A Systematic Review of Internet-Based Worksite Wellness Approaches for Cardiovascular Disease Risk Management: Outcomes, Challenges & Opportunities

Context The internet is gaining popularity as a means of delivering employee-based cardiovascular (CV) wellness interventions though little is known about the cardiovascular health outcomes of these programs. In this review, we examined the effectiveness of internet-based employee cardiovascular wellness and prevention programs. Evidence Acquisition We conducted a systematic review by searching PubMed, Web of Science and Cochrane library for all published studies on internet-based programs aimed at improving CV health among employees up to November 2012. We grouped the outcomes according to the American Heart Association (AHA) indicators of cardiovascular wellbeing – weight, BP, lipids, smoking, physical activity, diet, and blood glucose. Evidence Synthesis A total of 18 randomized trials and 11 follow-up studies met our inclusion/exclusion criteria. Follow-up duration ranged from 6 – 24 months. There were significant differences in intervention types and number of components in each intervention. Modest improvements were observed in more than half of the studies with weight related outcomes while no improvement was seen in virtually all the studies with physical activity outcome. In general, internet-based programs were more successful if the interventions also included some physical contact and environmental modification, and if they were targeted at specific disease entities such as hypertension. Only a few of the studies were conducted in persons at-risk for CVD, none in blue-collar workers or low-income earners. Conclusion Internet based programs hold promise for improving the cardiovascular wellness among employees however much work is required to fully understand its utility and long term impact especially in special/at-risk populations.

Best Management Practices in Green Lodging Defined and Explained

Best management practices in green lodging are sustainable or “green” business strategies designed to enhance the lodging product from the perspective of owners, operators and guests. For guests, these practices should enhance their experience while for owners and operators, generate positive returns on investments. Best management practices in green lodging typically starts with a clear understanding of each lodging firm’s role in society, its impact on the environment and strategies developed to mitigate negative environmental externalities generated from the production of lodging goods and services. Negative externalities of hotel operations manifest themselves in energy and water usage, waste generation and air pollution. Hence, best management practices in green lodging are dynamic, cost effective, innovative, stakeholder driven and environmentally sound technical and behavioral solutions that attempt to ameliorate or eliminate the negative environmental externalities associated with lodging operations, while simultaneously generate positive returns on green investments. Thus, best management practices in green lodging should reduce lodging firms’ operating costs, increase guest satisfaction, reduce or eliminate the negative environmental impacts associated with hotel operations while simultaneously enhance business operations.

Effect of Water Management on Interannual Variation in Bulk Soil Properties from the Eastern Coastal Everglades

We examined interannual variation in soil properties from wetlands occurring in adjacent drainage basins from the southeastern Everglades. Triplicate 10-cm soil cores were collected, homogenized, and analyzed during the wet season 2006–2010 from five freshwater sawgrass wetland marshes and three estuarine mangrove forests. Soil bulk density from the Taylor Slough basin ranged from 0.15 gm-cm−3 to 0.5 gm-cm−3, was higher than from the Panhandle basin every year, and generally increased throughout the study period. Organic matter as a percent loss on ignition ranged from 7 % to 12 % from freshwater marshes and from 13 % to 56 % from estuarine mangroves. Extractable iron in soils was similar among drainage basins and wetland types, typically ranging from 0.6 to 2.0 g Fe kg−1. In contrast, inorganic sulfur was on average over four times higher from estuarine soils relative to freshwater, and was positively correlated with soil organic matter. Finally total soil phosphorus (P) was lower in freshwater soils relative to estuarine soils (84 ± 5 versus 326 ± 32 mg P kg−1). Total P from the freshwater marshes in the Panhandle basin rose throughout the study period from 54.7 ± 8.4 to 107 ± 17 mg P kg−1, a possible outcome of differences in water management between drainage basins.

Recent Fish Introductions Into Everglades National Park: An Unforeseen Consequence of Water Management?

