Clinical and economic impact of implementing a comprehensive diabetes management program in managed care

Diabetes mellitus places a significant burden on the U.S. healthcare system. Because of the potential to reduce diabetic complications and costs through intensive management, diabetes has become a primary target for disease management programs. We performed a retrospective analysis of short-term baseline and follow-up clinical, economic, and member and provider satisfaction data from approximately 7,000 people with diabetes being treated through seven managed care plans using Diabetes Treatment Centers of America's Diabetes NetCare, (Nashville, TN), a comprehensive diabetes management program. Our analysis indicates that Diabetes NetCare achieved gross economic adjusted savings of $50 per diabetic member per month (12.3%), with gross unadjusted savings of $44 (10.9%) per diabetic member per month. Hospital admissions per 1,000 diabetic member years decreased by 18%, and bed days fell by 21%. Patients with diabetes were more likely to get HbAlc tests, foot exams, eye exams, and cholesterol screenings while enrolled in the program. These data suggest that implementation of a comprehensive healthcare management program for people with diabetes can lead to substantial improvements in costs and clinical outcomes in the short-term. It is expected that improvements will increase over time, with continuing improvements in health status and a reduction in the number of future diabetic complications.     

Motivated attention and prepulse inhibition of startle in rats: Using conditioned reinforcers as prepulses.

In humans, prepulse inhibition (PPI) of startle is greater during attended prestimuli than it is during ignored prestimuli, whereas in rats, most work has focused on passive PPI, which does not require attention. In the work described in this article, researchers developed a paradigm to assess attentional modification of PPI in rats using motivationally salient prepulses. Water-deprived rats were either conditioned to attend to a conditioned stimulus (CS; 1-s, 7-dB increase in white noise) paired with water (CS+ group), or they received uncorrelated presentations of white noise and water (CSo group). After 10 conditioning sessions, startle probes (50 ms, 115 dB) were introduced, with the CS serving as a continuous prepulse. Three experiments examined PPI across a range of prepulse intensities (4-10 dB) and stimulus onset asynchronies (SOAs; 30-960 ms). PPI was consistently reduced in the CS+ group, particularly with a 10-dB prepulse and a 60-ms SOA. Thus, PPI in rats differed between attended and ignored prestimuli, but the effect was reversed in the results of research with humans. A fourth study eliminated the group difference by reversing the CS-water contingency. Methodological and motivational hypotheses regarding the current findings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of postchill application of acidified sodium chlorite to control Campylobacter spp. and Escherichia coli on commercial broiler carcasses

Experiments were performed to assess the reduction of Campylobacter spp. and Escherichia coli in commercial broiler carcasses by postchill dip applications of acidified sodium chlorite. Carcass rinses were collected before the inside-outside-bird washer (IOBW), post-IOBW, postchill, and after the postchill application of acidified sodium chlorite. Prevalence and counts of Campylobacter spp. and E. coli were determined. The mean values for Campylobacter spp. and E. coli counts differed significantly at sampling sites. The IOBW reduced the bacterial counts significantly in only one experiment. The chiller reduced Campylobacter counts significantly in both experiments but failed to significantly reduce the counts of E. coli in one experiment. No major reduction in the prevalence after enrichment for Campylobacter spp. was detected post-IOBW or postchill. However, a significant reduction in Campylobacter spp. and in E. coli counts and Campylobacter spp. prevalence was seen after the postchill application of acidified sodium chlorite. These results demonstrate that the antimicrobial effect of acidified sodium chlorite applied postchill may be used to significantly reduce Campylobacter spp. and E. coli in commercial broiler carcasses. Postchill systems may eventually be used in different applications, such as mist, spray, or bath, which could be applied closer to the final stages in processing.     

Do small lapses predict relapse to smoking behavior under bupropion treatment?

