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To understand participant perspectives on an effective, practical, comprehensive telehealth intervention for persistently poorly controlled diabetes mellitus and examine how its components contributed to improved outcomes, with the goal of informing broader telehealth-based diabetes management strategies.
Methods:
We conducted semi-structured interviews of a purposive sample of patients and staff in the comprehensive telehealth arm of the Practical Telehealth to Improve Control and Engagement for Patients with Clinic-Refractory Diabetes Mellitus study. Using the lens of patient engagement, we applied directed content analysis to categorize themes across the five components of the intervention.
Results:
The purposive sample included 19 patients (79% male, 53% Black, varying levels of intervention engagement) and 8 staff. The telemonitoring component was associated with encouragement and motivation among patients; staff found satisfaction in providing metrics of success for participants. For the self-management component, patients saw staff as helpful with problem-solving; staff felt patients were receptive to education. Medication management supported medication adherence and optimization and was acceptable to patients. Diet/activity support motivated behavioral changes among patients. Staff felt that depression support allowed for responsiveness to medical and behavioral factors influencing self-management. Identified areas for improvement included staff time constraints, patient difficulties with taking and transmitting data, and challenges with patient adherence among those with mental health conditions.
Conclusion:
Findings from this study provide insights that may inform the design, implementation, and scalability of comprehensive telehealth models for diabetes management across diverse healthcare settings.
Law and society scholars have long studied rights mobilization and gender inequality from the vantage point of complainants in private workplaces. This article pursues a new direction in this line of inquiry to explore, for the first time, mobilization from the vantage points of complainants and those accused of violating the rights of others in public-school workplaces in the United States. We conceptualize rights mobilization as legal, quasilegal, and/or extralegal processes. Based on a national random survey of teachers and administrators, and in-depth interviews with educators in California, New York, and North Carolina, we find an integral relationship between gender inequality and experiencing rights violations, choices about rights mobilization, and obstacles to formal mobilization. Compared to complainants, those accused of rights violations – especially male administrators – are more likely to use quasilegal and legal mobilization to defend themselves or to engage in anticipatory mobilization. Actors in less powerful status positions (teachers) most often pursue extralegal mobilization to complain about rights violations during which they engage in rights muting as a means of self-protection; when in more powerful status positions, actors use rights muting as a means of self-protection and to suppress the rights claims of others. This paper concludes with implications for future research on rights mobilization in school workplaces amidst changing political and demographic conditions.
Society's problems cannot be alleviated via mere policy interventions, whether individual- or system-level, when the system is the problem. To bring about true and lasting change to the better, we must replace the present global political-economic system – oligarchic capitalism backed by the power of the state – with one that would let the people take charge of their lives.
Interpretation biases and inflexibility (i.e., difficulties revising interpretations) have been linked to increased internalizing symptoms. Although adolescence is a developmental period characterized by novel social situations and increased vulnerability to internalizing disorders, no studies have examined interpretation inflexibility in adolescents. Additionally, no studies (on adolescents or adults) have examined interpretation flexibility as a protective factor against adverse outcomes of interpersonal events. Using a novel task and a 28-day diary we examined relations among interpretation bias and inflexibility, internalizing symptoms, and negative interpersonal events in a sample of children and adolescents (N = 159, ages 9–18). At baseline, negative interpretation bias was positively correlated with social anxiety symptoms, and positive interpretation bias negatively correlated with social anxiety and depressive symptoms. Inflexible positive interpretations were correlated with higher social anxiety and depressive symptoms, while inflexible negative interpretations were correlated with higher social anxiety. Finally, interpretation inflexibility moderated daily associations between negative interpersonal events and depressive symptoms in daily life, such that higher inflexibility was associated with stronger associations between interpersonal events and subsequent depressive symptoms, potentially increasing depressive symptom instability. These results suggest that interpretation biases and inflexibility may act as both risk and protective factors for adolescent anxiety and depression.
OBJECTIVES/GOALS: Silicosis is a highly fatal progressive fibrotic disease of the lungs characterized by accumulation and persistence of fibroblasts that excessively deposit Collagen1a1. We sought to eliminate Collagen1a1-expressing fibroblasts through a targeted genetic ablation strategy and hypothesized that this would arrest the progression of Silicosis. METHODS/STUDY POPULATION: Silicosis was induced with a single intratracheal (i.t.) instillation of silica particles ( RESULTS/ANTICIPATED RESULTS: Targeted ablation of Col1a1+ fibroblast in established Silicosis resulted in a decrease in: 1) Col1a1+ fibroblasts by flow cytometry and within fibrotic nodules by immunofluorescent staining, 2) total lung collagen content by histology and hydroxyproline assay, 3) tissue-associated disease by microCT and an increase in arterial oxygen saturation by pulse oximetry. Cessation of targeted Col1a1+ fibroblast ablation resulted in a rebound effect in Silicosis disease progression. Following ablation, Col1a1+ fibroblasts expanded by proliferation (Ki67+) and total lung collagen levels returned to pre-ablation levels. DISCUSSION/SIGNIFICANCE: Silicosis is a often fatal disease with no FDA approved therapies. These results suggest that targeted loss of Col1a1+ fibroblasts in Silicosis is sufficient to arrest disease progression. Thus, it is essential to understand how targeted loss of pro-fibrotic fibroblasts can alter disease progression as a tool to develop novel therapeutic strategies.
