scholarly journals Improvement in A1c levels in early adulthood in the T1D Exchange: Impact of racial, socioeconomic, and clinical factors

2021 ◽  
Author(s):  
Elena Toschi ◽  
Ryan J Bailey ◽  
Kellee M Miller ◽  
Peter M Calhoun
Keyword(s):  
Higher Education ◽  
Glycemic Control ◽  
Early Adulthood ◽  
Rapid Decline ◽  
Stable Group ◽  
Gradual Decline ◽  
Slow Decline ◽  
High Hba1c ◽  
Very High ◽  
Over Time

Abstract Context Glycemic control in adolescents with type 1 diabetes is poor; yet, it typically improves during early adulthood. Factors related to improvement of glycemic control are unclear. Objective Examine how demographic and clinical variables may impact trajectories of glycemic control over time. Design Retrospective observational. Setting T1D Exchange clinic registry. Patients or Other Participants A total of 1,775 participants ages 18-30 years at enrollment. Main Outcome Measures Latent class trajectory modeling was used to determine sub-groups following a similar HbA1c trajectory over time. Results Five distinct trajectories of HbA1c classes were identified: “low-decline” and “moderate-decline” Groups had low or moderate HbA1c with a gradual decline, the “high-stable” Group had high HbA1c and remained stable, and the “very high-rapid decline” and “very high-slow decline” Groups had very high HbA1c with rapid or gradual decline. Compared with the “high-stable” Group, the “low-decline” and “moderate-decline” Groups were more likely to be male (P=0.009), white non-Hispanic (P=0.02), non-smokers (P<0.001), check self-monitoring blood glucose (SMBG) more frequently (P<0.001), and have higher education (P<0.001), lower BMI (P=0.02), and lower daily insulin dose (P<0.001). Compared with the “very high-rapid decline” and “very high-slow decline” Groups, “low-decline” and “moderate-decline” Groups were more likely to be male (p=0.02), have higher education (p<0.001), use insulin pumps (p=0.01), be non-smokers (p<0.001), and have a higher number of SMBG checks per day at enrollment (p<0.001). Conclusions We determined 5 distinct patterns of glycemic control from early adulthood into adulthood. Further evaluation into the modifiable factors associated with a declining HbA1c trajectory would aid in the development of targeted interventions.

scholarly journals Characterization of long-term oral anticoagulant adherence trajectories among patients with atrial fibrillation: a retrospective observational study

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
S Salmasi ◽  
A Safari ◽  
M De Vera ◽  
L Lynd ◽  
M Koehoorn ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Oral Anticoagulant ◽  
Information Criteria ◽  
Rapid Decline ◽  
First Year ◽  
Good Adherence ◽  
Slow Decline ◽  
Rolling Windows ◽  
Over Time

Abstract Background Medication taking is a dynamic behaviour that changes over time. Conventional adherence summary measures (e.g. proportion days covered) used in the OAC adherence studies conducted so far, however, are insensitive to the fluid nature of adherence. For example, identical PDC values can be calculated for patients with initial good adherence followed by poor adherence, and for those with periodic non-adherence throughout the course of therapy. Purpose The objective of this study was to characterize atrial fibrillation (AF) patients' long-term unique oral anticoagulant (OAC) adherence trajectories. Methods Using linked, population-based administrative data containing physician billings, hospitalization and prescription records of 4.8 million British Columbians (1996–2019), incident adult cases of AF were identified. Only patients who had prescription refill data available for five years were included in the analysis. The primary measure of OAC adherence was the proportion of days covered (PDC) over consecutive 90-day rolling windows. We modelled continuous 90-day PDC values over time. The time variable was number of years since OAC initiation. Group-Based Trajectory Modelling (GBTM) was used to identify patients' unique longitudinal adherence trajectories. To determine the best model, a relative comparison was done between models using Bayesian information criteria (BIC), and the Akaike information criterion (AIC). Results The study cohort was 19,749 AF patients [mean age 70.6y (SD 10.64), 56% male, mean CHA2DS2-VASc score 2.77 (SD 1.39]. The model that best fit our data identified four distinct OAC adherence trajectories (Figure). These were “consistent good adherence” (n=14,631 patients, 74.1% of the cohort), “rapid decline and discontinuation” (n=2327, 11.8%), “rapid decline with recovery” (n=1973, 9.99%), and “slow decline and discontinuation” (n=819, 4.2%). Our results show that there is heterogeneity among non-adherers. PDC dropped significantly in the first year after therapy initiation for those with “rapid decline and discontinuation” trajectory. Patients exhibiting “rapid decline with recovery” also displayed a rapid decline in adherence in the first year but showed improvements around the third year. Those in the “slow decline and discontinuation” trajectory displayed slow decline in adherence over first three years which eventually led to permanent discontinuation of therapy. Conclusion In this retrospective study we distinguished between the different kinds of non-adherence in terms of timing and rate. While a majority of our cohort adhered to their medications, we identified three unique trajectories displaying declining adherence over time at varying rates. Our results emphasize the importance of early intervention and have direct implications for improving the design of adherence interventions. FUNDunding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Canadian Institutes of Health Research grant

