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IN BRIEF After assessing patient perspectives on the success of current diabetes therapies and the factors that have the greatest impact on daily life, we show that time-in-range is a crucial outcome for people with diabetes and that current therapies are falling short on this metric. We also show that patients feel significant stress and worry, and they believe they are falling short in diet, exercise, and weight maintenance. In addition, they believe diet and exercise and in-range blood glucose are the biggest drivers of improved diabetes management and mindset. Together, these findings support the need for therapies that improve outcomes including and beyond A1C.
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With the migration of sex workers to online advertising in Canada, a substantial body of research has emerged on how they communicate with prospective clients. However, given the enormous quantity of archival material available, finding representative ways to identify what sex workers say is a difficult task. Numerical analysis of commonly used phrases allows for the analysis of large numbers of documents potentially identifying themes that may be missed using other techniques. This study considers how Canadian sex workers communicate by examining how the word "no" was used by online advertisers over a 15-year period. Source materials consisted of three collections of online classified advertising containing over 4.2 million ads collected between 2007 and 2022 representing 214456 advertisers. Advertisers and demographic variables were extracted from ad metadata. Common terms surrounding the word "no" were used to identify themes. The word "no" was used by 115127 advertisers. Five major themes were identified: client reassurance (54084 advertisers), communication (47130 advertisers), client race (32612 advertisers), client behavior (23863 advertisers), and service restrictions (8545 advertisers). The probability of there being an association between an advertiser and a major theme was found to vary in response to several variables, including: time period, region, advertiser gender, and advertiser ethnicity. Results are compared with previous work on race and risk messaging in sex work advertising and factors influencing client race restrictions are considered. Over time, the restriction related themes of client behavior, service restrictions, and client race became more prominent. Collectives, multi-regional, cis-female, and Black or Mixed ancestry advertisers were more likely to use restrictions.
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Comunicación , Trabajo Sexual , Humanos , Femenino , Estudios Prospectivos , Canadá , PublicidadRESUMEN
How long indoor sex workers stay employed in collectives is a poorly understood aspect of sex worker agency in industrialized democracies. This study provides estimates of turnover, the rate at which workers leave employment, using a subsample of 76 collectives representing 3545 workers over a one-year period. All the collectives provided data on individual workers via external websites. The collectives were identified in a larger random sample of 783 advertisers from a popular Canadian classifieds site used by sex workers, all of whom provided URLs as part of their ad contact information. Monthly between October 2022 and October 2023, individual workers associated with the subsample of advertisers were identified from web pages maintained by these advertisers and scheduling data was collected where available. Worker turnover was estimated based on whether workers were visible one month to the next. Over the year, estimated turnover ranged from 12.0% to 16.0% (mean 14.2% SD 1.1%). Turnover was not affected by month or number of workers in the collectives. Mean 41.1% workers (SD 23.5%, N = 51 advertisers) were scheduled on any given day. Workers were visible for a mean 5.5 months (SD 4.5) with those visible for one month being the largest single group. Most sex workers in collectives are likely not permanent full time employees, and the extremely brief work histories of many suggest that failure in the industry may be common for this subpopulation.
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Trabajadores Sexuales , Humanos , Canadá , Industrias , EmpleoRESUMEN
[This corrects the article DOI: 10.1371/journal.pone.0301600.].
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Research indicates that having electronic resources readily available increases learners' ability to make clinical decisions and confidence in patient care. This mixed-method, descriptive pilot study collected data about senior prelicensure nursing students using smartphones, a type of mobile electronic device (MED), in the clinical area. The smartphones contained nursing diagnosis, pharmacology, and laboratory information; an encyclopedia; and the MEDLINE database. Student (n = 7) data about smartphone use during a 10-week clinical rotation were collected via student-recorded usage logs and focus group recordings. Staff nurses' (n = 5) perceptions of students' use of smartphones for clinical educational resources were collected by anonymous survey. Both the focus group transcript and staff surveys were evaluated and the themes summarized by content analysis. Positive results and barriers to use, such as cost and technological comfort levels, are discussed. The results may help nurse educators and administrators initiate further research of MEDs as a clinical resource.
