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Objective This cross-sectional study aimed to 1) explore the relationships among work-life balance (WLB), burnout, and empathy and 2) investigate the roles of the subtypes of burnout relating to WLB and empathy.Methods A total of 105 health care professionals from a general hospital in Seoul were assessed using the Maslach Burnout Inventory, Jefferson Scale of Physician Empathy, and a one-sentence-question on subjective WLB. Multiple questions on psychiatric problems, including sleep problems, anxiety, depressive symptom, and alcohol problems, were also included.Results In the mediation analyses, personal achievement was considered as a potential mediating variable between WLB and empathy. The direct effect (β=3.93, 95% CI: 1.21–6.64) and the indirect effect (β=1.95, 95% CI: 0.52–3.76) of WLB on empathy were also significant.Conclusion Interventions encouraging personal achievement may help mitigate burnout of health professionals.

Perceived racial discrimination is linked to unhealthy behaviors and stress-related morbidities. A compelling body of research indicates that perceived racial discrimination may contribute to health disparities among African Americans (AAs). The purposes of this study were to describe the study protocol including data collection procedures and study measures and to evaluate the feasibility and acceptability of intensive biobehavioral data collection using ecological momentary assessment (EMA), salivary biomarkers, and accelerometers over 7 days among middle-aged AAs with a goal of understanding the relationships between perceived racial discrimination and biobehavioral responses to stress. Twelve AA men and women participated in the feasibility/acceptability study. They completed surveys, anthropometrics, and received in-person training in EMA and saliva sample collection at baseline. Participants were asked to respond to the random prompt text message-based EMA five times a day, wear an accelerometer daily for 7 days, and to self-collect saliva samples four times a day for 4 consecutive days. The EMA surveys included perceived racial discrimination, affective states, lifestyle behaviors, and social and physical contexts. The mean EMA response rate was 82.8%. All participants collected saliva samples four times a day for 4 consecutive days. About 83% of participants wore the accelerometer on the hip 6 out of 7 days. Despite the perception that the intensive nature of assessments would result in high participant burden, the acceptability of the study procedures was uniformly favorable.

Vulnerable populations may be more vulnerable to mental health problems posed by the coronavirus disease 2019 (COVID-19) pandemic. A systematic review was performed to compare the mental health impact of COVID-19 between vulnerable and non-vulnerable groups. Five electronic databases were searched for observational studies reporting the psychological outcomes of both vulnerable populations and healthy controls during the COVID-19 era. The primary outcomes are the severity of depression and anxiety, and secondary outcomes include other aspects of mental health such as stress or sleep disturbance. Meta-analysis was performed for the severity of mental health symptoms, and the results were presented as standardized mean difference and 95% confidence intervals. A total of 25 studies were included. According to the findings, the elderly generally experienced significantly lower levels of psychological symptoms including depression, anxiety, and perceived stress. Pregnant women, patients with chronic diseases, and patients with pre-existing severe mental disorders showed mixed results according to each mental health outcome. The results indicate that vulnerable groups have been affected differently in the COVID-19 era. Though the insufficient number and heterogeneity of included studies leave the results inconclusive, our findings may contribute to identifying priorities of mental health needs among various vulnerable populations and allocating health resources with efficiency.

There is little research on why underrepresented minorities are less likely to specifically study Machine Learning and Artificial Intelligence (ML/AI). We surveyed 159 undergraduate students about their interest in, exposure to, and personal views on ML/AI in order to explore variations in responses by self-reported gender and race/ethnicity groups. We found that students underrepresented by race/ethnicity are ~6 times less likely to take a traditional ML/AI course than those not underrepresented by race/ethnicity, but no significant difference was found between gender representation. Additionally, students underrepresented by race/ethnicity are more likely to report interest in social, cultural, and political impacts of ML/AI rather than the more technical aspects of ML/AI itself, which is a prevalent interest of students not underrepresented by race/ethnicity. We explore potential reasoning for this difference through further analysis of their survey responses. Encouragingly, we find that regardless of representational status 72.0% of students who report lack of interest in a traditional introductory course are interested in a ML/AI course that focuses more on the political, philosophical, and ethical issues raised by ML/AI and its impacts on society. Our findings suggest that a 'CS Principles" style introductory ML/AI course, emphasizing social and political impacts, could be an effective way to promote diversity in ML/AI.