Since the late 1980s, peasants throughout Central America have begun to coordinate political and economic strategy. Agriculturalists from the five republics that constituted “la patria grande” of Spanish Central America (Guatemala, El Salvador, Honduras, Nicaragua, and Costa Rica) as well as representatives from Panama and Belize have founded regional organizations that meet to compare experiences with free-market policies, share new technologies, develop sources of finance, and create channels for marketing their products abroad. They have also established a presence in the increasingly distant arenas where decisions are made that affect their livelihood. Small-farmer organizations now lobby at the United Nations, the World Bank, the International Monetary Fund, the European Union, and regional summit meetings. Central American campesinos have attended numerous regional gatherings of agriculture ministers and presidents, as well as events like the 1992 Earth Summit in Rio de Janeiro, the 1995 Western Hemisphere Presidents' Summit in Miami, the 1995 World Summit for Social Development in Copenhagen, and the 1996 Food Security Summit in Rome.
Lockdowns have been a core infection control measure in many countries during the coronavirus disease 2019 (COVID-19) pandemic. In England's first lockdown, children of single parent households (SPHs) were permitted to move between parental homes. By the second lockdown, SPH support bubbles between households were also permitted, enabling larger within-household networks. We investigated the combined impact of these approaches on household transmission dynamics, to inform policymaking for control and support mechanisms in a respiratory pandemic context. This network modelling study applied percolation theory to a base model of SPHs constructed using population survey estimates of SPH family size. To explore putative impact, varying estimates were applied regarding extent of bubbling and proportion of different-parentage within SPHs (DSPHs) (in which children do not share both the same parents). Results indicate that the formation of giant components (in which COVID-19 household transmission accelerates) are more contingent on DSPHs than on formation of bubbles between SPHs, and that bubbling with another SPH will accelerate giant component formation where one or both are DSPHs. Public health guidance should include supportive measures that mitigate the increased transmission risk afforded by support bubbling among DSPHs. Future network, mathematical and epidemiological studies should examine both independent and combined impact of policies.
Palliative care guidelines recommend an interdisciplinary approach to address patients’ awareness of mortality and need for end-of-life preparation. An ethical will is a nonlegal way to address mortality by communicating a lasting and intangible legacy of values to others. The aim of this scoping review is to clarify the operationalization of ethical wills across disciplines and map the purposes and outcomes of creating an ethical will.
Methods
We followed the Joanna Briggs Institute methodology for scoping reviews. We searched 14 databases in November 2019 and January 2021 without filtering publication date or type. Two reviewers independently screened 1,948 publications. We extracted frequently used terms describing content, audience, format, purpose, and outcomes identified in ethical will creation.
Results
Fifty-one publications met inclusion criteria. Six (11.7%) were research articles. Twenty-four (47.1%) were lay literature published within law, estate, and financial planning. Collectively, our included studies defined an ethical will as a nonlegal way to express values, beliefs, life lessons and experiences, wisdom, love, history, hope for the future, blessings, apology, or forgiveness using any format (e.g., text, audio, video) that is meant to be shared with family, friends, or community. The most common purposes were to be remembered, address mortality, clarify life's meaning, and communicate what matters most. Creation provided opportunity to learn about self, served as a gift to both writer and recipient, and fostered generativity and sense of symbolic immortality.
Significance of results
Our findings highlight interdisciplinary utilization and a lack of research of ethical wills. This review provides supportive evidence for ethical wills as a way for patients to address mortality, renew intergenerational connections, solidify self, and promote transcendence before their final days. Ethical wills have potential to be incorporated into interdisciplinary palliative care in the future to address psychological symptoms for patients anticipating the end of life.
A national survey characterized training and career development for translational researchers through Clinical and Translational Science Award (CTSA) T32/TL1 programs. This report summarizes program goals, trainee characteristics, and mentorship practices.
Methods:
A web link to a voluntary survey was emailed to 51 active TL1 program directors and administrators. Descriptive analyses were performed on aggregate data. Qualitative data analysis used open coding of text followed by an axial coding strategy based on the grounded theory approach.
