Book Review: L2 Selves and Motivations in Asian Contexts (Matthew T. Apple, Dexter Da Silva, and Terry Fellner, Eds., 2016)

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Motivational Dynamics in Language Learning: Zoltán Dörnyei, Peter D. MacIntyre, and Alastair Henry (Eds.). Bristol: Multilingual Matters, 2015. 456 pp. ISBN: 978-1-78309-256-7

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Using economic evidence to set healthcare priorities in low-income and lower-middle-income countries: a systematic review of methodological frameworks

Policy makers in low-income and lower-middle-income countries (LMICs) are increasingly looking to develop 'evidence-based' frameworks for identifying priority health interventions. This paper synthesises and appraises the literature on methodological frameworks - which incorporate economic evaluation evidence - for the purpose of setting healthcare priorities in LMICs. A systematic search of Embase, MEDLINE, Econlit and PubMed identified 3968 articles with a further 21 articles identified through manual searching. A total of 36 papers were eligible for inclusion. These covered a wide range of health interventions with only two studies including health systems strengthening interventions related to financing, governance and human resources. A little under half of the studies (39%) included multiple criteria for priority setting, most commonly equity, feasibility and disease severity. Most studies (91%) specified a measure of 'efficiency' defined as cost per disability-adjusted life year averted. Ranking of health interventions using multi-criteria decision analysis and generalised cost-effectiveness were the most common frameworks for identifying priority health interventions. Approximately a third of studies discussed the affordability of priority interventions. Only one study identified priority areas for the release or redeployment of resources. The paper concludes by highlighting the need for local capacity to conduct evaluations (including economic analysis) and empowerment of local decision-makers to act on this evidence

Glycemic Control Patterns and Kidney Disease Progression among Primary Care Patients with Diabetes Mellitus

Background: Reducing glycosylated hemoglobin (HbA1c) to near or less than 7% in patients with diabetes is associated with diminished microvascular complications, but this level is not consistently achieved. The purpose of this study was to examine the relationship between fluctuations in HbA1c and changes in estimated glomerular filtration rate (eGFR) and estimated stage of chronic kidney disease (CKD) in an academic primary care practice. Methods: We analyzed data from 791 diabetic primary care patients (25% white; 75% African American) enrolled between 1998 to 2002 and followed through 2008 (mean follow-up, 7.6 1.9 years). We calculated baseline and final follow-up eGFR using the Modification of Diet in Renal Disease equation. We examined the relationship between fluctuations in HbA1c and changes in eGFR and stage of CKD using multivariable linear and logistic regression models that controlled for demographic and clinical variables associated with CKD progression. Results: From baseline to follow-up, mean eGFR in African Americans declined to a greater extent and more rapidly than in whites. Age, mean systolic blood pressure, initial HbA1c, initial eGFR, and number of HbA1c values (all P 7% (P < .02); however, this contributed little to explaining model variance. Conclusion: These data suggest that traditional demographic and clinical risk factors remain significantly associated with changes in eGFR and that the pattern of variability in HbA1c is only modestly important in contributing to changes in eGFR among African-American and white diabetic patients in primary care

Development and Validation of a Tool for Assessing Glucose Impairment in Adolescents

INTRODUCTION: Childhood obesity is associated with an increased risk for type 2 diabetes. Early identification of adolescents at risk for impaired fasting blood glucose may lead to earlier and more comprehensive evaluation and intervention. Because widespread blood glucose testing of adolescents is not recommended, community-based tools are needed to identify those who could benefit from further testing. One such tool, developed for adults, was the Tool for Assessing Glucose ImpairmenT (TAG-IT). Our objective was to validate whether a similar tool could be useful for community-based screening of glucose impairment risk among adolescents. METHODS: Our study sample consisted of 3,050 adolescents aged 12 to18 years who had participated in the 1999-2008 National Health and Nutrition Examination Survey (NHANES). Half of participants were female and 40% were nonwhite. NHANES measured fasting blood glucose and height, weight, and resting heart rate. We used Pearson correlations and regression analysis to determine key variables for predicting glucose impairment. From these measurements, we created a composite TAG-IT score for adolescents called TAG-IT-A. We then applied the TAG-IT-A model to 1988-1994 NHANES data, using linear regression analysis and receiver operating characteristic analysis to determine how well the TAG-IT-A score predicted a fasting blood glucose at or above 100 mg/dL. RESULTS: We determined that age, sex, body mass index, and resting heart rate were predictors of impaired fasting blood glucose and that TAG-IT-A was a better predictor of impaired fasting blood glucose than body mass index alone (area under the curve, 0.61, P < .001 vs 0.55, P = .10, respectively). A TAG-IT-A score of 3 or higher correctly identified 50% of adolescents with impaired fasting blood glucose, while a score of 5 or higher correctly identified 76% . CONCLUSION: The TAG-IT-A score is a simple screening tool that clinicians and public health professionals could use to easily identify adolescents who may have impaired fasting blood glucose and need a more comprehensive evaluation