Limits to Dominance?

2017 ◽  
Keyword(s):  
Communication Skills ◽  
Electoral System ◽  
Tony Blair ◽  
Prime Ministers ◽  
Margaret Thatcher ◽  
Capital Building ◽  
Low Levels ◽  
Very High ◽  
Over Time ◽  
Policy Vision

This chapter compares the leadership capital of two long-serving UK prime ministers: Tony Blair and Margaret Thatcher, treble election winners who held office for a decade. Mapping their capital over time reveals two very different patterns. Thatcher began with low levels of capital, building to a mid-term high and final fragile dominance, though her capital fell between elections. Blair possessed very high levels from the outset that gradually declined in a more conventional pattern. Both benefited from electoral dominance and a divided opposition, Thatcher’s strength lay in her policy vision while Blair’s stemmed from his popularity and communication skills. The LCI reveals that both prime ministers were successful without being popular, sustained in office by the electoral system. Towards the end of their tenures, both leaders’ continued dominance masked fragility, ousted when unrest in their parties and policy unpopularity eroded their capital.

Indigenous higher education sector: the evolution of recognised Indigenous Leaders within Australian Universities

2020 ◽  
pp. 1-7 ◽  
Author(s):  
Stacey Kim Coates ◽  
Michelle Trudgett ◽  
Susan Page
Keyword(s):  
Higher Education ◽  
Indigenous Education ◽  
Indigenous Australians ◽  
Access To Higher Education ◽  
Public Schooling ◽  
Indigenous Students ◽  
Early Experiences ◽  
Commonwealth Government ◽  
The 1960S ◽  
Over Time

Abstract There is clear evidence that Indigenous education has changed considerably over time. Indigenous Australians' early experiences of ‘colonialised education’ included missionary schools, segregated and mixed public schooling, total exclusion and ‘modified curriculum’ specifically for Indigenous students which focused on teaching manual labour skills (as opposed to literacy and numeracy skills). The historical inequalities left a legacy of educational disparity between Indigenous and non-Indigenous Australians. Following activist movements in the 1960s, the Commonwealth Government initiated a number of reviews and forged new policy directions with the aim of achieving parity of participation and outcomes in higher education between Indigenous and non-Indigenous Australians. Further reviews in the 1980s through to the new millennium produced recommendations specifically calling for Indigenous Australians to be given equality of access to higher education; for Indigenous Australians to be employed in higher education settings; and to be included in decisions regarding higher education. This paper aims to examine the evolution of Indigenous leaders in higher education from the period when we entered the space through to now. In doing so, it will examine the key documents to explore how the landscape has changed over time, eventually leading to a number of formal reviews, culminating in the Universities Australia 2017–2020 Indigenous Strategy (Universities Australia, 2017).