Non-native fishes present a management challenge to maintaining Everglades National Park (ENP) in a natural state. We summarized data from long-term fish monitoring studies in ENP and reviewed the timing of introductions relative to water-management changes. Beginning in the early 1950s, management actions have added canals, altered wetland habitats by flooding and drainage, and changed inflows into ENP, particularly in the Taylor Slough/C-111 basin and Rocky Glades. The first non-native fishes likely entered ENP by the late 1960s, but species numbers increased sharply in the early 1980s when new water-management actions were implemented. After 1999, eight non-native species and three native species, all previously recorded outside of Park boundaries, were found for the first time in ENP. Several of these incursions occurred following structural and operational changes that redirected water deliveries to wetlands open to the eastern boundary canals. Once established, control non-native fishes in Everglades wetlands is difficult; therefore, preventing introductions is key to their management. Integrating actions that minimize the spread of non-native species into protected natural areas into the adaptive management process for planning, development, and operation of water-management features may help to achieve the full suite of objectives for Everglades restoration.

Trajectories of Vegetation Response to Water Management in Taylor Slough, Everglades National Park, Florida

Ecosystem management practices that modify the major drivers and stressors of an ecosystem often lead to changes in plant community composition. This paper examines how closely the trajectory of vegetation change in seasonally-flooded wetlands tracks management-induced alterations in hydrology and soil characteristics. We used trajectory analysis, a multivariate method designed to test hypotheses about rates and directions of community change, to examine vegetation shifts in response to changes in water management practices within the Taylor Slough basin of Everglades National Park. We summarized vegetation data by non-metric multidimensional scaling ordination, and examined the time trajectory of each site along environmental vectors representing hydrology and soil phosphorus gradients. In the Taylor Slough basin, vegetation change trajectories closely followed the hydrologic changes caused by the operation of water pumps and detention ponds adjacent to the canals. We also observed a shift in vegetation composition along a vector of increasing soil phosphorus, which suggests the need for implementing measures to avoid P-enrichment in southern Everglades marl prairies. This study indicates that shifts in vegetation composition in response to changes in hydrologic conditions and associated parameters may be detected through trajectory analysis, thereby providing feedback for adaptive management of wetland ecosystems.

Loaxahatchee Impoundment Landscape Assessment (LILA): Tree Island Experiments and Management; May 1, 2005 to September 4, 2009: Final Report

Hydrologic modifications have negatively impacted the Florida Everglades in numerous significant ways. The compartmentalization of the once continuously flowing system into the Water Conservation Areas (WCAs) caused disruption of the slow natural flow of water south from Lake Okeechobee through the Everglades to Florida Bay. The ponding of water in the WCAs, the linking of water flow to controlled water levels, and the management of water levels for anthropogenic vs. ecological well-being has caused a reduction in the spatial heterogeneity of the Everglades leading to greater uniformity in topography and vegetation. These effects are noticeable as the degradation in structure of the Everglades Ridge and Slough environment and associated Tree Islands. In aquatic systems water flow is of fundamental importance in shaping the structure and function of the ecosystem. The organized patterns of parallel orientation of ridges, sloughs, and tear-drop shaped tree islands along historic flow paths attest to the importance of water movement in structuring this system. Our main objective was to operate and manage the LILA facility to provide a broad potential as a research platform for an integrated group of multidisciplinary, multi-agency scientists collaborating on multifunctional studies aimed primarily at determining the effects of CERP water management scenarios on the ecology of tree islands and ridge and slough habitats. We support Everglades water management, CERP, and the Long-Term Plan by defining hydrologic regimes that sustain healthy tree islands and ridge and slough ecosystems. Information gained through this project will help to reduce the uncertainty of predicting the tree island and ridge and slough ecosystem response to changes in hydrologic conditions. Additionally, we have developed the LILA site as a visual example of Everglades restoration programs in action.