Generic Medications and Blood Pressure Control in Diabetic Hypertensive Subjects

OBJECTIVE To investigate temporal improvements in blood pressure (BP) control in subjects with diabetes and policy changes regarding generic antihypertensives. RESEARCH DESIGN AND METHODS In a cross-sectional study we used logistic regression models to investigate the temporal relationship between access to generic antihypertensive medications and BP control (<130/80 mmHg) in 5,375 subjects (mean age, 66 ± 9 years; 61% African American) with diabetes and hypertension (HTN) enrolled in the national Results from the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort study between 2003 and 2007. At enrollment, BP was measured and medications in the home determined by medication label review by a trained professional. Generic antihypertensive medication status was ascertained from the U.S. Food and Drug Administration. RESULTS The percentage of subjects accessing generically available antihypertensive medications increased significantly from 66% in 2003 to 81% in 2007 (P < 0.0001), and the odds of achieving a BP <130/80 mmHg in 2007 was 66% higher (odds ratio 1.66 [95% CI 1.30–2.10]) than in 2003. Nevertheless, <50% of participants achieved this goal. African American race, male sex, limited income, and medication nonadherence were significant predictors of inadequate BP control. There was no significant relationship between access to generic antihypertensives and BP control when other demographic factors were included in the model (0.98 [0.96–1.00]). CONCLUSIONS Among African American and white subjects with HTN and diabetes, BP control remained inadequate relative to published guidelines, and racial disparities persisted. Although access to generic antihypertensives increased, this was not independently associated with improved BP control, suggesting that poor BP control is multifactorial

Assessing framing of uncertainties in water management practice

Dealing with uncertainties in water management is an important issue and is one which will only increase in light of global changes, particularly climate change. So far, uncertainties in water management have mostly been assessed from a scientific point of view, and in quantitative terms. In this paper, we focus on the perspectives from water management practice, adopting a qualitative approach. We consider it important to know how uncertainties are framed in water management practice in order to develop practice relevant strategies for dealing with uncertainties. Framing refers to how people make sense of the world. With the aim of identifying what are important parameters for the framing of uncertainties in water management practice, in this paper we analyze uncertainty situations described by decision-makers in water management. The analysis builds on a series of ¿Uncertainty Dialogues¿ carried out within the NeWater project with water managers in the Rhine, Elbe and Guadiana basins in 2006. During these dialogues, representatives of these river basins were asked what uncertainties they encountered in their professional work life and how they confronted them. Analysing these dialogues we identified several important parameters of how uncertainties get framed. Our assumption is that making framing of uncertainty explicit for water managers will allow for better dealing with the respective uncertainty situations. Keywords Framing - Uncertainty - Water management practic

Generational differences in practice site selection criteria amongst primary care physicians.

Background and Objectives: Generational differences are often viewed as shaping the overall attitudes and actions of different age cohorts. It is essential to understand the motivations and generational differences in primary care physicians for efforts to recruit, retain, and educate the future physician workforce. Determining what factors most influence different generations of primary care physicians when choosing a practice site is essential to build our future primary care system. This study examined generational differences in the factors that attracted primary care physicians to their current practice. Methods: A survey instrument was mailed to all active members of the North Carolina Medical Board who listed their primary occupation as a primary care specialty. The survey consisted of 24 demographic questions regarding personal and practice variables and a list of 21 reasons for choosing a practice location measured on a 7-point Likert type scale. A total of 975 surveys were returned and usable for the final analysis, for a return rate of 34.5%. Data were analyzed using regression and correlation procedures to determine attitudes of each generation and factors that significantly influenced responses. Results: While slight differences between generations did exist, the overall choices for choosing a site remained stable across generations. Personality of the practice, on-call responsibilities, ability to practice comprehensive care, and location were deemed the most important factors for all generations. Differences between various demographic groups and Family Medicine versus other primary care specialties were minor with very little alteration of the top ten items being seen between groups. Conclusion: This study indicated that there were few differences between generations regarding primary reasons for choosing a practice site. In addition, factors remained remarkably similar across different specialties, family situations, genders, and ethnic groups. Several of the top reasons that primary care physicians indicate are the most important for site selection were also potentially modifiable, such as on-call responsibilities, practice personality, and ability to practice comprehensive care. Managers, clinicians, and educators can potentially utilize this information to better prepare and recruit current and future generations of primary care physicians.ECU Open Access Publishing Fun

Interactions between the Nse3 and Nse4 Components of the SMC5-6 Complex Identify Evolutionarily Conserved Interactions between MAGE and EID Families

The SMC5-6 protein complex is involved in the cellular response to DNA damage. It is composed of 6-8 polypeptides, of which Nse1, Nse3 and Nse4 form a tight sub-complex. MAGEG1, the mammalian ortholog of Nse3, is the founding member of the MAGE (melanoma-associated antigen) protein family and Nse4 is related to the EID (E1A-like inhibitor of differentiation) family of transcriptional repressors.Using site-directed mutagenesis, protein-protein interaction analyses and molecular modelling, we have identified a conserved hydrophobic surface on the C-terminal domain of Nse3 that interacts with Nse4 and identified residues in its N-terminal domain that are essential for interaction with Nse1. We show that these interactions are conserved in the human orthologs. Furthermore, interaction of MAGEG1, the mammalian ortholog of Nse3, with NSE4b, one of the mammalian orthologs of Nse4, results in transcriptional co-activation of the nuclear receptor, steroidogenic factor 1 (SF1). In an examination of the evolutionary conservation of the Nse3-Nse4 interactions, we find that several MAGE proteins can interact with at least one of the NSE4/EID proteins.We have found that, despite the evolutionary diversification of the MAGE family, the characteristic hydrophobic surface shared by all MAGE proteins from yeast to humans mediates its binding to NSE4/EID proteins. Our work provides new insights into the interactions, evolution and functions of the enigmatic MAGE proteins