scholarly journals Adaptation of a Community-based Type-2 Diabetes Mellitus Remission Intervention During COVID-19: Empowering Persons Living With Diabetes to Take Control

2021 ◽  
Author(s):  
Kim Quimby ◽  
Madhuvanti Murphy ◽  
Heather Harewood ◽  
Christina Howitt ◽  
Ian Hambleton ◽  
...  
Keyword(s):  
Fasting Blood Glucose ◽  
Diabetes Remission ◽  
Application Site ◽  
Caloric Content ◽  
Adaptation Process ◽  
Community Based ◽  
Solid Meal ◽  
Face To Face ◽  
Meal Plan ◽  
The Face

Abstract Background: The Barbados Diabetes Remission Study-2 reported that a community-based low-calorie diet (LCD) for weight loss and diabetes remission was both an acceptable implementation strategy and a clinically effective intervention. This study aimed to examine the adaptability of the face-to-face BDRS-2 protocol into an online modality.Methods: The Iterative Decision‐making for Evaluation of Adaptations framework questions the necessity of the adaptation and the preservation of core elements of the intervention during the adaptation process – these elements were identified as the 12-week intervention duration, weekly monitoring of participants for change in weight and fasting blood glucose and daily 840kcal allowance. The adaptation outcomes were documented using the framework for reporting adaptations and modifications to evidence-based interventions. Implementation effectiveness was determined by fidelity to core intervention elements. Intervention effectiveness was determined from the analysis of clinical data.Results: We decided that an adaptation was needed as the COVID-19 measures to control transmission prohibited in-person interactions, and that key elements of the intervention could be preserved during the adaptation process. Adaptations were made to the following: (1) The context in which the data was collected: participants self-measured at home instead of being measured by community health advocates (CHA) at a community site. (2) The context in which the data was entered: participants first posted their measurements to a mobile application site which was accessible by the CHAs. As with the original protocol, CHAs then entered the measurements into an online database. (3) The formulation of the LCD: participants substituted the liquid formulation for a solid meal plan of equivalent caloric content. There was increased fidelity to the attendance schedule with the online format (1 incomplete entry out of 45 entries), as compared to the face-to-face modality (1 absence out of 20 visits). Regarding the solid meal plan, 1 participant logged difficultly averaging non-exact potion sizes. Weight change ranged from -14.3kgs to 0.4kgs over the 12-week period and all group members achieved induction of diabetes remission. Conclusion: Larger studies are needed to confirm that this adapted online protocol is both acceptable and clinically effective while maintaining fidelity to key elements of the original protocol.Trial Registration: NCT03536377 registered 24th May 2018 at https://clinicaltrials.gov/ct2/show/NCT03536377

scholarly journals Implementation of a community-based low-calorie dietary intervention for the induction of type-2 diabetes and pre-diabetes remission: a feasibility study utilising a type 2 hybrid design

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Kim R. Quimby ◽  
Natasha Sobers ◽  
Colette George ◽  
Natalie Greaves ◽  
Francine Browman-Jones ◽  
...  
Keyword(s):  
Weight Loss ◽  
Feasibility Study ◽  
Clinical Skills ◽  
Fasting Blood Glucose ◽  
Diabetes Remission ◽  
Community Based ◽  
Implementation Phase ◽  
Implementation Effectiveness ◽  
Low Calorie