Essays on intergenerational and regional aspects of water management

This dissertation consists of three essays on different aspects of water management. The first essay focuses on the sustainability of freshwater use by introducing the notion that altruistic parents do bequeath economic assets for their offspring. Constructing a two-period, over-lapping generational model, an optimal ratio of consumption and pollution for old and young generations in each period is determined. Optimal levels of water consumption and pollution change according to different parameters, such as, altruistic degree, natural recharge rate, and population growth. The second essay concerns water sharing between countries in the case of trans-boundary river basins. The paper recognizes that side payments fail to forge water-sharing agreement among the international community and that downstream countries have weak bargaining power. An interconnected game approach is developed by linking the water allocation issue with other non-water issues such as trade or border security problems, creating symmetry between countries in bargaining power. An interconnected game forces two countries to at least partially cooperate under some circumstances. The third essay introduces the concept of virtual water (VW) into a traditional international trade model in order to estimate water savings for a water scarce country. A two country, two products and two factors trade model is developed, which includes not only consumers and producer's surplus, but also environmental externality of water use. The model shows that VW trade saves water and increases global and local welfare. This study should help policy makers to design appropriate subsidy or tax policy to promote water savings especially in water scarce countries.^

Event mining for system and service management

Modern IT infrastructures are constructed by large scale computing systems and administered by IT service providers. Manually maintaining such large computing systems is costly and inefficient. Service providers often seek automatic or semi-automatic methodologies of detecting and resolving system issues to improve their service quality and efficiency. This dissertation investigates several data-driven approaches for assisting service providers in achieving this goal. The detailed problems studied by these approaches can be categorized into the three aspects in the service workflow: 1) preprocessing raw textual system logs to structural events; 2) refining monitoring configurations for eliminating false positives and false negatives; 3) improving the efficiency of system diagnosis on detected alerts. Solving these problems usually requires a huge amount of domain knowledge about the particular computing systems. The approaches investigated by this dissertation are developed based on event mining algorithms, which are able to automatically derive part of that knowledge from the historical system logs, events and tickets. ^ In particular, two textual clustering algorithms are developed for converting raw textual logs into system events. For refining the monitoring configuration, a rule based alert prediction algorithm is proposed for eliminating false alerts (false positives) without losing any real alert and a textual classification method is applied to identify the missing alerts (false negatives) from manual incident tickets. For system diagnosis, this dissertation presents an efficient algorithm for discovering the temporal dependencies between system events with corresponding time lags, which can help the administrators to determine the redundancies of deployed monitoring situations and dependencies of system components. To improve the efficiency of incident ticket resolving, several KNN-based algorithms that recommend relevant historical tickets with resolutions for incoming tickets are investigated. Finally, this dissertation offers a novel algorithm for searching similar textual event segments over large system logs that assists administrators to locate similar system behaviors in the logs. Extensive empirical evaluation on system logs, events and tickets from real IT infrastructures demonstrates the effectiveness and efficiency of the proposed approaches.^

Statistical dialog management for health interventions

Research endeavors on spoken dialogue systems in the 1990s and 2000s have led to the deployment of commercial spoken dialogue systems (SDS) in microdomains such as customer service automation, reservation/booking and question answering systems. Recent research in SDS has been focused on the development of applications in different domains (e.g. virtual counseling, personal coaches, social companions) which requires more sophistication than the previous generation of commercial SDS. The focus of this research project is the delivery of behavior change interventions based on the brief intervention counseling style via spoken dialogue systems. ^ Brief interventions (BI) are evidence-based, short, well structured, one-on-one counseling sessions. Many challenges are involved in delivering BIs to people in need, such as finding the time to administer them in busy doctors' offices, obtaining the extra training that helps staff become comfortable providing these interventions, and managing the cost of delivering the interventions. Fortunately, recent developments in spoken dialogue systems make the development of systems that can deliver brief interventions possible. ^ The overall objective of this research is to develop a data-driven, adaptable dialogue system for brief interventions for problematic drinking behavior, based on reinforcement learning methods. The implications of this research project includes, but are not limited to, assessing the feasibility of delivering structured brief health interventions with a data-driven spoken dialogue system. Furthermore, while the experimental system focuses on harmful alcohol drinking as a target behavior in this project, the produced knowledge and experience may also lead to implementation of similarly structured health interventions and assessments other than the alcohol domain (e.g. obesity, drug use, lack of exercise), using statistical machine learning approaches. ^ In addition to designing a dialog system, the semantic and emotional meanings of user utterances have high impact on interaction. To perform domain specific reasoning and recognize concepts in user utterances, a named-entity recognizer and an ontology are designed and evaluated. To understand affective information conveyed through text, lexicons and sentiment analysis module are developed and tested.^

