Effects of Guided Reflection on Diabetes Self-Care: A Randomized Controlled Trial.

The purpose of this study was to evaluate the effects of guided reflection on self-care behaviors, confidence scores, and diabetes knowledge among adults with diabetes. A randomized controlled trial with a pre/posttest design was used to generate data from a convenience sample of 62 adults with diabetes recruited from a single site. After viewing a 30-minute video on how to manage diabetes, participants were randomized to a control group (CG) (usual care) or an intervention group (IG). The IG further engaged in a reflection educational session. For 8 weeks, the IG isolated diabetes-related events weekly, critically analyzed them using Gibbs's reflective questions, and recorded their analysis in a journal. They also shared their perspective relative to using the journal in an audiotaped interview. Main measures included baseline and 8-week clinical outcomes (self-care maintenance, monitoring, management, and confidence scores and diabetes knowledge scores) and intervention acceptability. Compared to the CG, the IG had no statistically significant difference in self-care measures over time, although scores trended in the anticipated direction. Importantly, both groups had statistically significant improvement in self-care scores. Furthermore, there was statistically significant improvement in diabetes knowledge among IG participants. Informatively, IG critically analyzed 147 diabetes-related events concentrating on blood glucose, diet, exercise, monitoring, medication, sleep pattern, and health care visits. Participants found the guided reflection activity highly acceptable. Combined educational and reflection interventions are effective approaches for improving self-care outcomes and diabetes knowledge among adults with diabetes. Research concentrating on purposeful patient reflection is warranted in a larger sample paying careful attention to study limitations.

A Middle-Range Theory for Diabetes Self-management Mastery.

Diabetes mellitus is the seventh leading cause of death in America and affects 382 million people worldwide. Individuals with diabetes must manage the complexity of the disease, its treatment, and complications to avert deleterious consequences associated with the illness. However, not all patients with diabetes successfully gain mastery to positively impact self-management. A new middle-range theory is proposed that merges 2 extant theories, theory of mastery and organismic integration theory, to better understand this human response. The theories' philosophical, theoretical, and conceptual perspectives were examined and relational properties synthesized to provide a conceptual representation of the phenomenon of interest.

Effect on performance of learning a pilates skill with or without a mirror.

Mirrors are often used in an instructional environment where precise movements must be learned (e.g., martial arts, Pilates, dance). The potential for mirrors in the learning environment of a Pilates class, to affect the subsequent performance of a Pilates star movement when mirrors are not present, was examined. Twenty subjects learned the Pilates star movement over seven weeks, either with (n=11) or without (n=9), mirrors present in the Pilates studio. Performance of the star without mirrors present was assessed quantitatively before and after the training, by video analysis of the degree of lateral straightness of the subject's body at the start, middle, and end of the star movement. Performance of the star movement without a mirror present improved similarly for both the group that learned with, and the group that learned without, mirrors present (p<0.05). These results indicate that the inclusion of mirrors in a learning environment, to provide immediate visual feedback during learning, does not necessarily enhance the subsequent performance of a skill when mirrors are not present.

Observations on the detection of b- and y-type ions in the collisionally activated decomposition spectra of protonated peptides.

Tandem mass spectrometric data from peptides are routinely used in an unsupervised manner to infer product ion sequence and hence the identity of their parent protein. However, significant variability in relative signal intensity of product ions within peptide tandem mass spectra is commonly observed. Furthermore, instrument-specific patterns of fragmentation are observed, even where a common mechanism of ion heating is responsible for generation of the product ions. This information is currently not fully exploited within database searching strategies; this motivated the present study to examine a large dataset of tandem mass spectra derived from multiple instrumental platforms. Here, we report marked global differences in the product ion spectra of protonated tryptic peptides generated from two of the most common proteomic platforms, namely tandem quadrupole-time-of-flight and quadrupole ion trap instruments. Specifically, quadrupole-time-of-flight tandem mass spectra show a significant under-representation of N-terminal b-type fragments in comparison to quadrupole ion trap product ion spectra. Energy-resolved mass spectrometry experiments conducted upon test tryptic peptides clarify this disparity; b-type ions are significantly less stable than their y-type N-terminal counterparts, which contain strongly basic residues. Secondary fragmentation processes which occur within the tandem quadrupole-time-of-flight device account for the observed differences, whereas this secondary product ion generation does not occur to a significant extent from resonant excitation performed within the quadrupole ion trap. We suggest that incorporation of this stability information in database searching strategies has the potential to significantly improve the veracity of peptide ion identifications as made by conventional database searching strategies.