Abstract Objectives The aims of this feasibility study were to (1) examine the implementation of a community-based health advocate (CHA) training programme to develop the clinical skills needed to support a diabetes remission protocol based on a low-calorie diet (LCD) and (2) investigate if participant weight loss can be achieved and diabetes remission induced under these conditions. Methods This tripartite study followed a type 2 implementation-effectiveness design. Three faith-based organisations (FBOs) were purposively selected as study sites. Implementation outcomes were guided by the Consolidated Framework for Implementation Research. During the pre-implementation phase, site ‘readiness’ to facilitate the intervention was determined from a site visit and an interview with the FBOs’ leadership. During the implementation phase, congregants could volunteer for the 10-week CHA training which included practical exercises in weight, glucose and blood pressure (BP) measurement, and a summative practical assessment. Acceptability and implementation effectiveness were assessed via survey. During the intervention phase, other congregants and community members with T2DM or pre-diabetes and overweight were invited to participate in the 12-week LCD. Anti-diabetic medication was discontinued on day 1 of the intervention. Clinical effectiveness was determined from the change in weight, fasting blood glucose (FBG) and BP which were monitored weekly at the FBO by the CHA. HbA1C was performed at weeks 1 and 12. Results The FBOs were found to be ready as determined by their adequate resources and engagement in health-related matters. Twenty-nine CHAs completed the training; all attained a passing grade at ≥1 clinical station, indicating implementation effectiveness. CHA feedback indicated that the programme structure was acceptable and provided sufficient access to intervention-related material. Thirty-one persons participated in the LCD (11 T2DM:20 pre-diabetes). Mean (95%CI) weight loss was 6.0 kg (3.7 to 8.2), 7.9 kg in males vs 5.7 kg in females; A1C (%) decreased from 6.6 to 6.1, with a greater reduction in those with T2DM when compared to pre-diabetes. FBG decreased from 6.4 to 6.0mmol/L. T2DM remission rates were 60% and 90% by A1C<6.5% and FBG<7mmol/L respectively. Pre-diabetes remission was 18% and 40% by A1C<5.7% and FBG<5.6 respectively. Conclusion Implementation of a community-based diabetes remission protocol is both feasible and clinically effective. Its sustainability is to be determined. Adaptability to other disorders or other settings should be investigated. Trial registration NCT03536377 registered on 24 May 2018.

scholarly journals Implementation of a Community-Based Low-Calorie Dietary Intervention for the Induction of Type-2 Diabetes and Pre-Diabetes Remission: A Feasibility Study Utilising a Type-2 Hybrid Design

2021 ◽  
Author(s):  
Kim Quimby ◽  
Natasha Sobers ◽  
Colette George ◽  
Natalie Greaves ◽  
Francine Browman-Jones ◽  
...  
Keyword(s):  
Weight Loss ◽  
Feasibility Study ◽  
Clinical Skills ◽  
Fasting Blood Glucose ◽  
Diabetes Remission ◽  
Community Based ◽  
Implementation Phase ◽  
Implementation Effectiveness ◽  
Low Calorie

Abstract Objectives The aims of this feasibility study were to (1) examine the implementation of a community-based health advocate (CHA) training program to develop the clinical skills needed to support a diabetes remission protocol based on a low-calorie diet (LCD) and (2) investigate if participant weight loss can be achieved and diabetes remission induced under these conditions. Methods This tripartite study followed a type-2 implementation-effectiveness design. Three faith-based organizations (FBOs) were purposively selected as study sites. Implementation outcomes were guided by the Consolidated Framework for Implementation Research. During the pre-implementation phase, site ‘readiness’ to facilitate the intervention was determined from a site visit and an interview with the FBOs’ leadership. During the implementation phase, congregants could volunteer for the 10-week CHA training which included practical exercises in weight, glucose and blood pressure (BP) measurement, and a summative practical assessment. Acceptability and implementation effectiveness were assessed via survey. During the intervention phase, other congregants and community members with T2DM or pre-diabetes and overweight were invited to participate in the 12-week LCD. Anti-diabetic medication was discontinued on day-1 of the intervention. Clinical effectiveness was determined from the change in weight, fasting blood glucose (FBG) and BP which were monitored weekly at the FBO by the CHA. HbA1C was performed at week 1 and 12. Results The FBOs were found to be ready as determined by their adequate resources and engagement in health-related matters. Twenty-nine CHAs completed the training; all attained a passing grade at ≥ 1 clinical station, indicating implementation effectiveness. CHA feedback indicated that the program structure was acceptable and provided sufficient access to intervention-related material. Thirty-one persons participated in the LCD (11 T2DM:20 pre-diabetes). Mean (95%CI) weight loss was 6.8kgs (5.4–8.2) p < 0.00001; 7.9kgs in males vs 6.6kgs in females; A1C decreased from 6.6–6.2%, p = 0.003 and FBG from 6.4-6.0mmol/L; p = 0.004. T2DM remission rates were 60% and 90% by A1C < 6.5% and FBG < 7mmol/L respectively. Pre-diabetes remission was 18% and 40% by A1C < 5.7% and FBG < 5.6 respectively. Conclusion Implementation of a community-based diabetes remission protocol is both feasible and clinically effective. Its sustainability is to be determined. Adaptability to other disorders or other settings should be investigated. Trial Registration : NCT03536377 registered 24th May 2018 at https://clinicaltrials.gov/ct2/show/NCT03536377

