Reaching those most in need: a review of diabetes self-management interventions in disadvantaged populations

There has been increased recognition of the importance of developing diabetes self-management education (DSME) interventions that are effective with under-served and minority populations. Despite several recent studies in this area, there is to our knowledge no systematic review or synthesis of what has been learned from this research. An electronic literature search identified five formative evaluations and ten controlled DSME intervention trials focused on under-served (low-income, minority or aged) populations. The RE-AIM (Reach, Efficacy, Adoption, Implementation, Maintenance) evaluation framework was used to evaluate the controlled studies on the dimensions of reach, efficacy, adoption, implementation, and maintenance. Fifty percent of the studies identified reported on the percentage of patients who participated, and the percentages were highly variable. The methodological quality of the articles was generally good and the short-term results were encouraging, especially on behavioral outcomes. Data on adoption (representativeness of settings and clinicians who participate) and implementation were almost never reported. Studies of modalities in addition to group meetings are needed to increase the reach of DSME with under-served populations. The promising formative evaluation work that has been conducted needs to be extended for more systematic study of the process of intervention implementation and adaptation with special populations. Studies that explicitly address the community context and that address multiple issues related to public health impact of DSME interventions are recommended to enhance long-term results. Copyright (C) 2002 John Wiley Sons, Ltd.

Ultrasound evaluation of polymer gel dosimeters

A new method for the evaluation of radiotherapy 3D polymer gel dosimeters has been developed using ultrasound to assess the significant structural changes that occur following irradiation of the dosimeters. The ultrasonic parameters of acoustic speed of propagation, attenuation and transmitted signal intensity were measured as a function of absorbed radiation dose. The dose sensitivities for each parameter were determined as 1.8 x 10(-4) s m(-1) Gy(-1), 3.9 dB m(-1) Gy(-1) and 3.2 V-1 Gy(-1) respectively. All parameters displayed a strong variation with absorbed dose that continued beyond absorbed doses of 15 Gy. The ultrasonic measurements demonstrated a significantly larger dynamic range in dose response curves than that achieved with previously published magnetic resonance imaging (MRI) dose response data. It is concluded that ultrasound shows great potential as a technique for the evaluation of polymer gel dosimeters.

An economic evaluation of plasma production via erythroplasmapheresis and whole blood collection

This paper presents cost-effectiveness analyses (CEAs) of plasma collection via two alternative methods: whole blood collection (WBC) and erythroplasmapheresis collection (EPC). The objective of the study is to provide an answer to the question 'What is the least-cost method of plasma production'. This question is answered, both from the viewpoint of the blood collection agency (using financial CEA) and from that of 'society' as a whole (using economic CEA). We employ detailed financial data and economic survey data for collections made by a blood collection agency and to WBC and EPC donors in Brisbane, Australia. The results indicate that, despite the superior yield provided by EPC, WBC is actually more cost-effective. This result is robust to thorough sensitivity analysis and arises regardless of whether an economic or financial perspective is taken. We conclude that, ceteris paribus, the cost of recruiting new plasma donors would need to be quite substantial for marginal investments in EPC to be considered cost-effective. Crown Copyright (C) 2002 Published by Elsevier Science Ltd. All rights reserved.

Ecological interface design for pasteurizer II: A process description of semantic mapping

Ecological interface design (EID) is proving to be a promising approach to the design of interfaces for complex dynamic systems. Although the principles of EID and examples of its effective use are widely available, few readily available examples exist of how the individual displays that constitute an ecological interface are developed. This paper presents the semantic mapping process within EID in the context of prior theoretical work in this area. The semantic mapping process that was used in developing an ecological interface for the Pasteurizer II microworld is outlined, and the results of an evaluation of the ecological interface against a more conventional interface are briefly presented. Subjective reports indicate features of the ecological interface that made it particularly valuable for participants. Finally, we outline the steps of an analytic process for using EID. The findings presented here can be applied in the design of ecological interfaces or of configural displays for dynamic processes.

