Medical advice and diabetes self-management reported by Mexican-American, Black- and White-non-Hispanic adults across the United States

Background Diabetes has reached epidemic proportions in the United States, particularly among minorities, and if improperly managed can lead to medical complications and death. Healthcare providers play vital roles in communicating standards of care, which include guidance on diabetes self-management. The background of the client may play a role in the patient-provider communication process. The aim of this study was to determine the association between medical advice and diabetes self care management behaviors for a nationally representative sample of adults with diabetes. Moreover, we sought to establish whether or not race/ethnicity was a modifier for reported medical advice received and diabetes self-management behaviors. Methods We analyzed data from 654 adults aged 21 years and over with diagnosed diabetes [130 Mexican-Americans; 224 Black non-Hispanics; and, 300 White non-Hispanics] and an additional 161 with 'undiagnosed diabetes' [N = 815(171 MA, 281 BNH and 364 WNH)] who participated in the National Health and Nutrition Examination Survey (NHANES) 2007-2008. Logistic regression models were used to evaluate whether medical advice to engage in particular self-management behaviors (reduce fat or calories, increase physical activity or exercise, and control or lose weight) predicted actually engaging in the particular behavior and whether the impact of medical advice on engaging in the behavior differed by race/ethnicity. Additional analyses examined whether these relationships were maintained when other factors potentially related to engaging in diabetes self management such as participants' diabetes education, sociodemographics and physical characteristics were controlled. Sample weights were used to account for the complex sample design. Results Although medical advice to the patient is considered a standard of care for diabetes, approximately one-third of the sample reported not receiving dietary, weight management, or physical activity self-management advice. Participants who reported being given medical advice for each specific diabetes self-management behaviors were 4-8 times more likely to report performing the corresponding behaviors, independent of race. These results supported the ecological model with certain caveats. Conclusions Providing standard medical advice appears to lead to diabetes self-management behaviors as reported by adults across the United States. Moreover, it does not appear that race/ethnicity influenced reporting performance of the standard diabetes self-management behavior. Longitudinal studies evaluating patient-provider communication, medical advice and diabetes self-management behaviors are needed to clarify our findings.

Psychological and cognitive factors that influence post -exercise energy intake in normal weight and overweight sedentary males

Physical activity is recommended to facilitate weight management. However, some individuals may be unable to successfully manage their weight due to certain psychological and cognitive factors that trigger them to compensate for calories expended in exercise. The primary purpose of this study was to evaluate the effect of moderate-intensity exercise on lunch and 12-hour post-exercise energy intake (PE-EI) in normal weight and overweight sedentary males. Perceived hunger, mood, carbohydrate intake from beverages, and accuracy in estimating energy intake (EI) and energy expenditure (EE) were also assessed. The study consisted of two conditions, exercise (treadmill walking) and rest (sitting), with each participant completing each condition, in a counterbalanced-crossover design on two days. Eighty males, mean age 30 years (SD=8) were categorized into five groups according to weight (normal-/overweight), dietary restraint level (high/low), and dieting status (yes/no). Results of repeated measures, 5x2 ANOVA indicated that the main effects of condition and group, and the interaction were not significant for lunch or 12-hour PE-EI. Among overweight participants, dieters consumed significantly (p<0.05) fewer calories than non-dieters at lunch (M=822 vs. M=1149) and over 12 hours (M=1858 vs. M =2497). Overall, participants’ estimated exercise EE was significantly (p<0.01) higher than actual exercise EE, and estimated resting EE was significantly (p<0.001) lower than actual resting EE. Participants significantly (p<0.001) underestimated EI at lunch on both experimental days. Perceived hunger was significantly (p<0.05) lower after exercise (M=49 mm, SEM=3) than after rest (M=57 mm, SEM=3). Mood scores and carbohydrate intake from beverages were not influenced by weight, dietary restraint, and dieting status. In conclusion, a single bout of moderate-intensity exercise did not influence PE-EI in sedentary males in reference to weight, dietary restraint, and dieting status, suggesting that this population may not be at risk for overeating in response to exercise. Therefore, exercise can be prescribed and used as an effective tool for weight management. Results also indicated that there was an inability to accurately estimate EI (ad libitum lunch meal) and EE (60 minutes of moderate-intensity exercise). Inaccuracies in the estimation of calories for EI and EE could have the potential to unfavorably impact weight management.

