Home Telemedicine (CoYoT1 Clinic): A Novel Approach to Improve Psychosocial Outcomes in Young Adults With Diabetes

PURPOSE

To assess the impact of a home telemedicine clinic model (CoYoT1 Clinic) on psychosocial and behavioral outcomes designed for young adults (YAs) with type 1 diabetes (T1D).

METHODS

YAs self-selected to participate in the CoYoT1 Clinic or serve as a usual care control. CoYoT1 Clinic visits consisted of an individual appointment with a provider and a group appointment with other YAs with T1D using home telemedicine. Psychosocial and behavioral functioning was assessed by 4 measures: Diabetes Distress Scale, Self-Efficacy for Diabetes Scale, Self-Management of Type 1 Diabetes in Adolescence Scale, and Center for Epidemiologic Studies Depression Scale.

RESULTS

Forty-two patients participated in the CoYoT1 Clinic and 39 patients served as controls. CoYoT1 participants reported lower levels of distress (P = .03), increased diabetes self-efficacy (P = .01), and improved ability to communicate with others about diabetes (P = .04) over the study period compared to controls. YA males in the control group reported increases in depressive symptoms (P = .03) during the study period, but CoYoT1 participants showed no changes.

CONCLUSION

Group home telemedicine for YAs with T1D positively affects diabetes distress, self-efficacy, and diabetes-specific communication. These positive findings have the potential to also affect the YAs' long-term diabetes outcomes. Further investigation of the model is needed.

CoYoT1 Clinic: Home Telemedicine Increases Young Adult Engagement in Diabetes Care

BACKGROUND

Young adults with type 1 diabetes (T1D) experience poor glycemic control, disengagement in care, and are often lost to the medical system well into their adult years. Diabetes providers need a new approach to working with the population. The goal of this study was to determine whether an innovative shared telemedicine appointment care model (CoYoT1 Clinic [pronounced as "coyote"; Colorado Young Adults with T1D]) for young adults with T1D improves care engagement, satisfaction, and adherence to American Diabetes Association (ADA) guidelines regarding appointment frequency.

SUBJECTS AND METHODS

CoYoT1 Clinic was designed to meet the diabetes care needs of young adults (18-25 years of age) with T1D through home telemedicine. Visits occurred every 3 months over the 1-year study (three times by home telemedicine and one time in-person). Outcomes were compared to patients receiving treatment as usual (control).

RESULTS

Compared with controls, CoYoT1 patients attended significantly more clinic visits (P < 0.0001) and increased their number of clinic visits from the year before the intervention. Seventy-four percent of CoYoT1 patients were seen four times over the 12-month study period, meeting ADA guidelines, but none in the control group met the ADA recommendation. CoYoT1 patients used diabetes technologies more frequently and reported greater satisfaction with care compared with controls.

CONCLUSIONS

Delivering diabetes care by home telemedicine increases young adults' adherence to ADA guidelines and usage of diabetes technologies, and improves retention in care when compared to controls. Home telemedicine may keep young adults engaged in their diabetes care during this challenging transition period.

Association of parental health literacy with oral health of Navajo Nation preschoolers

Health literacy is 'the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions'. Although numerous studies show a link between health literacy and clinical outcomes, little research has examined the association of health literacy with oral health. No large-scale studies have assessed these relationships among American Indians, a population at risk for limited health literacy and oral health problems. This analysis was conducted as part of a clinical trial aimed at reducing dental decay among preschoolers in the Navajo Nation Head Start program. Using baseline data for 1016 parent-child dyads, we examined the association of parental health literacy with parents' oral health knowledge, attitudes, and behavior, as well as indicators of parental and pediatric oral health. More limited health literacy was associated with lower levels of oral health knowledge, more negative oral health attitudes, and lower levels of adherence to recommended oral health behavior. Parents with more limited health literacy also had significantly worse oral health status (OHS) and reported their children to have significantly worse oral health-related quality of life. These results highlight the importance of oral health promotion interventions that are sensitive to the needs of participants with limited health literacy.