2.5D IC packages are typically produced through Chip on Wafer (CoW) or Chip on Substrate (CoS) processes. Among these, 2.5D processing involves bonding the interposer chip and ASIC chip perpendicularly in sequence to the substrate for 2.5D package production. However, due to the large size of the interposer chip and its commensurately large high temperature warpage, attaching the interposer chip to the substrate carries a high risk of interconnection defects (non-wet/short) at the chip-substrate joints arising from the warpage difference. Moreover, the warpage difference between the attached interposer chip and ASIC also leads to a high risk of interconnection defects during bonding. For this reason, accurate prediction of the interposer chip high temperature warpage is of utmost importance in 2.5D packages In package warpage simulation, the reference (stress free) temperature is generally taken from high-T processes such as molding or F/C mounting, as they are most critical in inducing package warpage. However, unlike an IC package, the interposer chip undergoes no dominant process in particular which is critical to its chip warpage. Instead, all device fabrication processes prior to package formation impact the final interposer chip warpage. The initial room temperature warpage is determined by the residual stress from each processing step. The high temperature warpage is determined by the difference in metal density between the regions above and beneath the silicon as the temperature is increased. In the present study, we examine a $28.3\times 18.9\text{mm}$ 4-layer BEOL, 1-layer B-RDL interposer chip in order to predict the final interposer chip warpage via the finite element method (FEM) and thereby more effectively control it. To that end, we obtain the residual stress resulting from the front side (BEOL) and back side (B-RDL) processes through warpage measurement at each step. Moreover, we propose a method to maintain the interposer chip warpage close to zero, by adjusting the metal density and CVD film properties. In addition, we aim to address and improve possible Joint defects (non-wet/short) during ASIC chip bonding by predicting the warpage of the interposer chip attached to the substrate.

The prevalence of obesity among African Americans is higher than among other racial/ethnic groups. African American churches hold a central role in promoting health in the community; yet, church-based interventions have had limited impact on obesity. While recent studies have described the influence of social networks on health behaviors, obesity interventions informed by social network analysis have been limited. We conducted a cross-sectional study with 281 African American men and women from three churches in northeast urban cities in the USA. Data were collected on sociodemographic and clinical factors and anthropometrics. Using a social network survey applying a name generator, we computed network level metrics. Exponential random graph models (ERGM) were performed to examine whether each structural property found in the empirical (observed) networks occurred more frequently than expected by chance by comparing the empirical networks to the randomly simulated networks. Overall, church friendship networks were sparse (low density). We also found that while friendship ties were more reciprocated between dyads in church networks, and there were more tendencies for clustering of friendships (significant positive transitive closure) than in random networks, other characteristics such as expansiveness (number of actors with a great number of friends) did not differ from what would be expected by chance in random networks. These data suggest that interventions with African American churches should not assume a unitary network through which a single intervention should be used.

In Ghana, the HIV prevalence among MSM is more than 10 times greater than the general population of adults, and rates of engagement in HIV medical care are low among MSM diagnosed with HIV. Using structured surveys, we investigated the impact of HIV-related stigma, same-sex behavior stigma, and gender nonconformity stigma on linkage to HIV care (LTC) in MSM ( N = 225) living with HIV in Ghana. Autonomy-supportive healthcare climate ( OR = 1.63, p < .01), vicarious HIV stigma ( OR = 2.73, p < .01), and age ( OR = 1.06, p < .004) predicted LTC. Conversely, felt normative HIV stigma negatively predicted LTC ( OR = 0.65, p < .05). Finally, we identified regional disparities, with MSM from Takoradi being 4 times and 5 times more likely to be LTC compared to Kumasi and Accra, respectively. Our findings highlight the nuanced roles of stigmas in shaping the HIV care continuum among MSM living with HIV, while revealing potential gaps in current measures of HIV-related stigma.

The study aim was to examine the relationship between socioeconomic status and dietary behaviors through psychological and environmental mediators among African Americans with overweight or obesity. We conducted a cross-sectional study in 225 African American men and women. Data were analyzed using structural equation modeling with bootstrapping procedures. In the multiple mediation model, socioeconomic status had a significant indirect effect on dietary behaviors through psychological and environmental factors (β=−.27, p=.01, 95% confidence interval [CI]=−0.59 to −0.10), but it had no significant direct effect on dietary behaviors (β=.06, p=.70, 95% CI=−0.21 to 0.39). Socioeconomic status had significant direct effects on psychological (β=.52, p=.01, 95% CI=0.31 to 0.77) and environmental factors (β=−.40, p=.03, 95% CI=−0.53 to −0.25). Psychological (β=−.31, p=.02, 95% CI=−0.68 to −0.04) and environmental factors (β=.26, p=.01, 95% CI=0.04 to 0.47) also showed significant direct effects on dietary behaviors. Thus, psychological and environmental factors mediated the relationship between socioeconomic status and dietary behaviors in African Americans with overweight or obesity. Interventions that enhance psychological and environmental factors such as self-efficacy, perceived barriers to healthy eating, health perceptions, and physical and social environments may improve dietary behaviors among socioeconomically disadvantaged African Americans.

