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BackgroundPast mobile health (mHealth) efforts to empower type 2 diabetes (T2D) self-management include portals, text messaging, collection of biometric data, electronic coaching, email, and collection of lifestyle information. ObjectiveThe primary objective was to enhance patient activation and self-management of T2D using the US Department of Defense’s Mobile Health Care Environment (MHCE) in a patient-centered medical home setting. MethodsA multisite study, including a user-centered design and a controlled trial, was conducted within the US Military Health System. Phase I assessed preferences regarding the enhancement of the enabling technology. Phase II was a single-blinded 12-month feasibility study that randomly assigned 240 patients to either the intervention (n=123, received mHealth technology and behavioral messages tailored to Patient Activation Measure [PAM] level at baseline) or the control group (n=117, received equipment but not messaging. The primary outcome measure was PAM scores. Secondary outcome measures included Summary of Diabetes Self-Care Activities (SDSCA) scores and cardiometabolic outcomes. We used generalized estimating equations to estimate changes in outcomes. ResultsThe final sample consisted of 229 patients. Participants were 61.6% (141/229) male, had a mean age of 62.9 years, mean glycated hemoglobin (HbA1c) of 7.5%, mean BMI of 32.7, and a mean duration of T2D diagnosis of 9.8 years. At month 12, the control group showed significantly greater improvements compared with the intervention group in PAM scores (control mean 7.49, intervention mean 1.77; P=.007), HbA1c (control mean −0.53, intervention mean −0.11; P=.006), and low-density lipoprotein cholesterol (control mean −7.14, intervention mean 4.38; P=.01). Both groups showed significant improvement in SDSCA, BMI, waist size, and diastolic blood pressure; between-group differences were not statistically significant. Except for patients with the highest level of activation (PAM level 4), intervention group patients exhibited significant improvements in PAM scores. For patients with the lowest level of activation (PAM level 1), the intervention group showed significantly greater improvement compared with the control group in HbA1c (control mean −0.09, intervention mean −0.52; P=.04), BMI (control mean 0.58, intervention mean −1.22; P=.01), and high-density lipoprotein cholesterol levels (control mean −4.86, intervention mean 3.56; P

The goal of this investigation was to assess the accuracy of 18F-fluorodihydrorotenone (18F-FDHR) as a new deposited myocardial flow tracer and compare the results to those for 201Tl. Methods. The kinetics of these flow tracers were evaluated in 22 isolated, erythrocyte- and albumin-perfused rabbit hearts over a flow range encountered in patients. The two flow tracers plus a vascular reference tracer (131I-albumin) were introduced as a bolus through a port just above the aortic cannula. Myocardial extraction, retention, washout, and uptake parameters were computed from the venous outflow curves using the multiple indicator dilution technique and spectral analysis. Results. The mean initial extraction fractions of 18F-FDHR (0.85 +- 0.07) and 201Tl (0.87 +- 0.05) were not significantly different, although the initial extraction fraction for 18F-FDHR declined with flow (P < 0.0001), whereas the initial extraction fraction of 201Tl did not. Washout of 201Tl was faster (P < 0.001) and more affected by flow (P < 0.05) than 18F-FDHR washout. Except for initial extraction fraction, 18F-FDHR retention was greater (P < 0.001) and less affected by flow (P < 0.05) than 201Tl retention. Reflecting its superior retention, net uptake of 18F-FDHR was better correlated with flow than 201Tl uptake at both one and fifteen minutes after tracer introduction (P < 0.0001 for both comparisons). Conclusion. The superior correlation of 18F-FDHR uptake with flow indicates that it is a better flow tracer than 201Tl in the isolated rabbit heart. Compared to the other currently available positron-emitting flow tracers (82Rb, 13N-ammonia, and 15O-water), 18F-FDHR has the potential of providing excellent image resolution without the need for an on-site cyclotron.

Kinetic analysis of dynamic tracer data is performed with the goal of evaluating myocardial radiotracers for cardiac nuclear medicine imaging. Data from experiments utilizing the isolated rabbit heart model are acquired by sampling the venous blood after introduction of a tracer of interest and a reference tracer. We have taken the approach that the kinetics are properly characterized by an impulse response function which describes the difference between the reference molecule (which does not leave the vasculature) and the molecule of interest which is transported across the capillary boundary and is made available to the cell. Using this formalism we can model the appearance of the tracer of interest in the venous output of the heart as a convolution of the appearance of the reference tracer with the impulse response. In this work we parameterize the impulse response function as the sum of a large number of exponential functions whose predetermined decay constants form a spectrum, and each is required only to have a nonnegative coefficient. This approach, called spectral analysis, has the advantage that it allows conventional compartmental analysis without prior knowledge of the number of compartments which the physiology may require or which the data will support.

Purpose: The Rapid Assessment of Problem Solving test (RAPS) is a clinical measure of problem solving based on the 20 Questions Test. This article updates clinicians on the RAPS, addresses questions raised about the test in an earlier article (R. C. Marshall, C. M. Karow, C. Morelli, K. Iden, & J. Dixon, 2003a), and discusses the clinical utility of the RAPS. Method: The RAPS was administered to 373 normal adults. Tests were analyzed to assess the impact of demographic, psychometric, and other factors on performance on the RAPS. To determine the effects of strategy selection on test scores, participants were assigned to novel, category-focused, or mixed strategy groups based on the types of first questions asked. Results: Normal participants exhibited a range of performance levels on the RAPS. Participants in the novel strategy group performed significantly better than the participants in 2 other strategy groups. Conclusions: The RAPS is a clinically useful tool to examine problem solving that is easy to administer and to score. Findings suggest clinicians can use the RAPS with greater confidence than was the case 4 years ago. The RAPS is now part of the public domain and may be used by clinicians to assess clients' problem-solving deficits. (Contains 7 tables, 2 figures and 1 footnote.)

