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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.
The First Large Absorption Survey in H i (FLASH) is a large-area radio survey for neutral hydrogen in and around galaxies in the intermediate redshift range $0.4\lt z\lt1.0$, using the 21-cm H i absorption line as a probe of cold neutral gas. The survey uses the ASKAP radio telescope and will cover 24,000 deg$^2$ of sky over the next five years. FLASH breaks new ground in two ways – it is the first large H i absorption survey to be carried out without any optical preselection of targets, and we use an automated Bayesian line-finding tool to search through large datasets and assign a statistical significance to potential line detections. Two Pilot Surveys, covering around 3000 deg$^2$ of sky, were carried out in 2019-22 to test and verify the strategy for the full FLASH survey. The processed data products from these Pilot Surveys (spectral-line cubes, continuum images, and catalogues) are public and available online. In this paper, we describe the FLASH spectral-line and continuum data products and discuss the quality of the H i spectra and the completeness of our automated line search. Finally, we present a set of 30 new H i absorption lines that were robustly detected in the Pilot Surveys, almost doubling the number of known H i absorption systems at $0.4\lt z\lt1$. The detected lines span a wide range in H i optical depth, including three lines with a peak optical depth $\tau\gt1$, and appear to be a mixture of intervening and associated systems. Interestingly, around two-thirds of the lines found in this untargeted sample are detected against sources with a peaked-spectrum radio continuum, which are only a minor (5–20%) fraction of the overall radio-source population. The detection rate for H i absorption lines in the Pilot Surveys (0.3 to 0.5 lines per 40 deg$^2$ ASKAP field) is a factor of two below the expected value. One possible reason for this is the presence of a range of spectral-line artefacts in the Pilot Survey data that have now been mitigated and are not expected to recur in the full FLASH survey. A future paper in this series will discuss the host galaxies of the H i absorption systems identified here.
Objectives/Goals: Glucagon-like peptide-1 (GLP1) use prior to bariatric surgery may represent a novel approach to treating obesity. The objectives of this study were to describe trends in pre-bariatric GLP1 use, investigate social and clinical factors associated with their use, and evaluate differences in clinical outcomes based on preoperative GLP1RA use. Methods/Study Population: Patients who underwent bariatric surgery at three Indiana hospitals from 2018 to 2023 were identified. Patients who utilized GLP1 in the year preceding surgery were compared to those who did not. Social determinants of health included insurance, income, and unemployment. Outcomes included rates of GLP1 use, 30-day postoperative readmissions, ED visits, and percent total weight lost (%TWL) at one year. Associations between preoperative GLP1 use and outcomes of interest were evaluated using multivariable logistic and linear regressions. Results/Anticipated Results: Of 2,169 patients who underwent surgery, 293 (13.5%) utilized GLP1 preoperatively. The rate of GLP1 utilization increased threefold from 2018 to 2023. Males were more likely to receive preoperative GLP1 (20.1% vs, 12.2%, p<0.001). There were no significant differences in social determinants of health or 30-day postoperative outcomes between patients who did and did not use GLP1RA preoperatively. Similarly, there were no significant differences in %TWL at one year postoperatively between groups (median 25.5% vs. 27.3%, coefficient: -0.78, 95%CI: -2.26–0.70). Discussion/Significance of Impact: Utilization of GLP1 in the year prior to bariatric surgery has significantly increased. Preoperative GLP1 use is not associated with worse 30-day outcomes or differences in %TWL at one year postoperatively. Further work is needed to evaluate whether GLP1 dosing and duration of treatment impact postoperative outcomes.
Limited analyses based on national samples have assessed whether early attention-deficit/hyperactivity disorder (ADHD) symptoms predict later internalizing and externalizing symptoms in youth and the influence of sex and pubertal timing on subsequent psychiatric symptoms. This study analyzed data (n = 2818) from the Environmental influences on Child Health Outcomes Program national cohort. Analyses used data from early childhood (mean age = 5.3 years) utilizing parent-reported ADHD symptoms to predict rates of internalizing and externalizing symptoms from late childhood/adolescence (mean age = 11.9 years). Within a subsample age at peak height velocity (APHV) acted as a proxy to assess pubertal timing from early childhood (mean age = 5.4 years) to adolescence (mean age = 12.3 years). Early-childhood ADHD symptoms predicted later psychiatric symptoms, including anxiety, depression, aggressive behavior, conduct problems, oppositional defiant disorder, and rule-breaking behavior. Earlier APHV was associated with increased Conduct Disorder symptoms from late childhood to adolescence for females only. A stronger relation between ADHD symptoms and later aggression was observed in females with earlier APHV, whereas this same pattern with aggression, conduct problems and depression was observed in males with later APHV. Clinicians should consider that both young girls and boys with elevated ADHD symptoms, particularly with off-set pubertal timing, may be at risk for later psychiatric symptoms.
Data from neurocognitive assessments may not be accurate in the context of factors impacting validity, such as disengagement, unmotivated responding, or intentional underperformance. Performance validity tests (PVTs) were developed to address these phenomena and assess underperformance on neurocognitive tests. However, PVTs can be burdensome, rely on cutoff scores that reduce information, do not examine potential variations in task engagement across a battery, and are typically not well-suited to acquisition of large cognitive datasets. Here we describe the development of novel performance validity measures that could address some of these limitations by leveraging psychometric concepts using data embedded within the Penn Computerized Neurocognitive Battery (PennCNB).