In vivo static creep loading of the rat forelimb reduces ulnar structural properties at time-zero and induces damage-dependent woven bone formation.

Periosteal woven bone forms in response to stress fractures and pathological overload. The mechanical factors that regulate woven bone formation are poorly understood. Fatigue loading of the rat ulna triggers a woven bone response in proportion to the level of applied fatigue displacement. However, because fatigue produces damage by application of cyclic loading it is unclear if the osteogenic response is due to bone damage (injury response) or dynamic strain (adaptive response). Creep loading, in contrast to fatigue, involves application of a static force. Our objectives were to use static creep loading of the rat forelimb to produce discrete levels of ulnar damage, and subsequently to determine the bone response over time. We hypothesized that 1) increases in applied displacement during loading correspond to ulnae with increased crack number, length and extent, as well as decreased mechanical properties; and 2) in vivo creep loading stimulates a damage-dependent dose-response in periosteal woven bone formation. Creep loading of the rat forelimb to progressive levels of sub-fracture displacement led to progressive bone damage (cracks) and loss of whole-bone mechanical properties (especially stiffness) at time-zero. For example, loading to 60% of fracture displacement caused a 60% loss of ulnar stiffness and a 25% loss of strength. Survival experiments showed that woven bone formed in a dose-dependent manner, with greater amounts of woven bone in ulnae that were loaded to higher displacements. Furthermore, after 14 days the mechanical properties of the loaded limb were equal or superior to control, indicating functional repair of the initial damage. We conclude that bone damage created without dynamic strain triggers a woven bone response, and thus infer that the woven bone response reported after fatigue loading and in stress fractures is in large part a response to bone damage.

Damaging fatigue loading stimulates increases in periosteal vascularity at sites of bone formation in the rat ulna.

Bone formation in a variety of contexts depends on angiogenesis; however, there are few reports of the vascular response to osteogenic skeletal loading. We used the rat forelimb compression model to characterize vascular changes after fatigue loading. The right forelimbs of 72 adult rats were loaded cyclically in vivo to one of four displacement levels, to produce four discrete levels of ulnar damage. Rats were killed 3-14 days after loading, and their vasculature was perfused with silicone rubber. Transverse histological sections were cut along the ulnar diaphysis. We quantified vessel number, average vessel area, total vessel area, and bone area. On day 3, we observed a dramatic periosteal expansion near the ulnar midshaft, with significant increases in periosteal vascularity; total vessel area was increased 250-450% (P < 0.001). Vascularity remained elevated on days 7 and 14. Vessel number and average vessel area were not correlated (P = 0.09) and contributed independently to total vascular increases. Bone area was not increased on day 3 but on days 7 and 14 was increased significantly in all displacement groups (P < 0.01) due to periosteal woven bone formation. Vascular and bone changes depended on longitudinal location (P < 0.001), with peak increases 2 mm distal to the midshaft. Vascular and bone changes also depended on displacement level (P < 0.005), with greater increases at higher levels of fatigue displacement. We conclude that skeletal fatigue loading induces a rapid increase in periosteal vascularity, followed by an increase in bone area. The angiogenic-osteogenic response is spatially coordinated and scaled to the level of the mechanical stimulus.

PepSeeker: a database of proteome peptide identifications for investigating fragmentation patterns.

Proteome science relies on bioinformatics tools to characterize proteins via their proteolytic peptides which are identified via characteristic mass spectra generated after their ions undergo fragmentation in the gas phase within the mass spectrometer. The resulting secondary ion mass spectra are compared with protein sequence databases in order to identify the amino acid sequence. Although these search tools (e.g. SEQUEST, Mascot, X!Tandem, Phenyx) are frequently successful, much is still not understood about the amino acid sequence patterns which promote/protect particular fragmentation pathways, and hence lead to the presence/absence of particular ions from different ion series. In order to advance this area, we have developed a database, PepSeeker (http://nwsr.smith.man.ac.uk/pepseeker), which captures this peptide identification and ion information from proteome experiments. The database currently contains >185,000 peptides and associated database search information. Users may query this resource to retrieve peptide, protein and spectral information based on protein or peptide information, including the amino acid sequence itself represented by regular expressions coupled with ion series information. We believe this database will be useful to proteome researchers wishing to understand gas phase peptide ion chemistry in order to improve peptide identification strategies. Questions can be addressed to j.selley@manchester.ac.uk.