We examined the prevalence of U.S. healthcare workers who met the 2008 Physical Activity Guidelines for Americans (2008 Guidelines), and the relationships among meeting the 2008 Guidelines and health behaviors, musculoskeletal symptoms, and occupational- and workplace- factors. We estimated prevalence of meeting the 2008 Guidelines for aerobic and muscle-strengthening activity using data from the 2015 National Health Interview Survey. Among 1,502 U.S. healthcare workers, 56.2 % met the recommended guideline for aerobic activity; 30.1% met the recommended guideline for muscle-strengthening activity; and 25.3% met both recommended guidelines. Adjusting for covariates, meeting the 2008 Guidelines was associated with no history of smoking, current alcohol consumption, type of occupation, occupational activities, and availability of a health promotion program at work. Our findings suggest multi-level approaches (combining individual and organizational level efforts) are needed.

AIMS AND OBJECTIVES To describe obesity-risk behaviours (diet, physical activity and sedentary behaviour) and examine the relationships of the obesity-risk behaviours with body mass index (BMI) in school-aged Korean American children. BACKGROUND Korean American children have a risk of becoming overweight or obese and developing obesity-related complications; however, there is limited research about obesity-risk behaviours in Korean American children. DESIGN A cross-sectional study. METHODS Obesity-risk behaviours of children were assessed with well-validated self-report questionnaires (i.e., Elementary-level School-based Nutrition Monitoring Questionnaire) from children and their mothers. Height and weight of children were measured. Data were analysed with bivariate and multivariate analyses using mixed effects models to incorporate the correlation within siblings. RESULTS A total of 170 Korean American children (mean age 10.9 [2.0] years; 52.4% girls; mean BMI 19.3 [3.2]; 28.7% ≥85 percentiles) participated in the study. Only 38.3% of Korean American children met established recommendations of five fruits/vegetables per day; 56.5% met recommendations for more than 3 days per week of vigorous physical activity; and 40.8% met recommendations for

The objective was to describe Diabetes Prevention Program (DPP)-based lifestyle interventions delivered via electronic, mobile, and certain types of telehealth (eHealth) and estimate the magnitude of the effect on weight loss. A systematic review was conducted. PubMed and EMBASE were searched for studies published between January 2003 and February 2016 that met inclusion and exclusion criteria. An overall estimate of the effect on mean percentage weight loss across all the interventions was initially conducted. A stratified meta-analysis was also conducted to determine estimates of the effect across the interventions classified according to whether behavioral support by counselors post-baseline was not provided, provided remotely with communication technology, or face-to-face. Twenty-two studies met the inclusion/exclusion criteria, in which 26 interventions were evaluated. Samples were primarily white and college educated. Interventions included Web-based applications, mobile phone applications, text messages, DVDs, interactive voice response telephone calls, telehealth video conferencing, and video on-demand programing. Nine interventions were stand-alone, delivered post-baseline exclusively via eHealth. Seventeen interventions included additional behavioral support provided by counselors post-baseline remotely with communication technology or face-to-face. The estimated overall effect on mean percentage weight loss from baseline to up to 15months of follow-up across all the interventions was -3.98%. The subtotal estimate across the stand-alone eHealth interventions (-3.34%) was less than the estimate across interventions with behavioral support given by a counselor remotely (-4.31%), and the estimate across interventions with behavioral support given by a counselor in-person (-4.65%). There is promising evidence of the efficacy of DPP-based eHealth interventions on weight loss. Further studies are needed particularly in racially and ethnically diverse populations with limited levels of educational attainment. Future research should also focus on ways to optimize behavioral support.

Purpose This meta-analysis examined relationships between social support and self-care in type 1 (T1DM) and 2 diabetes mellitus (T2DM). Methods We searched for published and unpublished studies using the following databases: PubMed, Embase, PsycINFO, the Cochrane Library, and Medline. MeSH search terms included “diabetes mellitus,” “social support,” “caregiver,” “self-care,” “self-management,” “self-care skills,” and “coping behavior.” Studies reporting correlations between social support and self-care were included. Results Initially, 2 095 studies were extracted. After eliminating duplicate and irrelevant studies, 28 studies involving 5 242 patients with diabetes were included. Of these, 22 studies examined T2DM subjects. Social support was significantly associated with self-care ( k = 28, r = .28, 95% CI: .21-.34, P < .001). Among the diabetes self-care types, the strongest effect was found for glucose monitoring ( k = 6, r = .21, 95% CI: .08-.33). The relationship between social support and self-care was stronger in T2DM ( k = 22, r = .30, 95% CI: .22-.37), relative to T1DM, samples ( k = 5, r = .22, 95% CI: .02-.38). Conclusion It was concluded that the overall effect size for social support on self-care was moderate, and its strength differed by ethnic majority within the sample, type of social support measures, and publication status.