Supporting the Use of Rudimentary Vocalizations

2014 ◽  
Vol 23 (3) ◽  
pp. 132-139 ◽  
Author(s):  
Lauren Zubow ◽  
Richard Hurtig
Keyword(s):  
Rett Syndrome ◽  
Visual Cues ◽  
Acoustic Analysis ◽  
Eye Gaze ◽  
Research Question ◽  
Primary Research ◽  
Multiple Modalities ◽  
Face To Face ◽  
Perceptual Judgments ◽  
The Face

Children with Rett Syndrome (RS) are reported to use multiple modalities to communicate although their intentionality is often questioned (Bartolotta, Zipp, Simpkins, & Glazewski, 2011; Hetzroni & Rubin, 2006; Sigafoos et al., 2000; Sigafoos, Woodyatt, Tuckeer, Roberts-Pennell, & Pittendreigh, 2000). This paper will present results of a study analyzing the unconventional vocalizations of a child with RS. The primary research question addresses the ability of familiar and unfamiliar listeners to interpret unconventional vocalizations as “yes” or “no” responses. This paper will also address the acoustic analysis and perceptual judgments of these vocalizations. Pre-recorded isolated vocalizations of “yes” and “no” were presented to 5 listeners (mother, father, 1 unfamiliar, and 2 familiar clinicians) and the listeners were asked to rate the vocalizations as either “yes” or “no.” The ratings were compared to the original identification made by the child's mother during the face-to-face interaction from which the samples were drawn. Findings of this study suggest, in this case, the child's vocalizations were intentional and could be interpreted by familiar and unfamiliar listeners as either “yes” or “no” without contextual or visual cues. The results suggest that communication partners should be trained to attend to eye-gaze and vocalizations to ensure the child's intended choice is accurately understood.

Antecedent Factors to Recommendation Intention on the Face-to-Face Job Consulting

2013 ◽  
Vol 14 (3) ◽  
pp. 115-133
Author(s):  
조현 ◽  
Jaeshin Park ◽  
ki-jin jang
Keyword(s):  
Face To Face ◽  
The Face ◽  
Recommendation Intention

Student Perceptions of Face-to-Face and Online Discussions: The Advantage Goes To . . .

2008 ◽  
Vol 11 (4) ◽  
Author(s):  
Katrina A. Meyer
Keyword(s):  
Higher Education ◽  
Affirmative Action ◽  
Student Perceptions ◽  
Online Discussions ◽  
Political Tolerance ◽  
Self Assessment ◽  
Face To Face ◽  
The Face ◽  
Online Setting ◽  
And Gender

Thirteen students in a graduate-level course on Historical and Policy Perspectives in Higher Education held face-to-face and online discussions on five controversial topics: Diversity, Academic Freedom, Political Tolerance, Affirmative Action, and Gender. Students read materials on each topic and generated questions for discussion that were categorized by Bloom’s taxonomy so that the level of questions in the two discussion settings would be closely parallel. Upon completion of each discussion, they answered questions that addressed depth and length of the discussion, ability to remember, and a self-assessment of how the student learned. Students’ assessments show a consistent preference for the face-to-face discussion but a small number of students preferred the online setting. However, what is perhaps more interesting is a minority of approximately one-third of the students who perceived no difference between the settings, or that the two settings were perhaps complementary.

The Hierophanic Facets of the Seraphic Hymns

Trictrac ◽  
2018 ◽  
Vol 10 ◽  
Author(s):  
Petru Adrian Danciu
Keyword(s):  
Mutual Recognition ◽  
The Other ◽  
Human Being ◽  
Material World ◽  
Face To Face ◽  
The People ◽  
Musical History ◽  
The Face ◽  
The One

Starting from the cry of the seraphim in Isaiahʹ s prophecy, this article aims to follow the rhythm of the sacred harmony, transcending the symbols of the angelic world and of the divine names, to get to the face to face meeting between man and God, just as the seraphim, reflecting their existence, stand face to face. The finality of the sacred harmony is that, during the search for God inside the human being, He reveals Himself, which is the reason for the affirmation of “I Am that I Am.” Through its hypnotic cyclicality, the profane temporality has its own musicality. Its purpose is to incubate the unsuspected potencies of the beings “caught” in the material world. Due to the fact that it belongs to the aeonic time, the divine music will exceed in harmony the mechanical musicality of profane time, dilating and temporarily cancelling it. Isaiah is witness to such revelation offering access to the heavenly concert. He is witness to divine harmonies produced by two divine singers, whose musical history is presented in our article. The seraphim accompanied the chosen people after their exodus from Egypt. The cultic use of the trumpet is related to the characteristics and behaviour of the seraphim. The seraphic music does not belong to the Creator, but its lyrics speak about the presence of the Creator in two realities, a spiritual and a material one. Only the transcendence of the divine names that are sung/cried affirms a unique reality: God. The chant-cry is a divine invocation with a double aim. On the one hand, the angels and the people affirm God’s presence and call His name and, on the other, the Creator affirms His presence through the angels or in man, the one who is His image and His likeness. The divine music does not only create, it is also a means of communion, implementing the relation of man to God and, thus, God’s connection with man. It is a relation in which both filiation and paternity disappear inside the harmony of the mutual recognition produced by music, a reality much older than Adam’s language.