Results:
Fifty out of 51 (98%) invited CTSA hubs responded. Training program goals were aligned with the CTSA mission. The trainee population consisted of predoctoral students (50%), postdoctoral fellows (30%), and health professional students in short-term (11%) or year-out (9%) research training. Forty percent of TL1 programs support both predoctoral and postdoctoral trainees. Trainees are diverse by academic affiliation, mostly from medicine, engineering, public health, non-health sciences, pharmacy, and nursing. Mentor training is offered by most programs, but mandatory at less than one-third of them. Most mentoring teams consist of two or more mentors.
Conclusions:
CTSA TL1 programs are distinct from other NIH-funded training programs in their focus on clinical and translational research, cross-disciplinary approaches, emphasis on team science, and integration of multiple trainee types. Trainees in nearly all TL1 programs were engaged in all phases of translational research (preclinical, clinical, implementation, public health), suggesting that the CTSA TL1 program is meeting the mandate of NCATS to provide training to develop the clinical and translational research workforce.
There is a substantial literature today on the intersection of organizations, institutions, and law. The bulk of this literature falls into the school of thought known as the “new institutionalism” (or “neoinstitutionalism”), which came into play in the sociology of organizations in the late 1970s and early 1980s (Meyer and Rowan 1977; DiMaggio and Powell 1983). This literature has paid surprisingly little attention to an earlier version of institutionalism, often referred to as the “old institutionalism,” which is mostly associated with the work of Philip Selznick. This chapter reconsiders the sociological significance of the old institutionalism, focusing in particular on Selznick's Law, Society, and Industrial Justice (1969). More than half a century after its original publication, this work remains important for how it conceptualizes law, for how it conceptualizes organizations, and for the theory Selznick offers regarding the moral evolution of organizations as they become “institutions,” or living entities infused with values. I explore the place of Law, Society, and Industrial Justice in the sociology of law and the sociology of organizations, consider its argument in light of subsequent developments in the new institutionalism, and finally argue that it is time for a rapprochement between the old and new institutionalisms in the study of organizations, institutions, and law.
Law, Society, and Industrial Justice, parts of which were coauthored by Philippe Nonet and Howard Vollmer, was first published in 1969 by the Russell Sage Foundation and was reissued in 1980 by Transaction Books and again in 2020 by Quid Pro Books. In his distinctive style, Selznick combines both sociological and jurisprudential insights, calling our attention to the importance of understanding the evolution of public legal norms and ideals in private organizational governance. As the first comprehensive examination of the relationship between law and organizations and, perhaps more importantly, of how law operates within organizations, this study addresses complex issues of governance in organizations using a rich blend of history, sociology, politics, management theory, and jurisprudence. Written about a decade before the new institutionalism emerged as a dominant approach to law and organizations, it provides an important complement, showing us how norms and ideals can develop within organizations as well as at the broader organizational field level that is the focus of much contemporary scholarship.
ABSTRACT IMPACT: This is the first study to use QUINT analyses to examine heterogeneity of treatment effect for group medical visits among individuals with type 2 diabetes. QUINT is a data driven method that assumes no a priori assumptions regarding effect moderators - an important step in the path towards personalized medicine. OBJECTIVES/GOALS: To examine heterogeneity of treatment effect (HTE) in Jump Start, a trial that compared the effectiveness of group medical visits (GMVs) focused on medication management only versus the addition of intensive weight management (WM) on glycemic control for patients with type 2 diabetes and body mass index >=27kg/m^2. METHODS/STUDY POPULATION: Jump Start patients (n=263) were randomized to a GMV-based medication management plus low carbohydrate diet-focused WM program (WM/GMV; n = 127) or GMV-based medication management only (GMV; n = 136) for diabetes control. We used QUalitative INteraction Trees (QUINT), a tree-based clustering method, to determine if there were subgroups of patients who derived greater benefit from either WM/GMV or GMV. Subgroup predictors included 32 baseline demographic, clinical, and psychosocial factors. Outcome was hemoglobin A1c (HbA1c). We conducted internal validation via bootstrap resampling to estimate bias in the range of mean outcome differences among arms. RESULTS/ANTICIPATED RESULTS: QUINT analyses indicated that for patients who had not previously attempted weight loss, WM/GMV resulted in better glycemic control than GMV alone (mean difference in HbA1c improvement = 1.48%). For patients who had previously attempted weight loss and had lower cholesterol and blood urea nitrogen levels, GMV alone was better than WM/GMV (mean difference in HbA1c improvement = 1.51%). Internal validation resulted in moderate corrections in the mean HbA1c differences between arms; however, differences remained in the clinically significant range. DISCUSSION/SIGNIFICANCE OF FINDINGS: Among patients with diabetes and BMI>=27kg/m^2, a low-carbohydrate, weight loss focus may better improve HbA1c in those who have never attempted weight loss. A medication management focus may be better in those who have attempted weight loss and have lower cholesterol and blood urea nitrogen.