Ecological momentary assessment (EMA) is a mHealth method of real-time data collection in which people report on behavior and the context of the behavior at multiple time points in their natural environment. It is an innovative counterpart to traditional research methods that have relied on retrospective measures. The aim of this systematic review is to describe EMA methodology that has been used in studies of diabetes self-management. PubMed, CINAHL, PsycINFO, and EMBASE were searched for studies published between January 2000 and December 2018. We identified six studies that met the inclusion criteria. We evaluated the following areas of EMA methodology: 1) sampling and study design, 2) primary measures, 3) delivery technology, 4) EMA schedule and prompting strategy, and 5) EMA compliances. Five out of six studies were conducted in the U.S. with adolescents with type 1 diabetes. One study was conducted in Japan with adults with type 2 diabetes. Four studies used a prospective observational study design with a monitoring period ranging from 3 to 14 days (a total 1,000 to 2,128 observations:). Two studies were integrated with ecological momentary interventions (30 days and 6 months) with real-time biobehavioral feedbacks. All studies assessed diabetes self-management behaviors via EMA surveys. Most studies (78%) reported the relationship among psychosocial contexts, mood, affect, eating, and glucose monitoring. Three studies used handheld computers; two used automated telephone response systems; and one used a smartphone app. The prompt frequency ranged from twice a day to 1-2 times per hour using interval-contingent prompting strategy. Most studies failed to report EMA compliance rates. For those who reported, compliance rates ranged 59-96%. There has been limited research using EMA methodology to assess diabetes self-management and contextual factors. More research with standardized EMA reporting may help to develop personalized diabetes intervention. Disclosure S. Nam: None. R. Whittemore: None. D. Vlahov: None. G. Dunton: None.

Aim The objective of this systematic review was to summarize the ecological momentary assessment (EMA) methodology and associations between EMA-measured psychosocial, contextual factors and diabetes self-management. Methods The inclusion criteria were: research of EMA and diabetes self-management behaviors such as glucose checks, administration of insulin and eating-and dietary intake behaviors among persons with diabetes. A comprehensive search of several databases was conducted across all dates until July 2020. Results A modified Checklist for Reporting EMA Studies was used to assess the quality of studies. Among the ten included studies, participants were predominantly White adolescents with type 1 diabetes (T1D) and type 2 diabetes was studied in two studies. Time-varying, psychosocial contexts such as negative affect or negative social interaction were associated with missed insulin injection and poor adherence to glucose check. More preceding psychological stress was associated with more calorie intake from snacks or binge eating behaviors. Mornings were the most challenging time of day for adherence to diabetes self-management among adolescents with T1D. Intentional insulin withholding was more common in the afternoon in adults with T1D. Conclusions EMA has potential clinical utility in the assessment of diabetes self-management and in the development of timely and individualized diabetes interventions.

Background: This study investigated the prevalence of insulin refusal and compared the level of psychological insulin resistance (PIR) with the intention to accept insulin therapy among Korean patients with type 2 diabetes. Methods: Type 2 diabetes patients (n=1,209) were recruited from inner city outpatient diabetes clinics in 2016. Patient demographic, insulin recommendation, diabetes treatment type, intention to receive insulin therapy, and PIR information was collected using self-reports. The patients were divided into three groups: those who refused insulin therapy (n=184), those who accepted insulin therapy (n=331), and those not recommended for insulin therapy (n=694). Descriptive statistics were used to calculate the prevalence of insulin refusal; t-tests and analyses of variance were used to compare demographics with PIR. Results: The insulin refusal rate was 35.7%. The duration of diabetes, numbers of diabetes-related complications, and glycated hemoglobin levels were significantly lower in the group not recommended for insulin therapy than refused and accepted insulin groups. The level of PIR in insulin refusal group was significantly lower among patients agreeing to receive insulin therapy within 3 months than among those refusing insulin therapy. Conclusions: The prevalence of insulin refusal in Korea is not low, and people who refuse insulin therapy have high levels of PIR. Strategies to reduce PIR levels are needed.

Since computing education began, we have sought to learn why students struggle in computer science and how to identify these at-risk students as early as possible. Due to the increasing availability of instrumented coding tools in introductory CS courses, the amount of direct observational data of student working patterns has increased significantly in the past decade, leading to a flurry of attempts to identify at-risk students using data mining techniques on code artifacts. The goal of this work is to produce a systematic literature review to describe the breadth of work being done on the identification of at-risk students in computing courses. In addition to the review itself, which will summarize key areas of work being completed in the field, we will present a taxonomy (based on data sources, methods, and contexts) to classify work in the area.