Medical Advice and Diabetes Self-Management Reported by Mexican-American, Black- and White-Non-Hispanic Adults Across the United States

Background: Diabetes has reached epidemic proportions in the United States, particularly among minorities, and if improperly managed can lead to medical complications and death. Healthcare providers play vital roles in communicating standards of care, which include guidance on diabetes self-management. The background of the client may play a role in the patient-provider communication process. The aim of this study was to determine the association between medical advice and diabetes self care management behaviors for a nationally representative sample of adults with diabetes. Moreover, we sought to establish whether or not race/ethnicity was a modifier for reported medical advice received and diabetes self-management behaviors. Methods: We analyzed data from 654 adults aged 21 years and over with diagnosed diabetes [130 MexicanAmericans; 224 Black non-Hispanics; and, 300 White non-Hispanics] and an additional 161 with ‘undiagnosed diabetes’ [N = 815(171 MA, 281 BNH and 364 WNH)] who participated in the National Health and Nutrition Examination Survey (NHANES) 2007-2008. Logistic regression models were used to evaluate whether medical advice to engage in particular self-management behaviors (reduce fat or calories, increase physical activity or exercise, and control or lose weight) predicted actually engaging in the particular behavior and whether the impact of medical advice on engaging in the behavior differed by race/ethnicity. Additional analyses examined whether these relationships were maintained when other factors potentially related to engaging in diabetes self management such as participants’ diabetes education, sociodemographics and physical characteristics were controlled. Sample weights were used to account for the complex sample design. Results: Although medical advice to the patient is considered a standard of care for diabetes, approximately onethird of the sample reported not receiving dietary, weight management, or physical activity self-management advice. Participants who reported being given medical advice for each specific diabetes self-management behaviors were 4-8 times more likely to report performing the corresponding behaviors, independent of race. These results supported the ecological model with certain caveats. Conclusions: Providing standard medical advice appears to lead to diabetes self-management behaviors as reported by adults across the United States. Moreover, it does not appear that race/ethnicity influenced reporting performance of the standard diabetes self-management behavior. Longitudinal studies evaluating patient-provider communication, medical advice and diabetes self-management behaviors are needed to clarify our findings.

Psychological and Cognitive Factors that Influence Post-Exercise Energy Intake in Normal Weight and Overweight Sedentary Males

The primary purpose of this study was to evaluate the effects of a single bout of moderate-intensity exercise on acute (ad libitum lunch) post-exercise energy intake (PE-EI) and 12-hour energy intake in normal-weight and overweight sedentary males. Accuracy in estimating energy intake (EI) and energy expenditure (EE), solid vs. liquid carbohydrate intake, mood, and perceived hunger were also assessed. The study consisted of two conditions, exercise and rest, with each subject participating in each condition, in a counterbalanced-crossover design on two days. The participants were randomly assigned to either the exercise or resting (seated) control condition on the first day of the experiment, and then the condition was reversed on the second day. Exercise consisted of walking on a treadmill at moderate-intensity for 60 minutes. Eighty males, mean age 30+8 years were categorized into five groups according to weight status (overweight/normal-weight), dietary restraint status (high/low), and dieting status (yes/no). The main effects of condition and group, and the interaction were not significant for acute (lunch) or 12-hour PE-EI. Overall, participants estimated EE for exercise at 46% higher than actual exercise EE, and they estimated EE for rest by 45% lower than actual resting EE. Participants significantly underestimated EI at lunch on both the exercise and rest days by 43% and 44%, respectively. Participants with high restraint were significantly better at estimating EE on the exercise day, and better at estimating EI on the rest day. Mood, perceived hunger, and solid vs. liquid carbohydrate intake were not influenced by dietary restraint, weight, or dieting status. In conclusion, a single bout of moderate-intensity exercise did not influence PE-EI in sedentary males in reference to dietary restraint, weight, and dieting status. Results also suggested that among sedentary males, there is a general inability to accurately estimate calories for moderate-intensity physical activity and EI. Inaccurate estimates of EE and EI have the potential to influence how males manage their weight.