scholarly journals Influence of Hydrogeochemistry on Tunnel Drainage in Evaporitic Formations: El Regajal Tunnel Case Study (Aranjuez, Spain)

2021 ◽  
Vol 13 (3) ◽  
pp. 1505
Author(s):  
Ignacio Menéndez Pidal ◽  
Jose Antonio Mancebo Piqueras ◽  
Eugenio Sanz Pérez ◽  
Clemente Sáenz Sanz
Keyword(s):  
High Speed ◽  
Civil Engineering ◽  
Saturation Index ◽  
The Subject ◽  
Under Construction ◽  
Underground Flow ◽  
Very High ◽  
Over Time

Many of the large number of underground works constructed or under construction in recent years are in unfavorable terrains facing unusual situations and construction conditions. This is the case of the subject under study in this paper: a tunnel excavated in evaporitic rocks that experienced significant karstification problems very quickly over time. As a result of this situation, the causes that may underlie this rapid karstification are investigated and a novel methodology is presented in civil engineering where the use of saturation indices for the different mineral specimens present has been crucial. The drainage of the rock massif of El Regajal (Madrid-Toledo, Spain, in the Madrid-Valencia high-speed train line) was studied and permitted the in-situ study of the hydrogeochemical evolution of water flow in the Miocene evaporitic materials of the Tajo Basin as a full-scale testing laboratory, that are conforms as a whole, a single aquifer. The work provides a novel methodology based on the calculation of activities through the hydrogeochemical study of water samples in different piezometers, estimating the saturation index of different saline materials and the dissolution capacity of the brine, which is surprisingly very high despite the high electrical conductivity. The circulating brine appears unsaturated with respect to thenardite, mirabilite, epsomite, glauberite, and halite. The alteration of the underground flow and the consequent renewal of the water of the aquifer by the infiltration water of rain and irrigation is the cause of the hydrogeochemical imbalance and the modification of the characteristics of the massif. These modifications include very important loss of material by dissolution, altering the resistance of the terrain and the increase of the porosity. Simultaneously, different expansive and recrystallization processes that decrease the porosity of the massif were identified in the present work. The hydrogeochemical study allows the evolution of these phenomena to be followed over time, and this, in turn, may facilitate the implementation of preventive works in civil engineering.

Equality and Equity in Chinese Higher Education in the Post-massification Era: An Analysis Based on Chinese Scholarly Literature

2021 ◽  
pp. 1-22
Author(s):  
Qiang Zha
Keyword(s):  
Higher Education ◽  
Literature Review ◽  
Bibliometric Analysis ◽  
Chinese Higher Education ◽  
Scholarly Literature ◽  
The Core ◽  
Research Questions ◽  
Changes Over Time ◽  
Core Issues ◽  
Over Time

Abstract This paper examines several research questions relating to equality and equity in Chinese higher education via an extended literature review, which in turn sheds light on evolving scholarly explorations into this theme. First, in the post-massification era, has the Chinese situation of equality and equity in higher education improved or deteriorated since the late 1990s? Second, what are the core issues with respect to equality and equity in Chinese higher education? Third, how have those core issues evolved or changed over time and what does the evolution indicate and entail? Methodologically, this paper uses a bibliometric analysis to detect the topical hotspots in scholarly literature and their changes over time. The study then investigates each of those topical terrains against their temporal contexts in order to gain insights into the core issues.

Determining Appropriate Zones for Knowledge Intensive Firms Site Selection Using GIS

2019 ◽  
Vol 10 (1) ◽  
pp. 1-30
Author(s):  
Alireza Mohammadi
Keyword(s):  
Higher Education ◽  
Information And Communication Technology ◽  
Communication Technology ◽  
Site Selection ◽  
Transportation Network ◽  
Theoretical Background ◽  
Analytic Hierarchy ◽  
Information And Communication ◽  
Knowledge Intensive ◽  
Very High