Despite the well documented effectiveness of insulin on glycemic control, many patients with type 2 diabetes are reluctant to receive insulin therapy, called Psychological Insulin Resistance (PIR). Motivational Interviewing (MI) is a client-centered counseling method that may improve PIR and insulin acceptance behavior. The purpose of the study was to examine the effect of MI on insulin acceptance in insulin naïve patients with type 2 diabetes. Participants were recruited from outpatient clinics in two academic affiliated hospitals in South Korea. A matched subjects design was used to allocate the intervention (n=55) and control (n=55) groups based on age, gender, and the stage of intention to receive insulin therapy. The stages of intention to receive insulin therapy were pre-contemplation, contemplation, and action stages. Sociodemographic and clinical factors (years of diabetes diagnosis, medications, HbA1c, comorbidity) were collected by chart reviews. Six MI sessions (2 face-to-face [60 min/session] + 4 telephone sessions [20 min/session]) were provided to the intervention group by 6 trained nurses for 3 months. The effect of MI was measured by attitudes toward diabetes, PIR, and intention to receive insulin therapy at baseline and at 3 months using validated measures. Data were analyzed with paired t-test, t-test, and χ²-test. There was no significant difference in clinical factors, attitudes toward diabetes, PIR, and intention to receive insulin therapy between intervention and control groups at baseline. After the 6 MI sessions, the intervention group improved the intention to receive insulin therapy (χ²=10.44, p=.01) and attitudes toward diabetes (t=2.60, p Disclosure Y. Song: None. J. Cho: None. H. Lee: None. K. Park: None. Y. Lee: None. B. Kim: None. K. Seo: None. A. Lim: None. Y. Jun: None. S. Nam: None.

There is limited understanding about the obesity-related behaviors of diet, physical activity, and sedentary behavior in Korean American women. The purpose of this study was to cluster obesity-related behavior patterns of Korean American women and to examine group differences in acculturation, socioeconomic status (SES), and body mass index (BMI). A secondary analysis from a cross-sectional study was conducted using two-step cluster analysis for clustering groups. A total of 137 Korean American women ( M age = 42.7 years, SD = 3.9 years; M BMI = 23.1 kg/m2, SD = 3.1 kg/m2; 47.7% BMI ⩾ 23 kg/m2) participated. Three clusters were identified: healthy lifestyle, unhealthy lifestyle, and low physical activity but healthy diet group. The unhealthy lifestyle group was more likely to have high acculturation compared with other groups ( p = .03). SES and BMI were not significantly different between groups. Further intervention is needed to improve obesity-related behaviors of acculturated Korean American women.

Nurses have a high prevalence of musculoskeletal symptoms from patient handling tasks such as lifting, transferring, and repositioning. Comorbidities such as musculoskeletal symptoms may negatively affect engagement in leisure-time physical activity (LTPA). However, limited data are available on the relationship between musculoskeletal symptoms and LTPA among nurses. The purpose of this study was to describe musculoskeletal symptoms and LTPA, and to examine the relationships of musculoskeletal symptoms, sociodemographics, and body mass index with LTPA among nurses. Cross-sectional data on sociodemographics, employment characteristics, musculoskeletal symptoms, body mass index, and LTPA were collected from a statewide random sample of 454 California nurses from January to July 2013. Descriptive statistics, bivariate and multiple logistic regressions were performed. We observed that non-White nurses were less likely to engage in regular aerobic physical activity than White nurses (odds ratio [OR] = 0.61; 95% confidence interval [CI] = [0.40, 0.94]). Currently working nurses were less likely to engage in regular aerobic physical activity than their counterparts (OR = 0.48; 95% CI = [0.25, 0.91]). Nurses with higher body mass index were less likely to perform regular aerobic physical activity (OR = 0.93; 95% CI = [0.89, 0.97]) or muscle-strengthening physical activity (OR = 0.92; 95% CI = [0.88, 0.96]). This study found no evidence that musculoskeletal symptoms may interfere with regular engagement in LTPA. Physical activity promotion interventions should address employment-related barriers, and particularly target racial minority nurses and those who have a high body mass index.

The ability to predict student performance in a course or program creates opportunities to improve educational outcomes. With effective performance prediction approaches, instructors can allocate resources and instruction more accurately. Research in this area seeks to identify features that can be used to make predictions, to identify algorithms that can improve predictions, and to quantify aspects of student performance. Moreover, research in predicting student performance seeks to determine interrelated features and to identify the underlying reasons why certain features work better than others. This working group report presents a systematic literature review of work in the area of predicting student performance. Our analysis shows a clearly increasing amount of research in this area, as well as an increasing variety of techniques used. At the same time, the review uncovered a number of issues with research quality that drives a need for the community to provide more detailed reporting of methods and results and to increase efforts to validate and replicate work.

Liquefied natural gas (LNG) is primarily carried by a membrane type LNG ship, which has a cryogenic containment system composed of dual tightness barriers and insulation boards. The insulation board should have cryogenic reliability as well as high thermal insulation for the safe and efficient transportation. Sandwich construction and fiber reinforced polyurethane foam (PUF) are generally used for the insulation board and the core materials, respectively. During the operation of the LNG ship, cavitation and sloshing could generate an impact load on the PUF, which is an ongoing concern in the ship building industry. Therefore, the cryogenic impact resistance of the chopped E-glass fiber reinforced PUF was investigated with respect to the amount of chopped fibers. The drop weight impact test was conducted at a cryogenic temperature of −196 °C using liquid nitrogen. The applied maximum impact pressure, permanent strain and damage factor were measured to assess the damage caused by the impact test, from which the critical impact energy was investigated. From the experimental results, a criterion was suggested to assess the cryogenic impact resistance of the PUF and it was determined that the chopped fiber reinforcement significantly increased the impact resistance of the PUF at the cryogenic temperature.