Purpose: Semantic feature analysis (SFA) was used to determine whether training contextually related words would improve the discourse of individuals with nonfluent aphasia in preselected contexts. Method: A modified multiple-probes-across-behaviors design was used to train target words using SFA in 3 adults with nonfluent aphasia. Pretreatment, posttreatment, and follow-up sessions obtained language samples for the preselected contexts. Contexts included 4 story retellings and 4 procedure explanations. Results: All participants improved naming ability for treated words. No generalization to untrained items was found. Within discourse samples, participants increased number of target words produced from pretreatment to posttreatment sessions but did not increase lexical diversity across samples. Participants maintained performance on standardized measures from the beginning to the end of the study. Conclusions: Results support and extend previous research by indicating that SFA improves confrontational naming ability and may benefit word retrieval in discourse production of closed-set contexts. (Contains 5 tables and 3 figures.)

Purpose: The Kentucky Aphasia Test (KAT) is an objective measure of language functioning for persons with aphasia. This article describes materials, administration, and scoring of the KAT; presents the rationale for development of test items; reports information from a pilot study; and discusses the role of the KAT in aphasia assessment. Method: The KAT has 3 parallel test batteries, KAT-1, KAT-2, and KAT-3. Each battery contains the same orientation test and 6 subtests, each with 10 items, assessing expressive and receptive language functions. Subtests for KAT-1, KAT-2, and KAT-3 systematically increase in difficulty so that it is possible to assess individuals with severe, moderate, and mild aphasia, respectively. The KAT was administered to 38 participants with aphasia and 31 non-brain-damaged (NBD) participants. Results: Results with the KAT clearly differentiated the language performance of individuals with and without aphasia. NBD participants made few errors, and overall scores on the test for individuals with aphasia were rarely within 1 "SD" of the NBD group. Performance of the participants with aphasia administered KAT-1, KAT-2, and KAT-3 suggested that the 3 versions of the test represent a hierarchy of difficulty. Conclusions: The KAT remains in its early stages of development. However, it does appear to meet the requirements for a "clinician-friendly" aphasia test and, as such, offers a rapid, convenient means of obtaining an objective score to determine changes in language functioning during the early postonset period. (Contains 4 tables, 1 figure and 1 footnote.)

Purpose: The personalized cueing method is a novel procedure for treating naming deficits of persons with aphasia that is relatively unfamiliar to most speech-language pathologists. The goal of this article is to introduce the personalized cueing method to clinicians so that it might be expanded and improved upon. It is also hoped that this article will promote further research in the treatment of naming deficits of clients with aphasia. Method: This clinical focus article (a) describes the origins of the personalized cueing method, the steps involved in creating personalized cues, and training and assessment procedures used with the personalized cueing method; (b) summarizes the published research supporting the use of the personalized cueing method; and (c) highlights some of the clinical advantages of this novel naming treatment for clients and clinicians. Results: Research with the personalized cueing method indicates that durability (long-term naming accuracy) for items trained with the personalized cueing method exceeds that for items trained with phonological cueing and other methods. It further shows that as the stimuli used to train naming in the personalized cueing experiments have become more realistic, durability of personalized cueing has increased. Conclusions: Personalized cueing is a parsimonious approach for treatment of naming deficits of persons with aphasia that has shown positive treatment effects in 8-12 training sessions.

The purpose of this review was to examine the effects of aphasia therapy on language and/or communication outcome measures when treatment was initiated within four months post-onset. The review evaluated the methodological quality of relevant studies and summarised the findings of the high-quality studies according to three clinical questions about the provision of aphasia treatment in the early period of recovery: (1) Is treatment better than no treatment? (2) Is one type of treatment more effective than another? (3) Do different treatment intensities result in different outcomes? A literature search was performed for articles in which aphasia treatments were initiated fewer than four months post-aphasia onset and evaluated with a control or comparison group. Two authors rated the studies on defined methodological quality criteria and extracted data for addressing the clinical questions. A total of 23 studies met the inclusion criteria. Sixteen of the studies received high-quality ratings. Nine studies provided data addressing clinical question 1; however, only four of them were considered as high-quality studies. Results from the high-quality studies were mixed: two studies demonstrated treatment efficacy for early aphasia therapy, and two studies found no differences in outcome measures between participants who received treatment and a no-treatment control. Eleven studies provided data addressing clinical question 2; six of them were considered as high-quality. None of the eleven treatment-comparison studies found that one type of treatment resulted in greater gains compared to another type of treatment on primary outcome measures. Finally, six studies contributed data for addressing clinical question 3; all of them were considered as high-quality studies. Five studies found no significant difference in outcomes between participants assigned to lower- and higher-intensive weekly treatment schedules, and one study reported superior findings in outcomes when participants received less intensive treatment. This review found mixed results across studies that examined whether early aphasia treatment improved language/communication outcomes more than no treatment. The review also found that when different types of aphasia treatments were compared, no treatment was more efficacious than another treatment and that increasing the weekly intensity of treatment beyond 2–5 hours did not improve outcomes on language/communication measures. The review highlights the need for additional research on the effects of early aphasia therapy. We suggest that future research considers participant characteristics that might influence how a person will respond to a specific therapeutic approach and intensity. [ABSTRACT FROM AUTHOR]