Prevalence and comorbidity of behavioral problems of children aged three to six: Results of the Braunschweiger Kindergartenstudie

Prevalence and comorbidity of behavioral problems of children aged three to six: Results of the Braunschweiger Kindergartenstudie Objectives: To analyze the frequency of behavioral and emotional problems and comorbidity of kindergarten children in Braunschweig as rated by their parents. Method: The analysis is part of the Braunschweiger Kindergartenstudie. In a sample of N = 809 children aged three to six the parents rated their children using a modified version of the Child Behavior Checklist/CBCL 4-18. Results: The prevalence rates range from 0.5% to 5.0%. The most frequent behavioral problems in kindergarten children were aggressive behavior and attention problems, followed by social problems. The study also provides bidirectional comorbidity rates. Conclusion: Finally the prevalence rates and the implications of the findings for prevention of behavioral problems in children are discussed.

Evaluation of elastic modulus and hardness of thin films by nanoindentation

Simple equations are proposed for determining elastic modulus and hardness properties of thin films on substrates from nanoindentation experiments. An empirical formulation relates the modulus E and hardness H of the film/substrate bilayer to corresponding material properties of the constituent materials via a power-law relation. Geometrical dependence of E and H is wholly contained in the power-law exponents, expressed here as sigmoidal functions of indenter penetration relative to film thickness. The formulation may be inverted to enable deconvolution of film properties from data on the film/substrate bilayers. Berkovich nanoindentation data for dense oxide and nitride films on silicon substrates are used to validate the equations and to demonstrate the film property deconvolution. Additional data for less dense nitride films are used to illustrate the extent to which film properties may depend on the method of fabrication.

Cognitive behavioral therapy for older adults: Practical guidelines for the use of homework assignments

There is emerging evidence to support the effectiveness of cognitive behavior therapy (CBT) for older adults. However, there are a number of clinical difficulties that practitioners often encounter when using homework assignments with the older adult population. In this article, we provide a brief summary of the research findings on homework in CBT, review common obstacles to the use of homework, and provide concrete suggestions for the adaptation of homework assignments to increase their potential effectiveness with older adults. We also describe several types of homework assignments that may be most helpful, augmenting these suggestions with clinical examples.

An evaluation of the evidence for linkages between mangroves and fisheries: A synthesis of the literature and identification of research directions

There is a widely held paradigm that mangroves are critical for sustaining production in coastal fisheries through their role as important nursery areas for fisheries species. This paradigm frequently forms the basis for important management decisions on habitat conservation and restoration of mangroves and other coastal wetlands. This paper reviews the current status of the paradigm and synthesises the information on the processes underlying these potential links. In the past, the paradigm has been supported by studies identifying correlations between the areal and linear extent of mangroves and fisheries catch. This paper goes beyond the correlative approach to develop a new framework on which future evaluations can be based. First, the review identifies what type of marine animals are using mangroves and at what life stages. These species can be categorised as estuarine residents, marine-estuarine species and marine stragglers. The marine-estuarine category includes many commercial species that use mangrove habitats as nurseries. The second stage is to determine why these species are using mangroves as nurseries. The three main proposals are that mangroves provide a refuge from predators, high levels of nutrients and shelter from physical disturbances. The recognition of the important attributes of mangrove nurseries then allows an evaluation of how changes in mangroves will affect the associated fauna. Surprisingly few studies have addressed this question. Consequently, it is difficult to predict how changes in any of these mangrove attributes would affect the faunal communities within them and, ultimately, influence the fisheries associated with them. From the information available, it seems likely that reductions in mangrove habitat complexity would reduce the biodiversity and abundance of the associated fauna, and these changes have the potential to cause cascading effects at higher trophic levels with possible consequences for fisheries. Finally, there is a discussion of the data that are currently available on mangrove distribution and fisheries catch, the limitations of these data and how best to use the data to understand mangrove-fisheries links and, ultimately, to optimise habitat and fisheries management. Examples are drawn from two relatively data-rich regions, Moreton Bay (Australia) and Western Peninsular Malaysia, to illustrate the data needs and research requirements for investigating the mangrove-fisheries paradigm. Having reliable and accurate data at appropriate spatial and temporal scales is crucial for mangrove-fisheries investigations. Recommendations are made for improvements to data collection methods that would meet these important criteria. This review provides a framework on which to base future investigations of mangrove-fisheries links, based on an understanding of the underlying processes and the need for rigorous data collection. Without this information, the understanding of the relationship between mangroves and fisheries will remain limited. Future investigations of mangrove-fisheries links must take this into account in order to have a good ecological basis and to provide better information and understanding to both fisheries and conservation managers.