A worksite nutrition education program increased firefighters' knowledge and resulted in healthier attitudes toward fad diets

The effectiveness of a worksite nutrition education program to improve firefighters' knowledge and weight management strategies was evaluated. One hundred fifty Miami-Dade Fire Rescue workers recruited for the study were randomly assigned to an intervention or a control group. The intervention group attended four 30-minute worksite nutrition education sessions. A nutrition knowledge test completed by both groups before and after the intervention showed no significant differences between groups for pre-intervention nutrition knowledge. The post-intervention increase in nutrition knowledge was significantly greater (p < 0.001) for the intervention group (16.8% ± 8.2) compared to the control group (4% ± 8.9). No significant pre-intervention difference was found between the groups' predilection toward a ketogenic diet. A statistically significant (p < 0.01) reduction was seen in the intervention group's willingness (0.57 ± 1.06) to use this diet compared to the control group (0.02 ± 0.99). Results indicate that worksite nutrition education can improve firefighters' knowledge and weight reduction strategies. ^

Tropical seagrass-associated macroalgae distributions and trends relative to water quality

Tropical coastal marine ecosystems including mangroves, seagrass beds and coral reef communities are undergoing intense degradation in response to natural and human disturbances, therefore, understanding the causes and mechanisms present challenges for scientist and managers. In order to protect our marine resources, determining the effects of nutrient loads on these coastal systems has become a key management goal. Data from monitoring programs were used to detect trends of macroalgae abundances and develop correlations with nutrient availability, as well as forecast potential responses of the communities monitored. Using eight years of data (1996–2003) from complementary but independent monitoring programs in seagrass beds and water quality of the Florida Keys National Marine Sanctuary (FKNMS), we: (1) described the distribution and abundance of macroalgae groups; (2) analyzed the status and spatiotemporal trends of macroalgae groups; and (3) explored the connection between water quality and the macroalgae distribution in the FKNMS. In the seagrass beds of the FKNMS calcareous green algae were the dominant macroalgae group followed by the red group; brown and calcareous red algae were present but in lower abundance. Spatiotemporal patterns of the macroalgae groups were analyzed with a non-linear regression model of the abundance data. For the period of record, all macroalgae groups increased in abundance (Abi) at most sites, with calcareous green algae increasing the most. Calcareous green algae and red algae exhibited seasonal pattern with peak abundances (Φi) mainly in summer for calcareous green and mainly in winter for red. Macroalgae Abi and long-term trend (mi) were correlated in a distinctive way with water quality parameters. Both the Abi and mi of calcareous green algae had positive correlations with NO3−, NO2−, total nitrogen (TN) and total organic carbon (TOC). Red algae Abi had a positive correlation with NO2−, TN, total phosphorus and TOC, and the mi in red algae was positively correlated with N:P. In contrast brown and calcareous red algae Abi had negative correlations with N:P. These results suggest that calcareous green algae and red algae are responding mainly to increases in N availability, a process that is happening in inshore sites. A combination of spatially variable factors such as local current patterns, nutrient sources, and habitat characteristics result in a complex array of the macroalgae community in the seagrass beds of the FKNMS.