Data from a social network-based human immunodeficiency virus (HIV)/sexually transmitted infection (STI) prevention study with a total of 330 men and women at high risk for HIV/STIs were used to examine the relationships between substance use, depressive symptoms, general health, cardiovascular disease risk factors, sociodemographic characteristics, and systolic/diastolic blood pressure (SBP/DBP). Approximately 60% of the participants had prehypertension to stage 2 hypertension. In the base model, older patients (P

Little is known about the effect of different lifestyle interventions on sleep disturbances among sedentary obese or overweight persons. We randomized 35–65 year-old men and women, to 6-months of a weight loss diet (D); or D combined with supervised exercise training (D+E). Measurements were self-reported sleep disturbances; the Profile of Mood States questionnaire; BMI; total, abdominal subcutaneous and visceral fat by magnetic resonance imaging; and aerobic fitness expressed as VO2peak. The groups did not differ in changes for body weight, abdominal total fat, VO2peak, and sleep disturbances. The novel finding herein is that reduced abdominal subcutaneous fat and depressive symptoms with either D or D+E, were associated with less sleep disturbances.

Despite significant efforts to decrease obesity rates, the prevalence of obesity continues to increase in the United States. Obesity risk behaviors including physical inactivity, unhealthy eating, and sleep deprivation are intertwined during daily life and are difficult to improve in the current social environment. Studies show that social networks-the thick webs of social relations and interactions-influence various health outcomes, such as HIV risk behaviors, alcohol consumption, smoking, depression, and cardiovascular mortality; however, there is limited information on the influences of social networks on obesity and obesity risk behaviors. Given the complexities of the biobehavioral pathology of obesity and the lack of clear evidence of effectiveness and sustainability of existing interventions that are usually focused on an individual approach, targeting change in an individual's health behaviors or attitude may not take sociocontextual factors into account; there is a pressing need for a new perspective on this problem. In this review, we evaluate the literature on social networks as a potential approach for obesity prevention and treatment (i.e., how social networks affect various health outcomes), present two major social network data analyses (i.e., egocentric and sociometric analysis), and discuss implications and the future direction for obesity research using social networks.

Although the Korean church has been frequently used to recruit Korean immigrants in research, little is known about the specific strategies and process. The purpose of this integrative review was to describe recruitment strategies in studies of Korean immigrants and to identify the process of Korean church-based recruitment. Thirty-three studies met inclusion criteria. Four stages of church-based recruitment were identified: initiation, endorsement, advertisement, and implementation. This review identified aspects of the church-based recruitment process in Korean immigrants, which are different from the Black and Hispanic literature, due to their hierarchical culture and language barriers. Getting permission from pastors and announcing the study by pastors at Sunday services were identified as the key components of the process. Using the church newsletter to advertise the study was the most effective strategy for the advertisement stage. Despite several limitations, church-based recruitment is a very feasible and effective way to recruit Korean immigrants.

Healthy behaviors including limited screen time (ST), high physical activity (PA), and adequate fruits and vegetables consumption (FV) are recommended for adolescents, but it is unclear how gender, race/ethnicity, and weight status relate to these public health guidelines in diverse urban adolescents. Participants ( N = 384) were recruited from three public high schools in or near New Haven, Connecticut. Descriptive statistics and logistic regression analyses were conducted. Most adolescents exceeded recommended levels of ST (70.5%) and did not meet guidelines for PA (87.2%) and FV (72.6%). Only 3.5% of the sample met all three guidelines. Boys were more likely to meet guidelines for PA ( p < .01), while girls were engaged in less ST ( p < .001). Black, non-Latinos were less likely to meet PA guidelines ( p < .05). There were no significant differences in meeting ST, PA, or FV guidelines by weight status for the overall sample or when stratified by gender or race/ethnicity. We found alarmingly low levels of healthy behaviors in normal weight and overweight/obese adolescents.

Liquefied natural gas (LNG) is mainly carried by membrane type LNG ships, whose cargo containment system is composed of dual tightness barriers and two insulation boards. The insulation board should have not only cryogenic reliability against thermal load, but also high thermal insulation performance for safe and efficient transportation of LNG. Although polyurethane foam (PUF) has been widely used for the insulation board due to its low production cost and relatively good thermal and mechanical properties, the cryogenic reliability of PUF is a remaining concern in marine fields due to its brittleness at cryogenic temperatures. In this work, the PUF was reinforced with chopped E-glass fiber because of its good dispersion and distribution characteristics. The compression, tension and the fracture toughness test were conducted with respect to the amount of the chopped E-glass fiber both at the room (25 °C) and cryogenic (−150 °C) temperatures. From the experimental results, it was found that the chopped E-glass fiber reinforcement increased the fracture toughness of the PUF much, especially at the cryogenic temperature. Therefore, the PUF reinforced with chopped glass fibers will improve much the reliability of the LNG cryogenic containment system during the voyage of LNG ships.