As any devoted theatregoer will attest, watching a performance is a unique experience, as the social setting, rules, and standards of theatre often combine to create a feeling of liberation from the everyday world. This book explores the phenomenon of theatre as simultaneously distinct from and yet connected to society as a whole. Combining theoretical reflections with materials from European case studies, the authors offer intriguing new methods for the sociological study of theatre while contributing equally to theatre and performance studies.
OBJECTIVES/GOALS: The impact of baseline BMI on glycemic response to group medical visits (GMV) and weight management (WM)-based interventions is unclear. Our objective is to determine how baseline BMI class impacts patient responses to GMV and interventions that combine WM/GMV. METHODS/STUDY POPULATION: We will perform a secondary analysis of Jump Start, a randomized, controlled trial that compared the effectiveness of a GMV-based low carbohydrate diet-focused WM program (WM/GMV) to traditional GMV-based medication management (GMV) on diabetes control. The primary and secondary outcomes will be change in hemoglobin A1c (HbA1c) and weight at 48 months, respectively. Study participants will be stratified into BMI categories defined by BMI 27-29.9kg/m2, 30.0-34.9kg/m2, 35.0-39.9kg/m2, and ≥40.0kg/m2. Hierarchical mixed models will be used to examine the differential impact of the WM/GMV intervention compared to GMV on changes in outcomes by BMI class category. RESULTS/ANTICIPATED RESULTS: Jump Start enrolled 263 overweight Veterans (BMI ≥ 27kg/m2) with type 2 diabetes. At baseline, mean BMI was 35.3 and mean HbA1c was 9.1. 14.5% were overweight (BMI 27–29.9) and 84.5% were obese (BMI ≥ 30). The proposed analyses are ongoing. We anticipate that patients in the higher BMI obesity classes will demonstrate greater reductions in HbA1c and weight with the WM/GMV intervention relative to traditional GMV. DISCUSSION/SIGNIFICANCE OF IMPACT: This work will advance the understanding of the relationship between BMI and glycemic response to targeted interventions, and may ultimately provide guidance for interventions for type 2 diabetes.
Disasters are typically unforeseen, causing most social and behavioral studies about disasters to be reactive. Occasionally, predisaster data are available, for example, when disasters happen while a study is already in progress or where data collected for other purposes already exist, but planned pre-post designs are all but nonexistent. This gap fundamentally limits the quantification of disasters’ human toll. Anticipating, responding to, and managing public reactions require a means of tracking and understanding those reactions, collected using rigorous scientific methods. Oftentimes, self-reports from the public are the best or only source of information, such as perceived risk, behavioral intentions, and social learning. Significant advancement in disaster research, to best inform practice and policy, requires well-designed surveys with large probability-based samples and longitudinal assessment of individuals across the life-cycle of a disaster and across multiple disasters.
Arbib, Érdi, and Szentágothai's book should be a required reading for any serious student of the brain. The scope and the accessibility of its presentation of the neurobiological data (especially the functional anatomy of select parts of the central nervous system) more than make up for the peculiarities of the theoretical stance it adopts.
For over four hundred years, in every country where Shakespeare's plays have been performed, The Merchant of Venice has aroused controversy and excitement. This edition is the first to offer a comprehensive account of the Merchant in performance. Charles Edelman's introduction challenges many of the myths and preconceptions associated with the play, and shows how historical events and cultural attitudes have shaped actors' interpretations and audience responses. The commentary, printed alongside the text, describes how different actors, directors and designers have approached each character and episode on stage, film and television, from the first performances in the 1590s to the present day. The extraordinary variety of The Merchant of Venice in production will give every reader new and different insights into one of Shakespeare's most powerful but troubling plays.
The final chapter lays out strategies for reducing poverty and discusses three areas of work.The first is to pursue a broader frame for the work in order to command national attention more effectively, by including people with incomes twice the poverty lines and emphasizing both the interests of people of all races and the unique interests of people of color and of women, and by fighting the ever-widening chasm of inequality as well.The second is to consolidate our work about issues of income, jobs, and cash assistance, which the chapter calls the three-legged stool.It argues that past strategies have tended to consider these areas in isolation, not thinking of them coordinately and, therefore, failing to produce the most effective results possible.Wages, quality, and income supplements for workers; job creation as needed; and cash assistance must work in tandem to get the best outcomes.Finally, to move forward in very low-income areas (both urban and rural), actors must have a perspective of place that addresses all the multiple causes that produce the high poverty.