Relationship of Lifestyle Medical Advice and Non-HDL Cholesterol Control of a Nationally Representative US Sample with Hypercholesterolemia by Race/Ethnicity

Objective. The main purpose of this study was to evaluate the associations of lifestyle medical advice and non-HDL cholesterol control of a nationally representative US sample of adults with hypercholesterolemia by race/ethnicity. Methods. Data were collected by appending sociodemographic, anthropometric, and laboratory data from two cycles of the National Health and Nutrition Survey (2007-2008 and 2009-2010). This study acquired data from male and female adults aged ≥ 20 years (N = 11,577), classified as either Mexican American (MA), (), other Hispanic (OH) (), Black non-Hispanic (BNH) (), or White non-Hispanic (WNH) (). Results. Minorities were more likely to report having received dietary, weight management, and exercise recommendations by healthcare professionals than WNH, adjusting for confounders. Approximately 80% of those receiving medical advice followed the recommendation, regardless of race/ethnicity. Of those who received medical advice, reporting “currently controlling or losing weight” was associated with lower non-HDL cholesterol. BNH who reported “currently controlling or losing weight” had higher non-HDL cholesterol than WNH who reported following the advice. Conclusion. The results suggest that current methods of communicating lifestyle advice may not be adequate across race/ethnicity and that a change in perspective and delivery of medical recommendations for persons with hypercholesterolemia is needed.

Relationship of Lifestyle Medical Advice and Non-HDL Cholesterol Control of a Nationally Representative US Sample with Hypercholesterolemia by Race/Ethnicity

Objective: The main purpose of this study was to evaluate the associations of lifestyle medical advice and non-HDL cholesterol control of a nationally representative US sample of adults with hypercholesterolemia by race/ethnicity. Methods: Data were collected by appending sociodemographic, anthropometric, and laboratory data from two cycles of the National Health and Nutrition Survey (2007-2008 and 2009-2010). This study acquired data from male and female adults aged ≥ 20 years (N = 11,577), classified as either Mexican American (MA), (), other Hispanic (OH) (), Black non-Hispanic (BNH) (), or White non-Hispanic (WNH) (). Results: Minorities were more likely to report having received dietary, weight management, and exercise recommendations by healthcare professionals than WNH, adjusting for confounders. Approximately 80% of those receiving medical advice followed the recommendation, regardless of race/ethnicity. Of those who received medical advice, reporting “currently controlling or losing weight” was associated with lower non-HDL cholesterol. BNH who reported “currently controlling or losing weight” had higher non-HDL cholesterol than WNH who reported following the advice. Conclusion: The results suggest that current methods of communicating lifestyle advice may not be adequate across race/ethnicity and that a change in perspective and delivery of medical recommendations for persons with hypercholesterolemia is needed.

Self -management factors, influences, and conditions for type 2 diabetes among Black ethnic groups in Miami, Florida and Abidjan, Cote d'Ivoire

The Dahlgren and Whitehead ecological theory provides the framework for a cross-sectional design to compare socio-demographic characteristics, living and working conditions, and lifestyle daily habits as well as cultural and ecological factors among six diabetic multiethnic Black groups in Miami and Abidjan. Approximately 180 Black Americans (African-, Caribbean-, and Haitian-) and 180 Black Africans (Akan, Malinke, and Krou) aged 20 years and older were surveyed. During the preliminary of this study participants' attitudes and behaviors were qualitatively assessed (N=60) and a tool was developed to describe, in the main study (N=360), differences in participants' strength of commitment to diabetes lifestyle self-management. Despite similarities found in terms of age and gender, statistically significant differences were also found within and among groups in terms of living and working conditions, education level, and religion. African American groups were more likely to participate in more diabetes classes than Haitian Americans and Caribbean Americans. However, African Americans were less likely to adhere to daily dietary and weight control regimens. Although, Black African groups reported limited access to equipment, facilities, and financial support they were more likely to follow dietary and weight control recommendations than Black American groups. Overall, African American participants showed the poorest attitudes towards recommended foods, Caribbean American respondents reported the best attitudes and behaviors towards weight control regimens, and the Malinke group had significantly more strength of commitment to successful weight control. Furthermore, Black African groups had significantly more strength of commitment to successful dietary adherence and significantly less support for weight control than Black American groups. ^ Significant differences found within Black groups suggest that understanding each patient's conditions may help healthcare professionals in initiating individualized appropriate counseling before goal setting, and in developing culturally relevant type 2 diabetes management programs. Moreover, significant differences exist in strength of commitment to lifestyle adherence among Black groups in Miami and Abidjan. Cultural, socio-demographic factors and self-management habits may explain differences in participants' outcomes. At the policy level, Black groups should not be approached as a homogenous group and assessment of the vulnerability of each ethnic group may be necessary in the decision-making process.^