Reversion of flowering in Glycine Max (Fabaceae)

Photoperiodic changes, if occurring before a commitment to flowering is established, can alter the morphological pattern of plant development. In this study, Glycine max (L.) Merrill cv. Ransom plants were initially grown under an inductive short-day (SD) photoperiod to promote flower evocation and then transferred to a long-day (LD) photoperiod to delay flower development by reestablishing vegetative growth (SD-LD plants). Some plants were transferred back to SD after 4-LD exposures to repromote flowering (SD-LD-SD plants). Alterations in organ initiation patterns, from floral to vegetative and back to floral, are characteristic of a reversion phenomenon. Morphological features that occurred at the shoot apical meristem in SD, LD, SD-LD, and SD-LD-SD plants were observed using scanning electron microscopy (SEM). Reverted plants initiated floral bracts and resumed initiation of trifoliolate leaves in the two-fifths floral phyllotaxy prior to terminal inflorescence development. When these plants matured, leaf-bract intermediates were positioned on the main stem instead of trifoliolate leaves. Plants transferred back to a SD photoperiod flowered earlier than those left in LD conditions. Results indicated that in plants transferred between SDs and LDs, photoperiod can influence organ initiation in florally evoked, but not committed, G. max plants.

CD4-independent infection by HIV-2 is mediated by fusin/CXCR4

Several members of the chemokine receptor family have been shown to function in association with CD4 to permit HIV-1 entry and infection. However, the mechanism by which these molecules serve as CD4-associated cofactors is unclear. In the present report, we show that one member of this family, termed Fusin/ CXCR4, is able to function as an alternative receptor for some isolates of HIV-2 in the absence of CD4. This conclusion is supported by the finding that (1) CD4-independent infection by these viruses is inhibited by an anti-Fusin monoclonal antibody, (2) Fusin expression renders human and nonhuman CD4-negative cell lines sensitive to HIV-2-induced syncytium induction and/or infection, and (3) Fusin is selectively down-regulated from the cell surface following HIV-2 infection. The finding that one chemokine receptor can function as a primary viral receptor strongly suggests that the HIV envelope glycoprotein contains a binding site for these proteins and that differences in the affinity and/or the availability of this site can extend the host range of these viruses to include a number of CD4-negative cell types.

Involvement of p21ras distinguishes positive and negative selection in thymocytes

Small molecular weight GTP binding proteins of the ras family have been implicated in signal transduction from the T cell antigen receptor (TCR). To test the importance of p21ras in the control of thymocyte development, we generated mice expressing a dominant-negative p21ras protein (H-rasN17) in T lineage cells under the control of the lck proximal promoter. Proliferation of thymocytes from lck-H-rasN17 mice in response to TCR stimulation was nearly completely blocked, confirming the importance of p21ras in mediating TCR-derived signals in mature CD4+8- or CD8+4- thymocytes. In contrast, some TCR-derived signals proceeded unimpaired in the CD4+8+ thymocytes of mice expressing dominant-negative p21ras. Analysis of thymocyte development in mice made doubly transgenic for the H-Y-specific TCR and lck-H-rasN17 demonstrated that antigen-specific negative selection occurs normally in the presence of p21H-rasN17. Superantigen-induced negative selection in vivo also proceeded unhindered in H-rasN17 thymocytes. In contrast, positive selection of thymocytes in the H-Y mice was severely compromised by the presence of p21H-rasN17. These observations demonstrate that positive and negative selection, two conceptually antithetical consequences of TCR stimulation, are biochemically distinguishable.

Promontory electrical stimulation in postoperative acoustic tumor patients

Complete deafness can follow acoustic tumor surgery and results from labyrinthine injury, auditory nerve trauma, and/or vascular compromise. A central auditory prosthesis is one potential rehabilitative strategy in such patients. Anatomical studies suggest that some spiral ganglion cells may survive after vascular occlusion, and we have demonstrated responses to electrical stimulation in patients after labyrinthectomy. It was thus hypothesized that patients deafened after a hearing conservation attempt, but maintaining an intact auditory nerve, could utilize an intracochlear implant. To investigate this possibility, promontory electrical stimulation was performed on three patients who had tumors less than 2 cm and who had serviceable preoperative hearing, but no responses postoperatively. Behavioral responses and electrically evoked auditory brainstem and middle latency responses were obtained from two patients, one of whom was 6 years postsurgery. These data indicate that a cochlear implant may be possible after acoustic tumor surgery.

Some social correlates with the dental health of young children

A socio-dental investigation was carried out among 405 five-year-old school children living in a predominantly rural area of West Wales. Information was gathered from a clinical examination of the children and a questionnaire to their parents. The replies to the questionnaires were then cross-tabulated with the clinical findings. The results indicated that lower dmft values were positively associated with household ownership of a telephone and a car and a higher educational attainment by mothers. Mothers with a high level of anxiety about a dental visit and an expectation of eventual edentulousness tended to be the parents of the children with the highest level of untreated carious teeth. The importance of a family pattern of service use is also demonstrated.