Identifying at-risk students early in the term is valuable. It is because an instructor can have more time to provide extra support, and students can also estimate how much extra effort they should put on to succeed in class. Prior work showed it is possible to predict at-risk students, but they either did not provide a specific prediction method or are too onerous to implement. Thus, my dissertation will develop and evaluate more robust, universal, and simple prediction methodology to classify at-risk students and propose how to automatically generate customized practice materials for early intervention. Once the methodology becomes robust, I will implement publicly accessible educational software application so that other CS instructors can easily adopt this method.

Background and objectiveAdverse working conditions contribute to obesity and physical inactivity. The purpose of this study was to examine the associations of occupational factors with obesity and leisure-time physical activity among nurses.MethodsThis study used cross-sectional data of 394 nurses (mean age 48 years, 91% females, 61% white) randomly selected from the California Board of Registered Nursing list. Data on demographic and employment characteristics, musculoskeletal symptom comorbidity, physical and psychosocial occupational factors, body mass index (BMI), and physical activity were collected using postal and on-line surveys from January to July in 2013.ResultsOf the participants, 31% were overweight and 18% were obese; 41% engaged in regular aerobic physical activity (≥ 150 min/week) and 57% performed regular muscle-strengthening activity (≥ 2 days/week). In multivariable logistic regression models, overweight/obesity (BMI ≥ 25 kg/m(2)) was significantly more common among nurse managers/supervisors (OR=2.54, 95% CI: 1.16-5.59) and nurses who worked full-time (OR=2.18, 95% CI: 1.29-3.70) or worked ≥ 40 h per week (OR=2.53, 95% CI: 1.58-4.05). Regular aerobic physical activity was significantly associated with high job demand (OR=1.63, 95% CI: 1.06-2.51). Nurses with passive jobs (low job demand combined with low job control) were significantly less likely to perform aerobic physical activity (OR=0.49, 95% CI: 0.26-0.93). Regular muscle-strengthening physical activity was significantly less common among nurses working on non-day shifts (OR=0.55, 95% CI: 0.34-0.89). Physical workload was not associated with obesity and physical activity.ConclusionsOur study findings suggest that occupational factors significantly contribute to obesity and physical inactivity among nurses. Occupational characteristics in the work environment should be considered in designing effective workplace health promotion programs targeting physical activity and obesity among nurses.

While the role of health literacy in chronic disease management is well documented, few intervention studies have been reported. A major barrier to designing and implementing such interventions is the lack of valid health literacy tools. This study developed and tested a novel health literacy scale for individuals with high blood pressure (HBP).A two-step design process was used: In the construction phase, focus group studies and a literature review were conducted to generate a pool of items. The testing phase involved a psychometric evaluation and pilot-testing of the scale on hypertensive Korean Americans (n=386). The end product was a HBP-health literacy scale (HBP-HLS) with two essential domains, print literacy and functional health literacy.Psychometric testing indicated that the scale was reliable (Kuder-Richardson-20 coefficient=0.98), valid (content validity index ≥0.8), and significantly correlated with theoretically selected variables (education, r=0.67, p0.01; HBP knowledge, r=0.33, p0.01).The HBP-HLS demonstrated its utility for evaluating HBP management interventions in the community setting.Utilizing the HBP-HLS should be considered as a potential tool for improving health literacy and evaluating intervention studies in the context of HBP management.

Background: Though a high amount of visceral fat is associated with insulin resistance, which can lead to type 2 diabetes (T2D) and cardiovascular diseases (CVDs), less is known about whether lifestyle modification (weight loss diet and exercise) induced changes in visceral fat are associated with improvements in glycemia. Methods: We randomized 77 individuals aged 35-65 years with T2D or pre-diabetes to 6-months of weight loss diet (D); or D combined with supervised moderate-intensity exercise training (D+E). Study measures were total abdominal, visceral and subcutaneous fat volumes by magnetic resonance imaging, aerobic fitness expressed as VO 2 peak during treadmill testing, body mass index (BMI), and HbA1c levels from blood samples. Results: Of 77 subjects (mean age, 54.8±7.8 years; mean BMI, 34.5 ± 4.7 kg/m 2 , women, 77.9%; Whites-65%, Blacks-34%, Asians-1%), n=37 had T2D and n=40 had pre-diabetes. At 6 months, both D and D+E groups improved from baseline (p2 ; D+E:-104.16 ± 72.37 cm 2 , p= 0.92), visceral fat (D:-25.53 ± 39.44 cm 2 ; D+E:,-23.24 ± 35.62 cm 2 , p=0.85), HbA1c (D:0.04 ± 0.46%; D+E:0.03 ± 0.63%, p=0.96), and VO 2 peak (D: 2.26 ± 3.92 ml/kg/min ; D+E:3.71 ± 2.65 ml/kg/min, p=0.11). In a multivariate analysis, adjusting for baseline visceral fat, T2D status, body weight loss and increases in aerobic fitness, a reduction in HbA1c (β=-0.49, p =0.007) was associated with a reduction in visceral fat (R 2 =0.34, p=0.02). Conclusion: The key finding was that diet or diet plus exercise-mediated reductions in visceral fat was associated with reduced HbA1c among individuals with T2D or pre-diabetes. These data contribute to growing body of evidence of the benefits of reducing abdominal obesity, in this case, resulting in better glycemic control in T2D and pre-diabetes.

