomes measures including the Oxford knee score and range of motion were recorded.

RESULTS

A linear correlation (R² of 0.7-0.97) was observed between peak tibial acceleration (from wearables) and musculoskeletal model predicted knee joint loading during gait in healthy participants first. Whilst patient related outcome measures (Oxford knee score and patient range of motion) were observed to improve consistently during rehabilitation, this was not consistent with all patient's tibial acceleration. Only those patients that exhibited increasing peak tibial acceleration over 6-weeks rehabilitation were positively correlated with the Oxford knee score (R² of 0.51 to 0.97). Wearable predicted tibial acceleration revealed three patients with a consistent knee loading, five patients with improving knee loading, and two patients with declining knee loading during recovery. Hence, 20% of patients did not present with satisfactory joint loading following total knee joint replacement and this was not detected with current patient related outcome measures.

CONCLUSIONS

The use of inertial measurement units or wearables in this study provided additional insight into patients who were not exhibiting functional improvements in joint loading, and offers clinicians an 'off-site' early warning metric to identify potential complications during recovery and provide the opportunity for early intervention. This study has important implications for improving patient outcomes, equity, and for those who live in rural regions.

Bilingual care navigation and enhanced case management during COVID-19

COVID-19 disparities exposed health inequity across socioeconomic status, with community members of color experiencing higher rates of COVID-19 infections, hospitalizations, and death. Racial/ethnic differences were especially disparate in Benton and Washington counties in northwest Arkansas, a region in the United States that experienced high COVID-19 infection rates. To address these disparities and support families with COVID-19, the University of Arkansas for Medical Sciences and Community Clinic (a federally qualified health center) worked with the Arkansas Department of Health and community partners to develop systematic Care Navigation and Enhanced Case Management. During an initial screening process, contact tracers offered Care Navigation and Enhanced Case Management services to individuals who tested positive for COVID-19 within Washington and Benton counties. Bilingual community health navigators, social workers, and nurses began providing enhanced case management to households that accepted services. Between September 9, 2020 and June 19, 2021, 3,502 households representing ∼13,000 individuals were offered services, and 1,511 (43.1%) households requested/accepted services. Based on our experience, we provide four recommendations for practice: (a) provide contact tracing in community members' preferred language, (b) incorporate assessments into the contact tracing process to ensure community members have necessary resources for quarantine, (c) implement comprehensive care navigation and case management services for those who need additional support, and (d) integrate bilingual health navigators who are part of the target community into the process. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Family model diabetes self-management education and support in faith-based organizations in the republic of the Marshall Islands study protocol

BACKGROUND

Marshallese living in the Republic of the Marshall Islands (RMI) experience significant health disparities, with high rates of type 2 diabetes mellitus. In addition to health disparities, the RMI experienced nuclear testing that exposed inhabitants to nuclear fallout, unethical research practices, and contaminated natural food sources.

OBJECTIVES

This research uses a community-based participatory research (CBPR) approach to effectively engage community partners and honor their contributions in all stages of the research. A CBPR approach will leverage culturally situated knowledge and practices of the Marshallese community in the RMI to ensure the success of the research.

METHODS

This manuscript describes the methods used to test the feasibility of delivering a culturally adapted family model of diabetes self-management education and support in faith-based organizations in the RMI.

CONCLUSIONS

This manuscript describes the protocol for creating working with community partners and implementing a feasibility study in the RMI.

Dissemination Protocol for Community-Based Participatory Research Partnerships with Marshallese Pacific Islanders in Arkansas

BACKGROUND

The Pacific Islander population in the United States (U.S.) has rapidly increased since 2000, especially in southern states like Arkansas where the largest population of Marshallese in the continental U.S. reside. The Marshallese community faces significant health disparities with high prevalence of diabetes, obesity, obesity-related cancers, and other chronic conditions.

OBJECTIVES

Researchers have utilized a community-based participatory research (CBPR) approach that fully engages Marshallese stakeholders in research to address the community's health disparities. Sharing research findings with participants and stakeholders is a core principle of CBPR.

METHODS

This manuscript describes the methods that the academic-community research partnership used to develop a dissemination protocol for sharing results from multiple pilot studies and randomized control trials. Examples and details of specific activities that resulted from putting the dissemination plan in action are presented.

CONCLUSIONS

Implementation of CBPR principles ensures that researchers fully engage stakeholders in all aspects of research, including the dissemination of study results. This manuscript describes the dissemination protocol for an academic- community research partnership with the Marshallese community and provides a practical example for how to implement successful community-engaged dissemination.

