Automatic laboratory-based strategy to improve the diagnosis of type 2 diabetes in primary care

Introduction

To study the pre-design and success of a strategy based on the addition of hemoglobin A1c (HbA1c) in the blood samples of certain primary care patients to detect new cases of type 2 diabetes.

Materials and methods

In a first step, we retrospectively calculated the number of HbA1c that would have been measured in one year if HbA1c would have been processed, according to the guidelines of the American Diabetes Association (ADA). Based on those results we decided to prospectively measure HbA1c in every primary care patient above 45 years, with no HbA1c in the previous 3 years, and glucose concentration between 5.6-6.9 mmol/L, during an 18 months period. We calculated the number of HbA1c that were automatically added by the LIS based on our strategy, we evaluated the medical record of such subjects to confirm whether type 2 diabetes was finally confirmed, and we calculated the cost of our intervention.

Results

In a first stage, according to the guidelines, Hb1Ac should have been added to the blood samples of 13,085 patients, resulting in a cost of 14,973€. In the prospective study, the laboratory added Hb1Ac to 2092 patients, leading to an expense of 2393€. 314 patients had an HbA1c value ≥ 6.5% (48 mmol/mol). 82 were finally diagnosed as type 2 diabetes; 28 thanks to our strategy, with an individual cost of 85.4€; and 54 due to the request of HbA1c by the general practitioners (GPs), with a cost of 47.5€.

Conclusion

The automatic laboratory-based strategy detected patients with type 2 diabetes in primary care, at a cost of 85.4€ per new case.Key words: type 2 diabetes, HbA1c, diagnosis, preanalytical phase, test request appropriateness, costs, cost analysis     

Does rhetorical competence moderate the effect of rhetorical devices on the comprehension of expository texts beyond general comprehension skills?

Many studies have demonstrated the facilitating role of rhetorical devices in text comprehension, but there are also studies where rhetorical devices have not shown such effect. The present study sets out to explore whether readers’ knowledge of rhetorical devices (that is, rhetorical competence) moderates their effectiveness beyond general comprehension skills and, consequently, whether rhetorical competence may be considered a component skill of reading comprehension. 192 sixth- to seventh-grade students were assessed on rhetorical competence and were required to read a difficult marked text with specific rhetorical devices (a refutation, an objective, and four organizational signals) or the same text without them. After reading, students produced a summary in order to obtain three dependent variables: main ideas (as a measure of participants’ ability to select relevant information from the text), causal links between them (as an indicator of participants’ ability to grasp the logical structure of the text and to organize its ideas), and the combination of main ideas plus causal links (as an indicator of participants’ global comprehension of the text). Analyses controlling for general comprehension skills and other important variables (working memory, prior knowledge, decoding) demonstrated that: (a) readers of the marked text scored higher in terms of all dependent variables, and (b) rhetorical competence level moderated the effect of rhetorical devices on the composite measure (main ideas plus causal links) and on the organization of the summary by means of causal links.     

Senior citizens and the ethics of e-inclusion

The ageing society poses significant challenges to Europe’s economy and society. In coming to grips with these issues, we must be aware of their ethical dimensions. Values are the heart of the European Union, as Article 1a of the Lisbon Treaty makes clear: “The Union is founded on the values of respect for human dignity…”. The notion of Europe as a community of values has various important implications, including the development of inclusion policies. A special case of exclusion concerns the gap between those people with effective access to digital and information technology and those without access to it, the “digital divide”, which in Europe is chiefly age-related. Policies to overcome the digital divide and, more generally speaking, e-inclusion policies addressing the ageing population raise some ethical problems. Among younger senior citizens, say those between 65 and 80 years old, the main issues are likely to be universal access to ICT and e-participation. Among the older senior citizens, say those more than 80 years old, the main issues are mental and physical deterioration and assistive technology. An approach geared towards the protection of human rights could match the different needs of senior citizens and provide concrete guidance to evaluate information technologies for them.     