Methods:
We first developed these validity measures using simulations of invalid response patterns with parameters drawn from real data. Next, we examined their application in two large, independent samples: 1) children and adolescents from the Philadelphia Neurodevelopmental Cohort (n = 9498); and 2) adult servicemembers from the Marine Resiliency Study-II (n = 1444).
Results:
Our performance validity metrics detected patterns of invalid responding in simulated data, even at subtle levels. Furthermore, a combination of these metrics significantly predicted previously established validity rules for these tests in both developmental and adult datasets. Moreover, most clinical diagnostic groups did not show reduced validity estimates.
Conclusions:
These results provide proof-of-concept evidence for multivariate, data-driven performance validity metrics. These metrics offer a novel method for determining the performance validity for individual neurocognitive tests that is scalable, applicable across different tests, less burdensome, and dimensional. However, more research is needed into their application.
The Variables and Slow Transients Survey (VAST) on the Australian Square Kilometre Array Pathfinder (ASKAP) is designed to detect highly variable and transient radio sources on timescales from 5 s to $\sim\!5$ yr. In this paper, we present the survey description, observation strategy and initial results from the VAST Phase I Pilot Survey. This pilot survey consists of $\sim\!162$ h of observations conducted at a central frequency of 888 MHz between 2019 August and 2020 August, with a typical rms sensitivity of $0.24\ \mathrm{mJy\ beam}^{-1}$ and angular resolution of $12-20$ arcseconds. There are 113 fields, each of which was observed for 12 min integration time, with between 5 and 13 repeats, with cadences between 1 day and 8 months. The total area of the pilot survey footprint is 5 131 square degrees, covering six distinct regions of the sky. An initial search of two of these regions, totalling 1 646 square degrees, revealed 28 highly variable and/or transient sources. Seven of these are known pulsars, including the millisecond pulsar J2039–5617. Another seven are stars, four of which have no previously reported radio detection (SCR J0533–4257, LEHPM 2-783, UCAC3 89–412162 and 2MASS J22414436–6119311). Of the remaining 14 sources, two are active galactic nuclei, six are associated with galaxies and the other six have no multi-wavelength counterparts and are yet to be identified.
Drawing on insights from Critical Race Theory and framing theory, as well as previous research, this study ties together and analyzes public opinions about two racialized and politicized sports-related issues: (1) the financial compensation of college athletes, and (2) athlete protests during the national anthem. Consequently, we highlight racial/ethnic identities, racial attitudes, and political identities as predictors of these public opinions. Data for our analyses come from a nationally representative sample of U.S. adults who were surveyed just prior to the 2016 presidential election. Descriptive results suggest that well over half of U.S. adults opposed having the NCAA pay college athletes; also, about two-thirds of adults viewed athlete protests during the national anthem as unacceptable. Regression results reveal that Black and Latinx adults were more supportive of paying college athletes and athlete protests during the national anthem than White adults. Other people of color were also more likely than White adults to support paying college athletes. Racial attitudes such as a lack of recognition of racial/ethnic inequalities in education and support for Black Lives Matter also shaped public opinions about these issues in expected ways. Finally, we find that political identities were linked to public opinions about these issues even after accounting for racial/ethnic identities and racial attitudes. Overall, this study documents public opinions about these prominent sports-related issues just prior to the 2016 election of a President who particularly racialized and politicized sports issues. Even then, these sports-related issues had been similarly filtered through both a White racial frame that encourages colorblind racism and a counter frame that promotes antiracist activism. Altogether, the present study offers further evidence of how sports provide cultural terrain for individuals to enact and negotiate racialized and politicized views of sports and society and illustrates how these processes were reflected in public opinions in 2016.
The focus of this commentary is Nettle et al.'s insurance hypothesis linking food insecurity to a high body mass index (BMI). We discuss how the relationship between race/ethnicity and obesity in the United States is consistent with this hypothesis, then present potential ways forward to elucidate the validity of this hypothesis in humans through rigorous controlled trials.
“Project Grow-2-Gether” is a child nutrition study of same-sex, 3- to 7-year-old monozygotic and dizygotic twin pairs. The study attempts to bridge two bodies of literature that have rarely interfaced with respect to obesity and ingestive behavior: the first being behavioral genetic approaches to obesity-related traits, and the second being developmental approaches focusing on parent–child relationships. The overarching aim of Project Grow-2-Gether is to disentangle genetic from potential home-environmental influences on child eating behavior and body fat. This paper reviews the rationale for Project Grow-2-Gether, its procedures, and core phenotypic measurement battery. A focus of the study is acquisition of controlled food intake measurements obtained in the laboratory, measurement of specific home environmental variables, and multi-method evaluation of parent–child feeding relations. Future directions may involve longitudinal assessment of child growth and molecular analyses for specific genes that influence child eating behavior.
We proposed hierarchical Poisson and binomial models for mapping multiple interacting quantitative trait loci (QTLs) for count traits in experimental crosses. We applied our methods to two counted reproductive traits, live fetuses (LF) and dead fetuses (DF) at 17 days gestation, in an F2 female mouse population. We treated observed number of corpora lutea (ovulation rate) as the baseline and the total trials in our Poisson and binomial models, respectively. We detected more than 10 QTLs for LF and DF, most having epistatic and pleiotropic effects. The epistatic effects were larger, involved more QTLs, and explained a larger proportion of phenotypic variance than the main effects. Our analyses revealed a complex network of multiple interacting QTLs for the reproductive traits, and increase our understanding of the genetic architecture of reproductive characters. The proposed statistical models and methods provide valuable tools for detecting multiple interacting QTLs for complex count phenotypes.