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Teléfono Celular , Bachillerato en Enfermería/métodos , Informática Aplicada a la Enfermería/métodos , Personal de Enfermería/psicología , Estudiantes de Enfermería/psicología , Adulto , Actitud hacia los Computadores , Computadoras de Mano , Recolección de Datos , Femenino , Grupos Focales , Humanos , Masculino , Investigación en Evaluación de Enfermería , Proyectos PilotoRESUMEN
BACKGROUND: Most sex worker population studies measure population at discrete points in time and very few studies have been done in industrialized democracies. The purpose of this study is to consider how time affects the population dynamics of contact sex workers in Canada using publicly available internet advertising data collected over multiple years. METHODS: 3.6 million web pages were collected from advertising sites used by contact sex workers between November, 2014 and December, 2016 inclusive. Contacts were extracted from ads and used to identify advertisers. First names were used to estimate the number of workers represented by an advertiser. Counts of advertisers and names were adjusted for missing data and overcounting. Two approaches for correcting overcounts are compared. Population estimates were generated weekly, monthly and for the two year period. The length of time advertisers were active was also estimated. Estimates are also compared with related research. RESULTS: Canadian sex workers typically advertised individually or in small collectives (median name count 1, IQR 1-2, average 1.8, SD 4.4). Advertisers were active for a mean of 73.3 days (SD 151.8, median 14, IQR 1-58). Advertisers were at least 83.5% female. Respectively the scaled weekly, monthly, and biannual estimates for female sex workers represented 0.2%, 0.3% and 2% of the 2016 Canadian female 20-49 population. White advertisers were the most predominant ethnic group (53%). CONCLUSIONS: Sex work in Canada is a more pervasive phenomenon than indicated by spot estimates and the length of the data collection period is an important variable. Non-random samples used in qualitative research in Canada likely do not reflect the larger sex worker population represented in advertising. The overall brevity of advertising activity suggests that workers typically exercise agency, reflecting the findings of other Canadian research.
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Trabajadores Sexuales , Femenino , Humanos , Masculino , Canadá , Publicidad , Trabajo SexualRESUMEN
Sustainable Childhood Obesity Prevention through Community Engagement (SCOPE) has developed Live 5-2-1-0, a multi-sectoral, multi-component community-based childhood obesity prevention initiative grounded in systems thinking and participatory research principles. Building on previous work, this study continued implementation of an innovative knowledge exchange model, RE-FRAME, in two 'new' and two 'existing' Live 5-2-1-0 communities. This mixed-methods study examined follow-up data to determine the nature and extent of the model's ability to build and sustain community capacity and facilitate the scale-up and sustainability of systems- and community-level change. Qualitative and quantitative data were collected using stakeholder interviews, and quantitative process tracking (PTT) and capacity building tools (CCBT), and were analyzed using thematic analysis and descriptive statistics, respectively. Results from three communities with baseline and follow-up CCBT data showed capacity domain scores increased (15/27; 56%) or remained constant (10/27; 37%) over the study period. PTT data showed over 50 multi-sectoral community partnerships formed in Community D (new) and 108 actions implemented. Stakeholder interviews identified having a common cause, co-ownership, champion networks and consistency of the Live 5-2-1-0 message as essential to sustainability of the initiative. RE-FRAME supports knowledge exchange and community capacity-building that is integral to initiating and sustaining a community-based childhood obesity prevention initiative.
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Promoción de la Salud/métodos , Obesidad Infantil/prevención & control , Creación de Capacidad , Niño , Servicios de Salud Comunitaria , Participación de la Comunidad , Humanos , Participación de los InteresadosRESUMEN
The mechanism by which leptin reverses diabetic ketoacidosis (DKA) is unknown. We examined the acute insulin-independent effects of leptin replacement therapy in a streptozotocin-induced rat model of DKA. Leptin infusion reduced rates of lipolysis, hepatic glucose production (HGP), and hepatic ketogenesis by 50% within 6 hours and were independent of any changes in plasma glucagon concentrations; these effects were abrogated by coinfusion of corticosterone. Treating leptin- and corticosterone-infused rats with an adipose triglyceride lipase inhibitor blocked corticosterone-induced increases in plasma glucose concentrations and rates of HGP and ketogenesis. Similarly, adrenalectomized type 1 diabetic (T1D) rats exhibited decreased rates of lipolysis, HGP, and ketogenesis; these effects were reversed by corticosterone infusion. Leptin-induced decreases in lipolysis, HGP, and ketogenesis in DKA were also nullified by relatively small increases (15 to 70 pM) in plasma insulin concentrations. In contrast, the chronic glucose-lowering effect of leptin in a STZ-induced mouse model of poorly controlled T1D was associated with decreased food intake, reduced plasma glucagon and corticosterone concentrations, and decreased ectopic lipid (triacylglycerol/diacylglycerol) content in liver and muscle. Collectively, these studies demonstrate marked differences in the acute insulin-independent effects by which leptin reverses fasting hyperglycemia and ketoacidosis in a rodent model of DKA versus the chronic pleotropic effects by which leptin reverses hyperglycemia in a non-DKA rodent model of T1D.