Southern-European signposts for critical popular adult education: Italy,Portugal and Spain

This paper focuses on three Southern European countries, Italy, Portugal and Spain, to explore examples of projects that provide signposts for a critical popular education that contributes to an ongoing democratic process – one whereby citizens are developed as social actors and members of a collectivity rather than simply passive producers/consumers. This approach would serve as an alternative to the traditional ‘top-down’ and current hegemonic economy-oriented discourses. In so doing, the paper seeks to redress an imbalance in the English language adult education and learning literature that often overlooks alternative discourses to the mainstream on and from this part of the world.     

Looking at Eye Gaze Processing and Its Neural Correlates in Infancy—Implications for Social Development and Autism Spectrum Disorder

The importance of eye gaze as a means of communication is indisputable. However, there is debate about whether there is a dedicated neural module, which functions as an eye gaze detector and when infants are able to use eye gaze cues in a referential way. The application of neuroscience methodologies to developmental psychology has provided new insights into early social cognitive development. This review integrates findings on the development of eye gaze processing with research on the neural mechanisms underlying infant and adult social cognition. This research shows how a cognitive neuroscience approach can improve our understanding of social development and autism spectrum disorder.     

The relation of knowledge of textual integration devices to expository text comprehension under different assessment conditions

In this study we propose a theoretical construct (called rhetorical competence) that represents the ability of readers to detect, understand, and use the linguistic cues or discourse markers that texts contain. We measure one of the three postulated components of rhetorical competence (knowledge of textual integration markers), assessing whether readers correctly interpret these markers while reading. The influence of this skill on reading competence is examined in a correlational study of 185 sixth-grade pupils (aged 11–12 years) using different assessment materials (a standardized test and an academic text) and reading conditions (habitual and aided). Multiple regression analyses of the data indicate that knowledge of textual integration devices makes a significant independent contribution to expository text comprehension under most assessment conditions when the effects of working memory, prior knowledge, and word recognition skills are controlled.     

Project ASTER III: A Model for Teacher Professional Development Integrating Science Museum Exhibits with State and National Science Education Content Standards

Abstract This article describes Project ASTER III (Active Science Teaching Encourages Reform), a science professional development program for early elementary teachers, which is based on the premise that people learn best by doing. Very few professional development programs focus on early childhood teacher development and how best to integrate informal science centers into teaching. In ASTER III, development teams—consisting of university scientists, science educators, K‐3 teachers, and educators from a hands‐on science museum—developed 5E lesson plans aligned with the Ohio Academic Content Standards and the National Science Education Standards in conjunction with the museum’s exhibits. This study explores the impact of the ASTER III model on teacher perceptions about the role and effect informal science museum visits have on subsequent teaching and student learning.     

Does the detection of misunderstanding lead to its revision?

When dealing with complex conceptual systems, low-prior- knowledge learners develop fragmentary and incorrect understanding. To learn complex topics deeply, these learners have to (a) monitor understanding to detect flaws and (b) generate explanations to revise and repair the flaws. In this research we explored if the detection of a flaw in understanding does lead to the generation of a revising explanation or, alternatively, if there is some independence between the two processes. In two studies participants with low prior domain knowledge learned about plate tectonics from a multimedia presentation. In Study 1 participants in two conditions received support for detection and their performance was compared to that of participants in two control conditions, one receiving no support and another one receiving support for both detection and revision. Performance on retention, transfer, and distortions revealed that the conditions with support for detection were not different from that with no support. The condition with support for both detection and revision was significantly better than all others. In Study 2 participants thought aloud while studying from the presentation. Self-generated detections were not correlated with revising explanations or with performance on retention or transfer measures. Overall, the results indicate that the detection of flaws in understanding does not necessarily lead to the generation of explanations to repair the flaws, meaning that this latter process is very difficult to execute and calls for instructional support.