Agents of Practice at the Public Library’s Reference Desk

2013 ◽  
Author(s):  
Mary Cavanagh
Keyword(s):  
Public Libraries ◽  
Face To Face ◽  
Professional Boundaries ◽  
The Public ◽  
Reference Librarians ◽  
Practice Perspective ◽  
The Face ◽  
Reference Et

The face to face interactions of reference librarians and reference assistants are studied from a theoretical practice perspective. Rather than reinforcing professional boundaries, the results of this analysis support reference practice in public libraries as a highly relational activity where reference “expertise” retains a significant subjectivist, relational dimension.Les interventions en personne des bibliothèques de référence et des adjoints à la référence sont étudiées du point de vue de la pratique théorique. Plutôt que de renforcer les frontières interprofessionnelles, les résultats de cette analyse appuient l'idée que les pratiques de référence en milieu public sont des activités hautement relationnelles où l'expertise de la référence conserve une dimension subjectiviste et relationnelle. 

scholarly journals The face of postural tachycardia syndrome – insights from a large cross‐sectional online community‐based survey

2019 ◽  
Vol 286 (4) ◽  
pp. 438-448 ◽  
Author(s):  
B. H. Shaw ◽  
L. E. Stiles ◽  
K. Bourne ◽  
E. A. Green ◽  
C. A. Shibao ◽  
...  
Keyword(s):  
Online Community ◽  
Postural Tachycardia Syndrome ◽  
Community Based ◽  
Cross Sectional ◽  
Postural Tachycardia ◽  
The Face

Marginal assessment of the cost and benefits of aphasia treatment: Evidence from community-based telerehabilitation treatment for aphasia

2021 ◽  
pp. 1357633X2098277
Author(s):  
Molly Jacobs ◽  
Patrick M Briley ◽  
Heather Harris Wright ◽  
Charles Ellis
Keyword(s):  
Cost Effectiveness ◽  
Economies Of Scale ◽  
Reference Group ◽  
Unit Cost ◽  
Community Based ◽  
Face To Face ◽  
Conduction Aphasia ◽  
Aphasia Treatment ◽  
The Cost ◽  
The Relationship

Introduction Few studies have reported information related to the cost-effectiveness of traditional face-to-face treatments for aphasia. The emergence and demand for telepractice approaches to aphasia treatment has resulted in an urgent need to understand the costs and cost-benefits of this approach. Methods Eighteen stroke survivors with aphasia completed community-based aphasia telerehabilitation treatment, utilizing the Language-Oriented Treatment (LOT) delivered via Webex videoconferencing program. Marginal benefits to treatment were calculated as the change in Western Aphasia Battery-Revised (WAB-R) score pre- and post-treatment and marginal cost of treatment was calculated as the relationship between change in WAB-R aphasia quotient (AQ) and the average cost per treatment. Controlling for demographic variables, Bayesian estimation evaluated the primary contributors to WAB-R change and assessed cost-effectiveness of treatment by aphasia type. Results Thirteen out of 18 participants experienced significant improvement in WAB-R AQ following telerehabilitation delivered therapy. Compared to anomic aphasia (reference group), those with conduction aphasia had relatively similar levels of improvement whereas those with Broca’s aphasia had smaller improvement. Those with global aphasia had the largest improvement. Each one-point of improvement cost between US$89 and US$864 for those who improved (mean = US$200) depending on aphasia type/severity. Discussion Individuals with severe aphasia may have the greatest gains per unit cost from treatment. Both improvement magnitude and the cost per unit of improvement were driven by aphasia type, severity and race. Economies of scale to aphasia treatment–cost may be minimized by treating a variety of types of aphasia at various levels of severity.

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