Lead intake and blood lead in two-year-old U.K. urban children

A comprehensive study of a group of 2-year-old urban children (n = 97), designed to provide quantitative information simultaneously for lead intakes via all identified pathways, has been carried out in Birmingham (U.K.). Results showed that for children whose blood levels and exposure to environmental lead were within the normal range for the U.K., blood lead concentration was significantly related to a combination of house dust lead loading and an overall rate of touching objects, to water lead concentration and to the parents' smoking habits. On the basis of assumptions used by the Royal Commission on Environmental Pollution (RCEP), the estimated average total uptake of lead was 36 micrograms day-1; of this, 97% was from ingestion from dust, food and water and only 3% from inhalation.

Assessment of an apparent relationship between availability of soluble carbohydrates and reduced nitrogen during floral initiation in tobacco

Daily relative accumulation rate of soluble carbohydrates (RARS) and reduced nitrogen (RARN) in the shoot, as estimates of source strength, were compared with daily relative growth rates (RGR) of the shoot, as an estimate of sink demand, during floral transformation in apical meristems of tobacco (Nicotiana tabacum 'NC 2326') grown at day/night temperatures of 18/14, 22/18, 26/22, 30/26, and 34/30 C. Source strength was assumed to exceed sink demand for either carbohydrates or nitrogen when the ratio of RARS/RGR or RARN/RGR was greater than unity, and sink demand was assumed to exceed source strength when the ratio was less than unity. Time of floral initiation, which was delayed up to 21 days with increases in temperature over the experimental range, was associated with intervals in which source strength of either carbohydrate or nitrogen exceeded sink demand, while sink demand for the other exceeded source strength. Floral initiation was not observed during intervals in which source strengths of both carbohydrates and nitrogen were greater than or less than sink demand. These results indicate that floral initiation is responsive to an imbalance in the relative availabilities of carbohydrate and nitrogen.

Safety margins for lead in the general population

The results of monitoring blood lead concentrations, the accepted biological indicator for lead in man, are examined against the three trigger values put forward in the UK, first as justifying environmental investigation (25 μg 100 ml(-1)), second as justifying health checks (35 μg 100 ml(-1)) and third as likely to give rise to obvious symptoms in a few individuals (50 μg 100 ml(-1)). Arguments for using the proportion or the number of individuals above a trigger value rather than the ratio of the mean blood lead concentration to the trigger value, the conventional safety margin, are presented. The numbers of individuals or proportions in the total population who are likely to be above the trigger values have been estimated and shown to be relatively small for all three. Factors likely to affect blood lead concentrations are examined against the possible effects of the changes, current and proposed, in the controls imposed on lead usage and on pathways. The qualitative changes expected are considered by groups-eg. smokers and drinkers, by regions, eg., those with lead-free drinking water as against those still with lead in their supplies, and for the general population eg. from the elimination of the soldered can for food and the reduction, and eventual elimination, of lead in petrol.Because the relationship between intake and blood concentration is non-linear in the UK, those with the highest existing blood lead concentrations in the general population must be expected to show the smallest relative reductions in blood lead for any small reduction in exposure. The analysis also concludes that those at highest risk will have to depend on their being identified individually and action taken on them and their immediate specific environment.

Intercellular localization of nitrate reductase in roots

Experiments were conducted with segments of corn roots to investigate whether nitrate reductase (NR) is compartmentalized in particular groups of cells that collectively form the root symplastic pathway. A microsurgical technique was used to separate cells of the epidermis, of the cortex, and of the stele. The presence of NR was determined using in vitro and enzyme-linked immunosorbent assays. In roots exposed to 0.2 millimolar NO(3) (-) for 20 hours, NR was detected almost exclusively in epidermal cells, even though substantial amounts of NO(3) (-) likely were being transported through cortical and steler cells during transit to the vascular system. Although NR was present in all cell groups of roots exposed to 20.0 millimolar NO(3) (-), the majority of the NR still was contained in epidermal cells. The results are consistent with previous observations indicating that limited reduction of endogenous NO(3) (-) occurs during uptake and reduction of exogenous NO(3) (-). Several mechanisms are advanced to account for the restricted capacity of cortical and stelar cells to induce NR and reduce NO(3) (-). It is postulated that (a) the biochemical system involved in the induction of NR in the cortex and stele is relatively insensitive to the presence of NO(3) (-), (b) the receptor for the NR induction response and the NR protein are associated with cell plasmalemmae and little NO(3) (-) is taken up by cells of the cortex and stele, and/or (c) NO(3) (-) is compartmentalized during transport through the symplasm, which limits exposure for induction of NR and NO(3) (-) reduction.