Although bupropion is known to be an effective aid to smoking cessation, little is known about its mode of action. In the present study we tested the hypothesis that bupropion reduces the likelihood that a smoking lapse, or slip, leads to a subsequent relapse. This hypothesis was tested in the context of a clinical trial of bupropion as a smoking cessation aid, using Cox regression and representing lapse history as a discrete time-varying covariate. Bupropion treatment reduced the probability of relapse during the treatment phase (hazard ratio, or HR=.421, p< or =.000) but not during the follow-up phase (end of treatment to 6 months, HR=.896, p< or=.67). As anticipated, having small lapses during treatment contributed to or predicted subsequent relapse, both during treatment (HR=2.897, p< or =.000) and during follow-up (HR=2.320, p< or=.008). Although an interaction was found between drug treatment and lapse history in predicting subsequent failure during the treatment phase, the finding suggested that drug slightly increased the effect of lapse on eventual failure during treatment (HR=1.706, p相似文献   

Convergent and divergent responses to emotional displays of ingroup and outgroup.

In the present research, we test the assumption that emotional mimicry and contagion are moderated by group membership. We report two studies using facial electromyography (EMG; Study 1), Facial Action Coding System (FACS; Study 2), and self-reported emotions (Study 2) as dependent measures. As predicted, both studies show that ingroup anger and fear displays were mimicked to a greater extent than outgroup displays of these emotions. The self-report data in Study 2 further showed specific divergent reactions to outgroup anger and fear displays. Outgroup anger evoked fear, and outgroup fear evoked aversion. Interestingly, mimicry increased liking for ingroup models but not for outgroup models. The findings are discussed in terms of the social functions of emotions in group contexts. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Microstructural and failure characteristics of metal-lntermetallic layered sheet composites

A processing technique for the fabrication of layered metal-intermetallic composites is presented, in which a self-propagating, high-temperature synthesis reaction (SHS) was initiated at the interface between dissimilar elemental metal foils. The resultant composite microstructure consisted of a fully dense, well-bonded metal-intermetallic layered composite. In this United States Bureau of Mines study, metal (Fe, Ni, or Ti) foils were reacted with Al foils to produce metal-metal aluminide layered composites. Tensile tests conducted at room temperature revealed that composites could be designed to behave in a high-strength and high-toughness manner by altering the thicknesses of the starting elemental foils. Failure characteristics revealed that the processes that govern ductilevs brittle behavior of the composites occur early in the fracture.     

Residential electricity consumption in industrialized countries: Changes since 1973

We consider the evolution of residential electricity use since the early 1970s in 11 OECD countries. Average growth in demand has been higher in Europe and Japan than in the U.S. This result is mainly attributable to the difference in saturation of appliances and electricity heating, which was higher in the U.S. than elsewhere at the beginning of the period. Growth in appliance ownership was responsible for high growth rates from 1960 through around 1973, when electric heating began to become popular in many countries. By the early 1980s, more efficient appliances and tighter new homes dampened growth in demand in most countries. Average growth in electricity demand per household between 1978 and 1983 was generally less than 2% per yr, and was negative in some countries.     

Testosterone increases and estradiol decreases middle cerebral artery occlusion lesion size in male rats

This study was undertaken to determine the effects of estrogen and testosterone on cerebral ischemic lesion size induced by middle cerebral artery (MCA) occlusion in male rats. Rats were gonadectomized and treated with testosterone, estrogen, or testosterone plus estrogen filled Silastic pellets. The animals were divided into 6 groups: intact, intact + estrogen (E2), castrate, castrate + testosterone (T), castrate + E2, and castrate + T + E2. One week after treatment, cerebral ischemia was induced by MCA occlusion for 40 min, followed by reperfusion. After 24 h, rats were sacrificed and slices were then stained to assess lesion size. The presence of testosterone increased and the removal of testosterone decreased lesion size. A strong positive correlation (r2 = 0.922) between plasma testosterone concentrations and ischemic lesion size was observed. Estradiol treatment reduced ischemic area. In summary, the present study provides evidence that testosterone exacerbates and estrogens ameliorate ischemic brain damage in an animal model of cerebral ischemia.