The state of emergency management 2000: The process of emergency management professionalization in the United States and Florida

This dissertation analyzes the current status of emergency management professionalization in the United States and Florida using a qualitative case study. I investigate the efforts of various organizations at the national and state levels in the private and public sectors to organize emergency management as a profession. I conceptualize emergency management professionalization as occurring in two phases: the indirect institutionalization of the occupation of emergency management and the formal advancement toward an emergency management profession. The legislative, organizational, and procedural developments that occurred between approximately 1900 and the late 1970s became the indirect institutionalization of the occupation of emergency management. Over time, as our society developed and became increasingly complex, more disasters affect the security of the population. In order to adapt to increasing risks and vulnerabilities the emergency management system emerged and with it the necessary elements upon which a future profession could be established providing the basis for the formal advancement toward an emergency management profession. ^ During approximately the last twenty years, the formal advancement toward an emergency management profession has encompassed two primary strategies—certification and accreditation—motivated by the objective to organize a profession. Certification applies to individual emergency managers and includes all training and education. Accreditation of state and local emergency management agencies is reached by complying to a minimum level of proficiency with established standards of performance. Certification and accreditation are the mechanisms used to create an emergency management profession and thus act as axes around which the field of emergency management is organizing. ^ The purpose of this research is to provide a frame of reference for whether or not the field of emergency management is a profession. Based on sociology of professions literature, emergency management can be considered to be professionalizing. The current emergency management professionalization efforts may or may not be sufficient to achieve the ultimate goal of becoming a legitimate profession based on legal and public support for the exclusive right to perform emergency management tasks (monopoly) as well as self-regulation of those tasks (autonomy). ^

Semantic distributed database management with applications to the Internet dissemination of environmental data

The research presented in this dissertation is comprised of several parts which jointly attain the goal of Semantic Distributed Database Management with Applications to Internet Dissemination of Environmental Data. ^ Part of the research into more effective and efficient data management has been pursued through enhancements to the Semantic Binary Object-Oriented database (Sem-ODB) such as more effective load balancing techniques for the database engine, and the use of Sem-ODB as a tool for integrating structured and unstructured heterogeneous data sources. Another part of the research in data management has pursued methods for optimizing queries in distributed databases through the intelligent use of network bandwidth; this has applications in networks that provide varying levels of Quality of Service or throughput. ^ The application of the Semantic Binary database model as a tool for relational database modeling has also been pursued. This has resulted in database applications that are used by researchers at the Everglades National Park to store environmental data and to remotely-sensed imagery. ^ The areas of research described above have contributed to the creation TerraFly, which provides for the dissemination of geospatial data via the Internet. TerraFly research presented herein ranges from the development of TerraFly's back-end database and interfaces, through the features that are presented to the public (such as the ability to provide autopilot scripts and on-demand data about a point), to applications of TerraFly in the areas of hazard mitigation, recreation, and aviation. ^

Data partitioning and replication management in distributed geographic information system (GIS) database