Promoting physical activity to older adults: a preliminary evaluation of three general practice-based strategies

The aim of this study was to explore the feasibility of an exercise scientist (ES) working in general practice to promote physical activity (PA) to 55 to 70 year old adults. Participants were randomised into one of three groups: either brief verbal and written advice from a general practitioner (GP) (G1, N=9); or individualised counselling and follow-up telephone calls from an ES, either with (G3, N=8) or without a pedometer (G2, N=11). PA levels were assessed at week 1, after the 12-wk intervention and again at 24 weeks. After the 12-wk intervention, the average increase in PA was 116 (SD=237) min/wk; N=28, p < 0.001. Although there were no statistically significant between-group differences, the average increases in PA among G2 and G3 participants were 195 (SD=207) and 138 (SD=315) min/wk respectively, compared with no change (0.36, SD=157) in G1. After 24 weeks, average PA levels remained 56 (SD=129) min/wk higher than in week 1. The small numbers of participants in this feasibility study limit the power to detect significant differences between groups, but it would appear that individualised counselling and follow-up contact from an ES, with or without a pedometer, can result in substantial changes in PA levels. A larger study is now planned to confirm these findings.

Evaluation of fly ash as a component of potting substrates

A series of laboratory and glasshouse experiments were undertaken to assess the potential for incorporation of fly ash in soilless potting substrates. The physical and chemical properties of a commercially available bark based substrate, the University of California (UC) 1:1 peat:sand mix and a range uf test substrates containing fly ash were characterised. In test mixtures, fly ash was substituted for a portion of either the peat or sand component of the UC mix, at rates of 10, 20, 30 and 50% of the mix volume, Incorporation of fly ash greatly increased the plant available water capacity (10-1500 kPa) of the substrate. However, high pH, increased substrate strength and reduced air-filled porosity were considered adverse effects, particularly at ash rates > 20%. The growth of tomato (Lycopersicon esculentum), petunia (Petunia x hybrida grandiflora) and Boston fern (Nephrolepis exaltata) in the substrates was assessed. Two watering regimes, capillary watering and irregular hosing, were used to identify effects of available water capacity on plant growth, but no effect was identified. Test mixtures containing fly ash as 20% of the substrate volume produced growth equal to that in the UC mix, with substrates containing 10% ash producing significantly greater growth of tomato and petunia. At rates of incorporation > 20% reduced plant growth was attributed to both adverse physical and chemical characteristics of the substrate. As fly ash is available at low cost and can be successfully substituted for a considerable portion of the expensive peat component, its use at low application rates in potting substrates may be desirable from an economic viewpoint.

Comparison of palmtop-computer-assisted brief cognitive-behavioral treatment to cognitive-behavioral treatment for panic disorder

In the present study, the authors sought to determine whether the efficiency and cost-effectiveness of cognitive-behavioral treatment (CBT) for panic disorder could be improved by adjunctive computer-assisted therapy. Eighteen participants who met Diagnostic and Statistical Manual of Mental Disorders (3rd ed., revised; American Psychiatric Association, 1987) criteria for panic disorder were randomly assigned to a 12-session CBT (CBT12) condition (D. H. Barlow & M. G. Craske, 1989) or to a 4-session computer-assisted CBT (CBT4-CA) condition. Palmtop computers, with a program developed to incorporate basic principles of CBT, were used by CBT4-CA clients whenever they felt anxious or wanted to practice the therapy techniques and were used by all participants as a momentary assessment tool. CBT4-CA clients carried the computer at all times and continued to use it for 8 weeks after termination of therapy. Analyses of clinically significant change showed superiority of CBT12 at posttest on some measures; however, there were no differences at follow-up.