In this study, the integration of fuzzy analytic hierarchy processes (FAHPs) and fuzzy overlays in GIS was used to determine appropriate geographic zones for the establishment of knowledge intensive firms in 22 districts of the Tehran metropolis. According to the theoretical background, a number of criteria were selected for the identification of appropriate geographic zones. The results show that among the selected criteria, proximity to existing knowledge intensity firms, and companies providing information and communication technology (ICT) services, higher education and research centers, being close to convenient transportation network and land use have more important role in the location of firms. According to the findings, among 22 regions, regions 3, 7, 6, 1, 2, 10, 4, 11, and 12 are the most desirable ones for the deployment of firms. Ultimately, regions 6, 7, 3, and 1 have received “very high” priority for the deployment of knowledge intensive firms.

Development of a model describing individuated adult child–parent relationships

2008 ◽  
Vol 32 (5) ◽  
pp. 381-389 ◽  
Author(s):  
Heike M. Buhl
Keyword(s):  
Early Adulthood ◽  
Adult Child ◽  
Measurement Model ◽  
Factor Analyses ◽  
Mothers And Fathers ◽  
Parent Relationships ◽  
Age Related ◽  
Mother Child Relationships ◽  
Over Time ◽  
Age Related Changes

This study investigates age-related changes and dyadic-specific differences in adult child–parent relationships. Using an individuation framework, two German samples of 224 and 105 participants aged between 21 and 47 years were administered the Network of Relationships Inventory, the Emotional Autonomy Scale and the Authority Reciprocity Questionnaire. Factor analyses resulted in a measurement model valid for adult children, their mothers and fathers. The model includes connectedness (with emotional and cognitive aspects) as well as individuality (assessed as power symmetry). Connectedness decreased with age. Symmetry in father–child relationships increased over time, while mother–child relationships were perceived to be symmetrical by early adulthood. Child–mother relationships were more connected than child–father relationships. Sons described themselves as more powerful than did daughters.

Abstract 14652: Systolic Blood Pressure Trajectories and Cardiovascular Outcomes in SPRINT

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Charles A German ◽  
Tali Elfassy ◽  
Matthew J Singleton ◽  
Carlos J Rodriguez ◽  
Walter T Ambrosius ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Latent Class ◽  
Stable Group ◽  
Coronary Syndrome ◽  
Average Blood Pressure ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Over Time

Introduction: Blood pressure trajectories have been associated with cardiovascular disease (CVD) in observational studies. It is unclear whether these associations are independent of average blood pressure over time. Methods: We used data from SPRINT to identify systolic blood pressure (SBP) trajectories among a cohort of 8901 participants by incorporating SBP measures during the first 12 months of the trial post randomization. Trajectories were identified using latent class based modeling. Study outcomes included incident CVD, defined as myocardial infarction, acute coronary syndrome not resulting in myocardial infarction, stroke, acute decompensated heart failure, or death attributable to CVD, and all-cause mortality. Cox proportional hazards models were used to evaluate associations between SBP trajectories and our outcomes of interest. Results: Four distinct SBP trajectories were identified: ‘low decline’ (40%), ‘high decline’ (6%), ‘low stable’ (48%), and ‘high stable’ (5%) (Figure 1). Relative to the low decline group, the low stable group was associated with a 29% increased risk of CVD (HR: 1.29, 95%CI: 1.06-1.57) and the high stable group was associated with a 76% increased risk of all-cause mortality (HR: 1.76, 95%CI: 1.15-2.68) after baseline multivariable adjustment. Relative to the low stable group, the high stable group was associated with a 54% increased risk of all-cause mortality (HR: 1.54, 95%CI: 1.05-2.28). When adjusting for average blood pressure across the 12 month time period, there were no significant differences in outcomes. Conclusion: We identified 4 SBP trajectories using data from SPRINT and found differences in the risk of CVD and all-cause mortality after baseline adjustment. However, there were no differences in the risk of these outcomes after adjusting for average blood pressure over time. These results suggest that the pattern of blood pressure control may not be relevant as long as the target blood pressure is achieved.

Sign in / Sign up

Export Citation Format

Share Document