Morphogenetic action through flux-limited spreading

A central question in biology is how secreted morphogens act to induce different cellular responses within a group of cells in a concentration-dependent manner. Modeling morphogenetic output in multicellular systems has so far employed linear diffusion, which is the normal type of diffusion associated with Brownian processes. However, there is evidence that at least some morphogens, such as Hedgehog (Hh) molecules, may not freely diffuse. Moreover, the mathematical analysis of such models necessarily implies unrealistic instantaneous spreading of morphogen molecules, which are derived from the assumptions of Brownian motion in its continuous formulation. A strict mathematical model considering Fick's diffusion law predicts morphogen exposure of the whole tissue at the same time. Such a strict model thus does not describe true biological patterns, even if similar and attractive patterns appear as results of applying such simple model. To eliminate non-biological behaviors from diffusion models we introduce flux-limited spreading (FLS), which implies a restricted velocity for morphogen propagation and a nonlinear mechanism of transport. Using FLS and focusing on intercellular Hh-Gli signaling, we model a morphogen gradient and highlight the propagation velocity of morphogen particles as a new key biological parameter. This model is then applied to the formation and action of the Sonic Hh (Shh) gradient in the vertebrate embryonic neural tube using our experimental data on Hh spreading in heterologous systems together with published data. Unlike linear diffusion models, FLS modeling predicts concentration fronts and the evolution of gradient dynamics and responses over time. In addition to spreading restrictions by extracellular binding partners, we suggest that the constraints imposed by direct bridges of information transfer such as nanotubes or cytonemes underlie FLS. Indeed, we detect and measure morphogen particle velocity in such cell extensions in different systems.

Compact, continuous-wave, singly resonant optical parametric oscillator based on periodically poled RbTiOAsO4 in a Nd:YVO4 laser

We describe a compact all-solid-state continuous-wave, singly resonant optical parametric oscillator (SRO) based on periodically poled RbTiOAsO4. The SRO is pumped at 1.064 microm by a Nd:YVO4 laser, which is itself pumped by a 3-W diode laser. Using the intracavity technique produced an oscillation threshold for the SRO of only 1.6 W (diode-laser power). For 3 W of diode pump power some 65 mW was obtained in the (nonresonant) idler (wavelength 3.52 microm). Temperature tuning over the range 10-100 degrees C resulted in tuning ranges of 1.52-1.54 and 3.41-3.54 microm for the signal and the idler waves, respectively. Importantly, relaxation oscillations were absent.

A dendrodendritic reciprocal synapse provides a recurrent excitatory connection in the olfactory bulb

Neuronal synchronization in the olfactory bulb has been proposed to arise from a diffuse action of glutamate released from mitral cells (MC, olfactory bulb relay neurons). According to this hypothesis, glutamate spills over from dendrodendritic synapses formed between MC and granule cells (GC, olfactory bulb interneurons) to activate neighboring MC. The excitation of MC is balanced by a strong inhibition from GC. Here we show that MC excitation is caused by glutamate released from bulbar interneurons located in the GC layer. These reciprocal synapses depend on an unusual, 2-amino-5-phosphonovaleric acid-resistant, N-methyl-d-aspartate receptor. This type of feedback excitation onto relay neurons may strengthen the original sensory input signal and further extend the function of the dendritic microcircuit within the main olfactory bulb.

Dose-dependent, prion protein (PrP)-mediated facilitation of excitatory synaptic transmission in the mouse hippocampus

Disruption of both alleles of the prion protein gene, Prnp, has been shown repeatedly to abolish the susceptibility of mice to developing prion diseases. However, conflicting results have been obtained from phenotypic analyses of prion protein (PrP)-deficient (Prnp0/0) mice lines. To explore the possible neurophysiological properties associated with expression or absence of the normal isoform of the cellular prion protein (PrPC), we used conventional in vitro extracellular field potential recordings in the hippocampal CA1 area of mice from two independently-derived Prnp0/0 strains. Basal synaptic transmission and a short-term form of synaptic plasticity were analysed in this study. Results were compared with animals carrying a wild-type mouse PrP transgene to investigate whether PrP expression levels influence glutamatergic synaptic transmission in the hippocampus. There was a clear correlation between excitatory synaptic transmission and PrP expression; i.e. the range of synaptic responses increased with the level of PrPC expression. On the other hand, the probability of transmitter release, as assessed by paired-pulse facilitation, appeared unchanged. Interestingly, whereas the overall range for synaptic responses was still greater in older mice over-expressing PrPC, this effect in these animals appeared to be due to better recruitment of fibres rather than facilitation of synaptic transmission per se. Taken together, these data are strong evidence for a functional role for PrPC in modulating synaptic transmission.