A comparison of dissected follicle numbers and follicle counts on the ovarian surface for the evaluation of ovarian follicular populations in Bos indicus cows

Ovaries (n = 140) from 70 mixed-age multiparous, lactating Brahman cross (3/4-7/8 Bos indicus) cows were used to examine the hypothesis that counts of follicles visible on the surface of the ovaries of Bos indicus cows and their classification into diameter size classes, are closely correlated with numbers of follicles in those size classes found by complete dissection of the ovary. immediately after ovariectomy, mean diameters (long and short axes averaged) of all follicles greater than or equal to 2 mm visible on the surface of each ovary were measured. All follicles greater than or equal to 2 mm were dissected from the ovaries, excess stroma removed and follicle diameters measured under a stereomicroscope using an ocular graticule. For each ovary, follicles were classified in either small (8 mm) categories based on either diameters of surface or dissected follicles. Data for numbers of surface and dissected follicles (mean +/- SE) in small, medium, large categories and total follicle numbers, respectively, were 24.4 +/- 1.6 vs. 28.0 +/- 1.9, 1.6 +/- + 0.2 vs. 11.6 +/- 1.0, 0.5 +/- 0.1 vs. 0.7 +/- 0.1 and 26.4 +/- 1.6 vs. 40.4 +/- 2.5. Correlation coefficients (r) for counts of surface and dissected follicles in small, medium, large and total follicle numbers were 0.76, 0.40, 0.69 and 0.79, respectively. Medium size follicles presented only a small translucent area on the surface of the ovary, leading to an underestimate of numbers when categorised by surface evaluation. Counts of follicles visible on the surface of the ovaries of Bos indicus cows and their classification into size classes based on estimated diameter, are closely correlated with numbers of follicles in those size classes found at dissection of the ovary for small (8 mm) and total follicles but not for medium sized (4-8 mm) follicles. (C) 1997 Elsevier Science B.V.

Biochemical synthesis, purification and preliminary pharmacological evaluation of normorphine-3-glucuronide

Normorphine was synthesised from morphine by thermal decomposition of an N-alpha-chloroethylchloroformate adduct, and purified (> 98% purity) using semipreparative HPLC with ultraviolet detection. Normorphine-3-glucuronide (NM3G) was biochemically synthesised using the substrate normorphine, uridine diphosphoglucuronic acid and Sprague-Dawley rat liver microsomes in a 75% yield (relative to normorphine base). The synthesised NM3G was purified by precipitation and washing with acetonitrile. Determinations of purity using HPLC with electrochemical and ultraviolet detection confirmed that the NM3G produced was of high (> 99%) purity. Mass spectrometry, fourier transform infrared spectrophotometry and nuclear magnetic resonance spectrometry confirmed the structure, especially placement of the glucuronide moiety at the 3-phenolic position and not at the 17-nitrogen. Administration of NM3G by the intracerebroventricular (icy) route to rats in doses of 2.5 and 7.5 mu g resulted in the development of central nervous system (CNS) excitatory behavioural effects including myoclonus, chewing, wet-dog shakes, ataxia and explosive motor behaviour. At an icy dose of 7.5 mu g, NM3G also induced short periods of tonic-clonic convulsive activity. Thus, NM3G elicits CNS excitation following supraspinal administration in a manner analogous to morphine-3-glucuronide (M3G), the major metabolite of morphine (1). Further studies are required to determine whether NM3G attenuates morphine-induced antinociception in se similar manner to M3G.