Randomised controlled trial of an automated, interactive telephone intervention to improve type 2 diabetes self-management (Telephone-Linked Care Diabetes Project) : study protocol

Background: An estimated 285 million people worldwide have diabetes and its prevalence is predicted to increase to 439 million by 2030. For the year 2010, it is estimated that 3.96 million excess deaths in the age group 20-79 years are attributable to diabetes around the world. Self-management is recognised as an integral part of diabetes care. This paper describes the protocol of a randomised controlled trial of an automated interactive telephone system aiming to improve the uptake and maintenance of essential diabetes self-management behaviours. ---------- Methods/Design: A total of 340 individuals with type 2 diabetes will be randomised, either to the routine care arm, or to the intervention arm in which participants receive the Telephone-Linked Care (TLC) Diabetes program in addition to their routine care. The intervention requires the participants to telephone the TLC Diabetes phone system weekly for 6 months. They receive the study handbook and a glucose meter linked to a data uploading device. The TLC system consists of a computer with software designed to provide monitoring, tailored feedback and education on key aspects of diabetes self-management, based on answers voiced or entered during the current or previous conversations. Data collection is conducted at baseline (Time 1), 6-month follow-up (Time 2), and 12-month follow-up (Time 3). The primary outcomes are glycaemic control (HbA1c) and quality of life (Short Form-36 Health Survey version 2). Secondary outcomes include anthropometric measures, blood pressure, blood lipid profile, psychosocial measures as well as measures of diet, physical activity, blood glucose monitoring, foot care and medication taking. Information on utilisation of healthcare services including hospital admissions, medication use and costs is collected. An economic evaluation is also planned.---------- Discussion: Outcomes will provide evidence concerning the efficacy of a telephone-linked care intervention for self-management of diabetes. Furthermore, the study will provide insight into the potential for more widespread uptake of automated telehealth interventions, globally.

Crowded Diphosphinomethane Ligands in Catalysis: [(R2PCH2PR′2-κ2P)-NiR″]+ Cations for Ethylene Polymerization without Activators

The preparation of a series of nickel dichloride complexes with bulky diphosphinomethane chelate ligands R2PCH2PR′2 is reported. Reaction with the appropriate Grignard reagent leads to the corresponding dimethyl and dibenzyl complexes. Cationic monomethyl and mono-η3-benzyl complexes are generated from these dialkyl complexes by protonation with [H(OEt2)2]+[B(3,5-(CF3)2C6H3)4]−, while the complex [(dtbpm κ2P)Ni(η3-CH(CH2Ph)Ph]+[B(3,5-(CF3)2C6H3)4]−is obtained from protonation of the Ni(0) olefin complex (dtbpm-κ2P)N(η2-trans-stilbene). Crystal structures of examples of dichlorides, dimethyl, dibenzyl, cationic methyl, and cationic η3-benzyl complexes are reported. Solutions of the cations polymerize ethylene under mild conditions and without the necessity of an activating agent, to form polyethylene having high molecular weights and low degrees of chain branching. In comparison to the Ni methyl cations, the η3-benzyl cation complexes are more stable and somewhat less active but still very efficient in C2H4 polymerization. The effect on the resulting polyethylene of varying the substituents R, R′ on the phosphine ligand has been examined, and a clear trend for longer chain PE with less branching in the presence of more bulky substituents on the diphosphine has been found. Density functional calculations have been used to examine the rapid suprafacial η3 to η3 haptotropic shift processes of the[(R2PCH2PR′2)Ni] fragment and the η3−η1 change of the coordination mode of the benzyl group required for polymerization in those cations.

The relationship between children's emotional and cognitive self-regulation at 2 to 3 years and prosocial behavior in the early years of school

This study used data from Growing Up in Australia: The Longitudinal Study of Australian Children (LSAC) to investigate how parent report of children’s emotional and cognitive regulation at age 2-3 years was associated with teacher ratings of children’s prosocial behaviors in the early years of school. A sample of 2,392 children was drawn from the LSAC Birth Cohort for the analyses. The analyses used structural equation modeling to estimate parameters of the relationships between key variables. Within the model, estimates of mother-reported emotional and cognitive regulation at age 2 to 3 years were significantly associated with teacher-reported prosocial behavior at 6 to 7 years. Emotional regulation was a slightly stronger indicator of prosocial behavior than cognitive regulation. Being female and from a family with a higher socioeconomic position were also associated with higher levels of prosocial behavior. Results are discussed in relation to the role of early childhood teachers in fostering children’s self-regulatory behaviors and in providing environments in which empathic and prosocial behaviors are modeled, guided, and scaffolded so that foundations are laid for caring behaviors to be understood and internalized by children.