Bicoid-independent formation of thoracic segments in Drosophila

The maternal determinant Bicoid (Bcd) represents the paradigm of a morphogen that provides positional information for pattern formation. However, as bicoid seems to be a recently acquired gene in flies, the question was raised as to how embryonic patterning is achieved in organisms with more ancestral modes of development. Because the phylogenetically conserved Hunchback (Hb) protein had previously been shown to act as a morphogen in abdominal patterning, we asked which functions of Bcd could be performed by Hb. By reestablishing a proposed ancient regulatory circuitry in which maternal Hb controls zygotic hunchback expression, we show that Hb is able to form thoracic segments in the absence of Bcd.

Multiple and opposing roles of cholinergic transmission in the main olfactory bulb

The main olfactory bulb is a critical relay step between the olfactory epithelium and the olfactory cortex. A marked feature of the bulb is its massive innervation by cholinergic inputs from the basal forebrain. In this study, we addressed the functional interaction between cholinergic inputs and intrinsic bulbar circuitry. Determining the roles of acetylcholine (ACh) requires the characterization of cholinergic effects on both neural excitability and synaptic transmission. For this purpose, we used electrophysiological techniques to localize and characterize the diverse roles of ACh in mouse olfactory bulb slices. We found that cholinergic inputs have a surprising number of target receptor populations that are expressed on three different neuronal types in the bulb. Specifically, nicotinic acetylcholine receptors excite both the output neurons of the bulb, i.e., the mitral cells, as well as interneurons located in the periglomerular regions. These nicotine-induced responses in interneurons are short lasting, whereas responses in mitral cells are long lasting. In contrast, muscarinic receptors have an inhibitory effect on the firing rate of interneurons from a deeper layer, granule cells, while at the same time they increase the degree of activity-independent transmitter release from these cells onto mitral cells. Cholinergic signaling thus was found to have multiple and opposing roles in the olfactory bulb. These dual cholinergic effects on mitral cells and interneurons may be important in modulating olfactory bulb output to central structures required for driven behaviors and may be relevant to understanding mechanisms underlying the perturbations of cholinergic inputs to cortex that occur in Alzheimer's disease.

Long-term but not short-term plasticity at mossy fiber synapses is impaired in neural cell adhesion molecule-deficient mice

Cell adhesion molecules (CAMs) are known to be involved in a variety of developmental processes that play key roles in the establishment of synaptic connectivity during embryonic development, but recent evidence implicates the same molecules in synaptic plasticity of the adult. In the present study, we have used neural CAM (NCAM)-deficient mice, which have learning and behavioral deficits, to evaluate NCAM function in the hippocampal mossy fiber system. Morphological studies demonstrated that fasciculation and laminar growth of mossy fibers were strongly affected, leading to innervation of CA3 pyramidal cells at ectopic sites, whereas individual mossy fiber boutons appeared normal. Electrophysiological recordings performed in hippocampal slice preparations revealed that both basal synaptic transmission and two forms of short-term plasticity, i.e., paired-pulse facilitation and frequency facilitation, were normal in mice lacking all forms of NCAM. However, long-term potentiation of glutamatergic excitatory synapses after brief trains of repetitive stimulation was abolished. Taken together, these results strongly suggest that in the hippocampal mossy fiber system, NCAM is essential both for correct axonal growth and synaptogenesis and for long-term changes in synaptic strength.

Cellular sites of hepatic ferritin activation and inactivation

Studies with viable reticulo-endothelial (RE) and parenchymal cells separated from the liver show that the parenchymal cells contain most of the liver ferritin. This ferritin is vasoinert, and anaerobic incubation of the parenchymal cells does not release it in vasoactive form. Aerobic parenchymal cells readily inactivate exogenous vasoactive ferritin. Parenchymal cells isolated from the liver of normal rats subjected to traumatic shock contain vasoactive ferritin and have lost their ferritin inactivating capacity, whereas those from resistant rats subjected to the same trauma contain only vasoinert ferritin and are still able to inactivate added ferritin. On the other hand, RE cells contain smaller amounts of vasoinert ferritin but readily release it in vasoactive form on anaerobic incubation. RE cells are not able to inactivate exogenous ferritin. When a small amount of a vasoinert, clear extract, prepared from homogenized RE cells, is added to parenchymal cells during anaerobic incubation, the parenchymal cells release their ferritin in vasoactive form. The ‘activator’ obtained from the RE cells has not been identified.

A comparative study of the inferior tibio-fibular joint

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Observations on the Problem of the Proprioceptive innervation of the Tongue

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Crossed Ectopia of the Kidney and its possible Cause

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