Internode and petiole elongation of soybean in response to photoperiod and end-of-day light quality

Elongation of main stem internodes and petioles of soybeans, Glycine max 'Ransom,' was examined in response to various photoperiod/temperature combinations and to end-of-day (EOD) light quality. Photoperiod treatments consisted of 10, 14, and 16 h in combination with day/night temperatures of 18/14, 22/18, 26/22, 30/26, and 34/30 C. The EOD treatments consisted of exposing plants to illumination from either incandescent (high far-red component, FR) or fluorescent (high red component, R) lamps during the final 0.5 h of a 10-h photoperiod. Internode elongation was not significantly promoted by the photoperiod treatments, and, in fact, under the two highest temperature regimes, internode elongation was suppressed under the longer photoperiods. Petiole elongation, however, was enhanced under the longer photoperiods at all temperatures. In the EOD light study, internode and petiole elongation was significantly greater on plants exposed to 0.5 h EOD from incandescent lamps than from fluorescent. Under the incandescent EOD treatment, plants increased dry matter production by 41% and exhibited greater partitioning of assimilates in stem and root portions than under fluorescent EOD.

Photoperiod regulation of floral initiation for soybean plants at different ages

Soybean plants [Glycine max (L.) Merr.] of the determinate cultivar Ransom growing in controlled environments under 16-h photoperiods were exposed to 10, 12, 14, 15, and 16-h photoperiods upon expansion of either the two primaries or fifth trifoliolate leaf (V1 and V6 developmental stages, respectively) to determine the influence of plant size on sensitivity to photoperiod. Plants were sampled at 2 to 3-day intervals over a 21-day treatment period and examined microscopically for evidence of floral development. Time of floral initiation for plants exposed to photoperiod treatments at either V1 or V6 stage varied only by a few days among photoperiods, but the subsequent differentiation of floral primordia was much more rapid at shorter than at longer photoperiods. These results confirm previous observations for plants transferred upon expansion of the first trifoliolate leaf (V2 stage) and indicate that sensitivity of floral responsiveness to photoperiod changed little with plant size.

Response of Agronomic and Forest Species to Elevated Atmospheric Carbon Dioxide

The effects of atmospheric carbon dioxide on corn, soybeans, loblolly pine, and sweetgum were studied in the field during a growing season. The plants were exposed to a range of concentrations of carbon dioxide day and night in open-topped, flow-through chambers. At a mean daytime carbon dioxide concentration of 910 parts per million, increases in total biomass ranged from 157 to 186 percent of the control values. Seed yield and wood volume increased and there were changes in plant anatomy and form. Net photosynthesis increased with increasing carbon dioxide concentration in soybeans and sweetgum, but was unaffected in corn. Water use efficiency also increased in corn, soybeans, and sweetgum.

Integrated monitoring - Principles and practice

The concept of integrated monitoring is examined and defined. The different types and applications of monitoring in the United Kingdom are considered against the information they can provide. Two examples of integrated monitoring of health hazards in the UK are described. The relevance of the principles and the practice to the assessment of regional and global environmental problems is discussed and suggestions made for their review.

Phytochrome Regulation of Flowering in the Long-Day Plant, Hyoscyamus niger

A daylength extension with incandescent light is more effective in promoting flowering of long-day plants like Hyoscyamus niger than fluorescent light. A low phytochrome photoequilibrium (Pfr/P(tot)), attained by a far-red irradiation at the close of long days under fluorescent light, also promotes flowering. Moreover, if flower initiation processes are initiated by several long days, a low phytochrome photoequilibrium at the end of short, postinduction photoperiods also enhances flowering. The initiation phase of flowering requires Pfr to be present whereas the development phase proceeds more rapidly in the absence of Pfr. Spectral dependence studies, therefore, could be misinterpreted if the initiation and development stages are combined into a single audit of flowering.

Sickle cell trait counseling-evaluation of counselors and counselees

In this study, information about both counselee and counselor performance was obtained from taped recordings of 193 structured counseling sessions with persons diagnosed as having sickle cell trait. The data provide evidence that: (1) lay persons can understand essential sickle cell information; (2) trained lay persons using a structured format can transmit successfully sickle cell information; (3) only education and age, among counselee characteristics studies, were related to successful learning; (4) the evaluation of information transfer in counseling programs cannot be limited to counselees' comprehension but must also consider other variables such as counselor performance and curriculum content; (5) a reduction in negative feelings associated with a diagnosis of sickle cell trait is an immediate effect of counseling; and (6) audio-taping of counseling sessions is client acceptable and useful for evaluation, quality control, and counselor training.