The Role of Family/Friend Social Support in Diabetes Self-Management for Minorities with Type 2 Diabetes

This study investigated how ethnicity, perceived family/friend social support (FSS), and health behaviors are associated with diabetes self-management (DSM) in minorities. The participants were recruited by community outreach methods and included 174 Cuban-, 121 Haitian- and 110 African-Americans with type 2 diabetes. The results indicated that ethnicity and FSS were associated with DSM. Higher FSS scores were associated with higher DSM scores, independent of ethnicity. There were ethnic differences in several elements of FSS. DSM was highest in Haitian- as compared to African-Americans; yet Haitian Americans had poorer glycemic control. The findings suggest FSS together with ethnicity may influence critical health practices. Studies are needed that further investigate the relationships among minorities with diabetes, their intimate network (family and friends) and the diabetes care process.

Effect of Medical Advice for Diet on Diabetes Self-Management and Glycemic Control for Haitian and African Americans with Type 2 Diabetes

Adequate care of type 2 diabetes is reflected by the individual’s adherence to dietary guidance; yet, few patients are engaged in diabetes self-care at the recommended level, regardless of race/ethnicity. Few studies on the effect of dietary medical advice on diabetes self-management (DSM) and glycemic control have been conducted on Haitian and African American adults with type 2 diabetes. These relationships were assessed in total of 254 Blacks with type 2 diabetes (Haitian Americans = 129; African Americans = 125) recruited from Miami-Dade and Broward Counties, Florida by community outreach methods. Although dietary advice received was not significantly different between the two Black ethnicities, given advice “to follow a diet” as a predictor of “using food groups” was significant for Haitian Americans, but not for African Americans. Haitian Americans who were advised to follow a diet were approximately 3 times more likely to sometimes or often use food groups (or exchange lists) in planning meals. Less than optimal glycemic control (A1C > 7.2) was inversely related to DSM for African Americans; but the relationship was not significant for Haitian Americans. A one unit increase in DSM score decreased the odds ratio point estimate of having less than optimal glycemic control (A1C > 7.2%) by a factor of 0.94 in African Americans. These results suggest that medical advice for diet plans may not be communicated effectively for DSM for some races/ethnicities. Research aimed at uncovering the enablers and barriers of diet management specific to Black ethnicities with type 2 diabetes is recommended.

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.

Acculturation and Diabetes Self-management of Cuban Americans: Is Age a Protective Factor?

Migration to the United States has been linked to obesity and poor diet quality. We investigated the relationship among diabetes self-management, diet, age and acculturation factors for 182 Cuban-Americans (Females = 110, Males = 72) with type 2 diabetes recruited from a randomized mailing list in South Florida. Inadequate glycemic control (β = 0.257), BMI (β = 0.251), total fat intake (β = 0.251), and smoking (β = 0.200), were positively associated, while understanding of overall diabetes care (β = -0.165), was negatively associated with migration (N = 162, adj.R2 = 0.286, F = 14.65, p < 0.001). These associations suggest that effective diabetes education targeting acculturation issues is lacking.