An investigation of factors influencing diabetes self-management among adults with type 2 diabetes in Vietnam

Background: In diabetes care, health care professionals need to provide support for their patients. In order to provide good diabetes self-management support for adults with type 2 diabetes in Vietnam, it is important that health care professionals in Vietnam understand the factors influencing diabetes self-management among these people. However, knowledge about factors influencing diabetes self-management among adults with type 2 diabetes in Vietnam is limited. Objectives: This study aimed to investigate factors influencing diabetes self-management among adults with type 2 diabetes in Vietnam. Methodology: A cross-sectional survey with convenience sampling was conducted on 198 adults with type 2 diabetes in VietnamData collection was administeted via interview. Descriptive statistics, simple correlation statistics and structural equation modelling statistics were used for data analysis. Results: Adults with type 2 diabetes in Vietnam had limited diabetes knowledge (Median = 6.0). The majority of the study participants (72.7%) believed that performing diabetes self-management activities was very important or extremely important for controlling their blood glucose levels and for preventing complications from diabetes; about half usually received support from their family and friends’ (48.5%), and around two thirds rarely received support from their health care providers (68.2%). Many of the participants (41.4%) had limited confidence to perform diabetes management activities. The practices of diabetes self-management were limited among the study population (Mean = 96.7, SD = 19.4). Diabetes knowledge (β = 0.17, p < .001), belief in treatment effectiveness (β = 0.13, p < .01), family and friends’ support (β = 0.13, p < .001), health care providers’ support (β = 0.27, p < .001) and diabetes management self-efficacy (β = 0.43, p < .001) directly influenced their diabetes self-management. Diabetes knowledge, and family and friends’ support also indirectly influenced diabetes self-management among these people through their belief in treatment effectiveness and their diabetes management self-efficacy (p < .05). Conclusion: Findings in this study indicated that health care professionals should provide diabetes self-management support for adults with type 2 diabetes in Vietnam in the future. The adapted theory-based model of factors influencing diabetes self-management among adults with type 2 diabetes in Vietnam found in this study could be a useful framework to develop this supporting program.

Development and evaluation of the Ontrack Diabetes Program : an automated, web-based type 2 diabetes self-management and dysphoria intervention

This research was conducted in the area of Clinical and Health Psychology. The study involved the development and evaluation of a novel, web-based program aimed to improve Type 2 diabetes self-management and mood. The program was developed as an original technological intervention aimed to improve access to support for rural and remote communities, and is currently being trialled across Australia with a larger sample size. The researcher aims to continue research into the field of clinical psychology, and in particular is interested in working on further interventions to support those with comorbid physical and mental health conditions.

Perceived needs for supported self-management of type 2 diabetes : a qualitative investigation of the potential for a web-based intervention

The estimated one million Australians with type 2 diabetes face significant risks of morbidity and premature mortality. Inadequate diabetes self-management is associated with poor glycaemic control, which is further impaired by comorbid dysphoria. Regular access to ongoing self-management and psychological support is limited, especially in rural and regional locations. Web-based interventions can provide complementary support to patients’ usual care. Semi-structured interviews were undertaken with two samples that comprised (a) 13 people with type 2 diabetes and (b) 12 general practitioners (GPs). Interviews explored enablers and barriers to self-care, emotional challenges, needs for support, and potential web-based programme components. Patients were asked about the potential utility of a web-based support programme, and GPs were asked about likely circumstances of patient referral to it. Thematic analysis was used to summarise responses. Most perceived facilitators and barriers to self-management were similar across the groups. Both groups highlighted the centrality of dietary self-management, valued shared decision-making with health professionals, and endorsed the idea of web-based support. Some emotional issues commonly identified by patients varied to those perceived by GPs, resulting in different attributions for impaired self-care. A web-based programme that supported self-management and psychological/emotional needs appears likely to hold promise in yielding high acceptability and perceived utility.

The OnTrack Diabetes web-based program for type 2 diabetes and dysphoria self-management: A randomized controlled trial protocol

Background: The prevalence of type 2 diabetes is rising with the majority of patients practicing inadequate disease self-management. Depression, anxiety, and diabetes-specific distress present motivational challenges to adequate self-care. Health systems globally struggle to deliver routine services that are accessible to the entire population, in particular in rural areas. Web-based diabetes self-management interventions can provide frequent, accessible support regardless of time and location Objective: This paper describes the protocol of an Australian national randomized controlled trial (RCT) of the OnTrack Diabetes program, an automated, interactive, self-guided Web program aimed to improve glycemic control, diabetes self-care, and dysphoria symptoms in type 2 diabetes patients. Methods: A small pilot trial is conducted that primarily tests program functionality, efficacy, and user acceptability and satisfaction. This is followed by the main RCT, which compares 3 treatments: (1) delayed program access: usual diabetes care for 3 months postbaseline followed by access to the full OnTrack Diabetes program; (2) immediate program: full access to the self-guided program from baseline onward; and (3) immediate program plus therapist support via Functional Imagery Training (FIT). Measures are administered at baseline and at 3, 6, and 12 months postbaseline. Primary outcomes are diabetes self-care behaviors (physical activity participation, diet, medication adherence, and blood glucose monitoring), glycated hemoglobin A1c (HbA1c) level, and diabetes-specific distress. Secondary outcomes are depression, anxiety, self-efficacy and adherence, and quality of life. Exposure data in terms of program uptake, use, time on each page, and program completion, as well as implementation feasibility will be conducted. Results: This trial is currently underway with funding support from the Wesley Research Institute in Brisbane, Australia. Conclusions: This is the first known trial of an automated, self-guided, Web-based support program that uses a holistic approach in targeting both type 2 diabetes self-management and dysphoria. Findings will inform the feasibility of implementing such a program on an ongoing basis, including in rural and regional locations.