This research presents several components encompassing the scope of the objective of Data Partitioning and Replication Management in Distributed GIS Database. Modern Geographic Information Systems (GIS) databases are often large and complicated. Therefore data partitioning and replication management problems need to be addresses in development of an efficient and scalable solution. ^ Part of the research is to study the patterns of geographical raster data processing and to propose the algorithms to improve availability of such data. These algorithms and approaches are targeting granularity of geographic data objects as well as data partitioning in geographic databases to achieve high data availability and Quality of Service(QoS) considering distributed data delivery and processing. To achieve this goal a dynamic, real-time approach for mosaicking digital images of different temporal and spatial characteristics into tiles is proposed. This dynamic approach reuses digital images upon demand and generates mosaicked tiles only for the required region according to user's requirements such as resolution, temporal range, and target bands to reduce redundancy in storage and to utilize available computing and storage resources more efficiently. ^ Another part of the research pursued methods for efficient acquiring of GIS data from external heterogeneous databases and Web services as well as end-user GIS data delivery enhancements, automation and 3D virtual reality presentation. ^ There are vast numbers of computing, network, and storage resources idling or not fully utilized available on the Internet. Proposed "Crawling Distributed Operating System "(CDOS) approach employs such resources and creates benefits for the hosts that lend their CPU, network, and storage resources to be used in GIS database context. ^ The results of this dissertation demonstrate effective ways to develop a highly scalable GIS database. The approach developed in this dissertation has resulted in creation of TerraFly GIS database that is used by US government, researchers, and general public to facilitate Web access to remotely-sensed imagery and GIS vector information. ^

Customer relationship management: A content analysis of issues and best practices

This dissertation is a study of customer relationship management theory and practice. Customer Relationship Management (CRM) is a business strategy whereby companies build strong relationships with existing and prospective customers with the goal of increasing organizational profitability. It is also a learning process involving managing change in processes, people, and technology. CRM implementation and its ramifications are also not completely understood as evidenced by the high number of failures in CRM implementation in organizations and the resulting disappointments. ^ The goal of this dissertation is to study emerging issues and trends in CRM, including the effect of computer software and the accompanying new management processes on organizations, and the dynamics of the alignment of marketing, sales and services, and all other functions responsible for delivering customers a satisfying experience. ^ In order to understand CRM better a content analysis of more than a hundred articles and documents from academic and industry sources was undertaken using a new methodological twist to the traditional method. An Internet domain name (http://crm.fiu.edu) was created for the purpose of this research by uploading an initial one hundred plus abstracts of articles and documents onto it to form a knowledge database. Once the database was formed a search engine was developed to enable the search of abstracts using relevant CRM keywords to reveal emergent dominant CRM topics. The ultimate aim of this website is to serve as an information hub for CRM research, as well as a search engine where interested parties can enter CRM-relevant keywords or phrases to access abstracts, as well as submit abstracts to enrich the knowledge hub. ^ Research questions were investigated and answered by content analyzing the interpretation and discussion of dominant CRM topics and then amalgamating the findings. This was supported by comparisons within and across individual, paired, and sets-of-three occurrences of CRM keywords in the article abstracts. ^ Results show that there is a lack of holistic thinking and discussion of CRM in both academics and industry which is required to understand how the people, process, and technology in CRM impact each other to affect successful implementation. Industry has to get their heads around CRM and holistically understand how these important dimensions affect each other. Only then will organizational learning occur, and overtime result in superior processes leading to strong profitable customer relationships and a hard to imitate competitive advantage. ^

Location management and routing in urban vehicular ad hoc networks

In recent years, urban vehicular ad hoc networks (VANETs) are gaining importance for inter-vehicle communication, because they allow for the local communication between vehicles without any infrastructure, configuration effort, and without expensive cellular networks. But such architecture may increase the complexity of routing since there is no central control system in urban VANETs. Therefore, a challenging research task is to improve urban VANETs' routing efficiency. ^ Hence, in this dissertation we propose two location-based routing protocols and a location management protocol to facilitate location-based routing in urban VANETs. The Multi-hop Routing Protocol (MURU) is proposed to make use of predicted mobility and geometry map in urban VANETs to estimate a path's life time and set up robust end-to-end routing paths. The Light-weight Routing Protocol (LIRU) is proposed to take advantage of the node diversity under dynamic channel condition to exploit opportunistic forwarding to achieve efficient data delivery. A scalable location management protocol (MALM) is also proposed to support location-based routing protocols in urban VANETs. MALM uses high mobility in VANETs to help disseminate vehicles' historical location information, and a vehicle is able to implement Kalman-filter based predicted to predict another vehicle's current location based on its historical location information. ^