RESUMEN
Objective: To demonstrate the clinical value of OneTouch (OT) Verio Flex glucose meter used in combination with a Spanish-language version of the OT Reveal mobile application (app) to support diabetes care and improve glycemic control in an underserved Hispanic population with type 2 diabetes. Research Design and Methods: Test subjects (n = 81) used the meter and app for 12 weeks, while a randomized control group (n = 39) used their own glucose meters without connection to an app. Thereafter, test subjects continued the same regimen for an additional 12 weeks to determine the durability of effect, and control subjects crossed over to use the new meter and app. Results: Test subjects experienced a mean reduction in A1C of 1.0% after 12 weeks (P <0.001), a statistically significant greater reduction than in control subjects (P = 0.045). The improvement in A1C in test subjects was sustained over the next 12 weeks. Crossed-over subjects also demonstrated significant improvements in A1C (P <0.001). Mean blood glucose was reduced significantly without an increase in hypoglycemia, and results in range increased over 12 weeks of meter and mobile app use. Results were independent of subjects' numeracy skills. Subjects using the new meter and app reacted favorably to the tools and expressed improvements in their diabetes treatment satisfaction based on Diabetes Treatment Satisfaction Questionnaire-Change scores. Conclusion: Use of the OT meter and a Spanish-language version of its diabetes management app in an underserved population helped participants achieve a sustained improvement in glycemic control. The tools were well received by the subjects and may have important utility in other low-numeracy, low-literacy populations.
RESUMEN
Objectives Violence against medical trainees confronts medical educators and academic leaders in perinatal medicine with urgent ethical challenges. Despite their evident importance, these ethical challenges have not received sufficient attention. The purpose of this paper is to provide an ethical framework to respond to these ethical challenges. Methods We used an existing critical appraisal tool to conduct a scholarly review, to identify publications on the ethical challenges of violence against trainees. We conducted web searches to identify reports of violence against trainees in Mexico. Drawing on professional ethics in perinatal medicine, we describe an ethical framework that is unique in the literature on violence against trainees in its appeal to the professional virtue of self-sacrifice and its justified limits. Results Our search identified no previous publications that address the ethical challenges of violence against trainees. We identified reports of violence and their limitations. The ethical framework is based on the professional virtue of self-sacrifice in professional ethics in perinatal medicine. This virtue creates the ethical obligation of trainees to accept reasonable risks of life and health but not unreasonable risks. Society has the ethical obligation to protect trainees from these unreasonable risks. Medical educators should protect personal safety. Academic leaders should develop and implement policies to provide such protection. Institutions of government should provide effective law enforcement and fair trials of those accused of violence against trainees. International societies should promulgate ethics statements that can be applied to violence against trainees. By protecting trainees, medical educators and academic leaders in perinatology will also protect pregnant, fetal, and neonatal patients. Conclusions This paper is the first to provide an ethical framework, based on the professional virtue of self-sacrifice and its justified limits, to guide medical educators and academic leaders in perinatal medicine who confront ethical challenges of violence against their trainees.
Asunto(s)
Educación Médica , Perinatología , Gestión de Riesgos/organización & administración , Estudiantes de Medicina/psicología , Violencia , Educación Médica/ética , Educación Médica/métodos , Educación Médica/organización & administración , Ética Médica , Docentes Médicos/ética , Docentes Médicos/normas , Humanos , México , Perinatología/educación , Perinatología/ética , Medio Social , Enseñanza/organización & administración , Enseñanza/normas , Violencia/ética , Violencia/prevención & control , Violencia/psicologíaAsunto(s)
Investigación Biomédica , Genómica , Consentimiento Informado , Sujetos de Investigación , Factores de Edad , Niño , Humanos , Adulto JovenAsunto(s)
Síndrome de Resistencia Androgénica/diagnóstico , Síndrome de Resistencia Androgénica/genética , Pruebas Genéticas/ética , Pruebas Genéticas/legislación & jurisprudencia , Síndrome de Resistencia Androgénica/complicaciones , Niño , Codón sin Sentido/genética , Revelación/ética , Femenino , Hernia Inguinal/complicaciones , Hernia Inguinal/patología , Heterocigoto , Humanos , Lactante , Consentimiento Informado/ética , Masculino , Linaje , Receptores Androgénicos/genética , Sexo , Hermanos , Testículo/patología , Estados UnidosRESUMEN
The status of the tropical African latrine blowfly Chrysomya putoria (Wiedemann, 1830) is recognized as distinct from the sub-tropical African blowfly C.chloropyga (Wiedemann, 1818) (Diptera: Calliphoridae). The biology of C.putoria in laboratory culture is described briefly with emphasis on the differences in development found in three strains of this species from Tanzania, Liberia and Brazil. All three strains were reproductively compatible and there was no evidence of F1 hybrid sterility or hybrid breakdown in subsequent generations. Larval development was significantly faster in the Brazilian strain than in the strain from Tanzania. Sexual maturity was significantly faster in adults of the Liberian and Brazilian strains compared to that found in the strain from Tanzania. This latter strain was affected by the source of protein available as adult food. These differences between strains did not appear to be due to selection in laboratory culture, but rather evidence of the evolution of physiological divergence within a species occupying different geographical regions.