Hydrogen-bonded supramolecular polymers as self-healing hydrogels: Effect of a bulky adamantyl substituent in the ureido-pyrimidinone monomer

In an attempt to generate supramolecular assemblies able to function as self-healing hydrogels, a novel ureido-pyrimidinone (UPy) monomer, 2-(N ′-methacryloyloxyethylureido)-6-(1-adamantyl)-4[1H]-pyrimidinone, was synthesized and then copolymerized with N,N-dimethylacrylamide at four different feed compositions, using a solution of lithium chloride in N,N-dimethylacetamide as the polymerization medium. The assembling process in the resulting copolymers is based on crosslinking through the reversible quadruple hydrogen bonding between side-chain UPy modules. The adamantyl substituent was introduced in order to create a “hydrophobic pocket” that may protect the hydrogen bonds against the disruptive effect of water molecules. Upon hydration to equilibrium, all copolymers generated typical hydrogels when their concentration in the hydrated system was at least 15%. The small-deformation rheometry showed that all hydrated copolymers were hydrogels that maintained a solid-like behavior, and that their extrusion through a syringe needle did not affect significantly this behavior, suggesting a self-healing capacity in these materials. An application as injectable substitutes for the eye's vitreous humor was proposed

Self-assembly of indole-2-carboxylic acid at graphite and gold surfaces

Model systems are critical to our understanding of self-assembly processes. As such, we have studied the surface self-assembly of a small and simple molecule, indole-2-carboxylic acid (I2CA). We combine density functional theory gas-phase (DFT) calculations with scanning tunneling microscopy to reveal details of I2CA assembly in two different solvents at the solution/solid interface, and on Au(111) in ultrahigh vacuum (UHV). In UHV and at the trichlorobenzene/highly oriented pyrolytic graphite (HOPG) interface, I2CA forms epitaxial lamellar structures based on cyclic OH⋯O carboxylic dimers. The structure formed at the heptanoic acid/HOPG interface is different and can be interpreted in a model where heptanoic acid molecules co-adsorb on the substrate with the I2CA, forming a bicomponent commensurate unit cell. DFT calculations of dimer energetics elucidate the basic building blocks of these structures, whereas calculations of periodic two-dimensional assemblies reveal the epitaxial effects introduced by the different substrates.

The electronic properties of Si(001)–Bi(2 × n)

A Bi 2 × n surface net was grown on the Si(001) surface and studied with inverse photoemission, scanning tunnelling microscopy and ab initio and empirical pseudopotential calculations. The experiments demonstrated that Bi adsorption eliminates the dimer related π1* and π2* surface states, produced by correlated dimer buckling, leaving the bulk bandgap clear of unoccupied surface states. Ab initio calculations support this observation and demonstrate that the surface states derived from the formation of symmetric Bi dimers do not penetrate the fundamental bandgap of bulk Si. Since symmetric Bi dimers are an important structural component of the recently discovered Bi nanolines, that self-organize on Si(001) above the Bi desorption temperature, a connection will be made between our findings and the electronic structure of the nanolines.

2.5-dimensional solution of the advective accretion disk:a self-similar approach

We provide a 2.5-dimensional solution to a complete set of viscous hydrodynamical equations describing accretion- induced outflows and plausible jets around black holes/compact objects. We prescribe a self-consistent advective disk-outflow coupling model, which explicitly includes the information of vertical flux. Inter-connecting dynamics of an inflow-outflow system essentially upholds the conservation laws. We provide a set of analytical family of solutions through a self-similar approach. The flow parameters of the disk-outflow system depend strongly on the viscosity parameter α and the cooling factor.

NMR (1H, 13C) and MO (ab initio, CNDO/2, EHT) studies on basic and N-protonated hydrazinecarbothioamide

The conformational preferences of hydrazinecarbothioamide (HCTA, H2NNHCSNH2) in its basic and N-protonated (PHCTA, H3NNNHCSNH2) forms have been studied by 1H and 13C NMR spectroscopy and by theoretical LCAO-MO methods (ab initio, CNDO/2 and EHT). The hindered rotation around the C---N bond has been investigated by a total line shape analysis for the thioamide protons and by the three MO methods. Changes in the molecular conformation and electronic structure on protonation are briefly discussed.