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Diabetes Mellitus Experimental/tratamiento farmacológico , Cetoacidosis Diabética/tratamiento farmacológico , Insulina/metabolismo , Leptina/farmacología , Lipólisis/efectos de los fármacos , Animales , Diabetes Mellitus Experimental/inducido químicamente , Diabetes Mellitus Experimental/metabolismo , Diabetes Mellitus Experimental/patología , Cetoacidosis Diabética/inducido químicamente , Cetoacidosis Diabética/metabolismo , Cetoacidosis Diabética/patología , Diglicéridos/metabolismo , Masculino , Ratones , Ratas , Ratas Sprague-Dawley , Triglicéridos/metabolismoRESUMEN
The pattern of use of glycoprotein (GP) IIb/IIIa receptor inhibitors in peripheral percutaneous interventions (PPI) remains unclear. Data on patients who received GP IIb/IIIa inhibitors during PPI were extracted from a prospective registry that tracks demographic, angiographic and in-hospital outcomes of patients at 2 medical centers. Primary success was defined as establishing thrombolysis in myocardial infarction (TIMI) 3 flow and < 30% residual in vessels treated. Primary safety endpoints included death, unplanned amputation, vascular access complications, major bleeding and thrombocytopenia. Patients were divided into planned versus bailout use of GP IIb/IIIa inhibitors. A total of 46 patients (128 vessels) were included in this study. The procedure was performed emergently, urgently and electively in 13%, 26.1% and 60.9% of patients, respectively. The mean age was 70.9 +/- 11.2 years and 52.2% of patients were males. The patients' Rutherford-Baker Classes III, IV and V-VI were observed in 32.6%, 32.6% and 34.8%, respectively. Patients had the following comorbidities: current smokers 37%, diabetics 35.8%, dyslipidemics 71.7% and hypertensives 78.3%. Angiographic thrombus was suspected in 45.7% of patients prior to and during the procedure. The primary success endpoint was met in 66.4% of vessels and 69.6% of patients. Primary safety endpoints were as follows: death 2.2%, vascular access complication 2.2%, major unplanned amputation 0%, major bleeding 0% and thrombocytopenia 2.2%. Treatment with GP IIb/IIIa inhibitors was planned in 13 (28.3%) patients and bailout in 33 patients (71.7%). Reasons for planned GP IIb/IIIa were the presence of angiographic thrombus in 7 (53.8%) patients, advanced limb ischemia (Rutherford-Baker IV-VI) with total occlusions in 5 (38.5%) patients and acute presentation with total occlusion in 1 (7.7%) patient. Reasons for bailout were slow-flow in 16 (48.5%) patients, thrombus with no slow-flow in 12 (36.4%) patients, poor runoff in 1 (3%) patient and preventative during the procedure in 4 (12%) patients. In patients who received planned GP IIb/IIIa treatment, slow-flow occurred in 1/13 (7.7%) and embolization in 0/13 (0%) patients. We conclude that GP IIb/IIIa inhibitors were used as adjunctive therapy prior to angioplasty in critical limb ischemia patients or thrombotic lesions or as bailout in patients experiencing slow-flow and thrombus during PPI. Planned GP IIb/IIIa inhibitors appear to have favorable outcomes with a low incidence of slow-flow and embolization, however, randomized data are needed before establishing the role of GP IIb/IIIa inhibitor use in high-risk PPI.
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Anticuerpos Monoclonales/uso terapéutico , Fragmentos Fab de Inmunoglobulinas/uso terapéutico , Infarto del Miocardio/tratamiento farmacológico , Péptidos/uso terapéutico , Enfermedades Vasculares Periféricas/tratamiento farmacológico , Inhibidores de Agregación Plaquetaria/uso terapéutico , Complejo GPIIb-IIIa de Glicoproteína Plaquetaria/antagonistas & inhibidores , Abciximab , Anciano , Angioplastia de Balón , Trombosis Coronaria/tratamiento farmacológico , Eptifibatida , Femenino , Humanos , Pacientes Internos , Masculino , Infarto del Miocardio/mortalidad , Infarto del Miocardio/terapia , Enfermedades Vasculares Periféricas/mortalidad , Enfermedades Vasculares Periféricas/terapia , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Terapia Trombolítica/métodos , Resultado del TratamientoRESUMEN
A number of Sphingomonas strains capable of synthesizing the bacterial exopolysaccharide gellan and related polymers were shown to possess constitutive gellanase activity. In each case, the degradation of deacylated gellan was due to extracellular, eliminase-type enzymes (lyases) which cleave the sequence ... beta-D-glucosyl 1,4-beta-D-glucuronosyl ... in the tetrasaccharide repeat unit of the substrate polysaccharides. Deacetylated rhamsan was an alternative substrate but there was little or no action against most other polysaccharides with similar structures. Slight differences were found between the specificities of the lyases from different strains. Activities of gellan lyase preparations were generally low. As well as the extracellular 'gellanase' activity, all the bacteria possessed varying amounts of beta-D-glucosidase and beta-D-glucuronidase activities apparently located in the periplasm. The products from deacylated gellan and the chemically deacylated form of polysaccharide S194 (rhamsan gum), which is effectively a gentiobiosylated form of gellan, closely resembled those recently obtained by the authors from other, gellan-degrading, non-gellan-producing bacteria. The enzymes had negligible activity against the natural, acylated gellan and rhamsan polysaccharides from bacteria now designated as strains of Sphingomonas.