It is important to understand East Asian immigrants (EAIs)’ unique perspectives in managing diabetes in order to provide culturally-competent care. However, it is not known whether EAIs’ perspectives are addressed in diabetes self-management interventions developed for EAIs. Therefore, a mixed-study review was conducted to identify EAIs’ perspective from qualitative research (n = 9 studies) and to evaluate the components of EAI diabetes self-management interventions (n = 7). Themes from the qualitative synthesis demonstrated that EAIs have unique cultural values and traditional health beliefs while struggling with multi-contextual barriers due to immigration. The evaluation of EAI diabetes self-management interventions revealed that there was a lack of consensus on cultural strategies for EAIs’ across the interventions. Addressing language barriers was the only factor consistently integrated in the cultural components of intervention by employing bilingual interventionists. EAIs’ perspectives and experiences need to be incorporated in the future diabetes self-management interventions to better provide culturally-competent care.

OBJECTIVE To describe the predictive relationships of selected sociodemographic, biomedical, and psychosocial variables to reluctance to use insulin among patients with type 2 diabetes. RESEARCH DESIGN AND METHODS A total of 178 patients with type 2 diabetes participated in this cross-sectional, observational study. Data were obtained by patient interview using validated measures of diabetes attitude, knowledge, self-efficacy, care communication, and perceived barriers to treatment, as well as sociodemographic and biomedical data. RESULTS Women and ethnic minorities with type 2 diabetes have more psychological barriers to insulin treatment (P < 0.05). The final regression model showed that individuals who believed in the value of tight glucose control, had strong self-efficacy, and had better interpersonal processes with their healthcare providers were less reluctant to use insulin treatment (R2 = 0.403; P < 0.0001). CONCLUSIONS Diabetes self-efficacy and better interaction with clinicians were important in decreasing patients' reluctance to use insulin, known as psychological insulin resistance.

Purpose To examine challenges in diabetes self-management among Korean Americans to guide clinicians in providing culturally appropriate and population-targeted diabetes care. Methods Five focus groups with 23 Korean Americans with type 2 diabetes, 30 to 75 years of age, were conducted. Open-ended questions were presented focusing on previous experiences in living with diabetes; digital recordings were transcribed verbatim; transcripts were coded and themes were identified. Results Most participants were reluctant to disclose diabetes because of social stigma and said that they did not know much about diabetes and its complications. Diabetes self-management is not always a top priority for Korean Americans over other family obligations or financial stability in their busy immigration lives. Many Korean Americans experience conflicts with family members in managing diabetes or would not request support from family members for their diabetes care. Traditional women’s roles and demanding immigration life seem to leave women particularly vulnerable to a lack of self-care. Lack of English proficiency limits access to mainstream health care. Conclusions Providing diabetes education at the community level is important to raise public awareness of diabetes and to eliminate social stigma. To facilitate family support for individuals with type 2 diabetes, it is appropriate to include the entire family in diabetes educational programs and to promote individual family members’ health in the context of maintaining their role within the family. Future efforts should be made with full implementation of language services in various clinical encounters and diabetes education.

BACKGROUND: Heart failure (HF) is a debilitating chronic disease with incidence and prevalence increasing worldwide. People with HF experience deteriorating functional status, severe fatigue, dyspnea, and repeated hospital admissions, which negatively affect health-related quality of life (HRQoL). Therefore, 1 of the primary goals of HF management is to improve HRQoL. OBJECTIVE: The purpose of this study was to describe the relationship among sociodemographics, clinical factors, functional status, depression, and HRQoL in elderly Korean patients with HF. METHODS: A descriptive, cross-sectional study design was used. We enrolled 134 HF patients from outpatient cardiology clinics at an academic-affiliated hospital and a tertiary care academic referral medical center in Cheonan, South Korea. We obtained sociodemographic and psychosocial variables from face-to-face interviews and obtained clinical variables from medical record reviews. We used the Minnesota Living With Heart Failure Questionnaire to measure HRQoL. RESULTS: Using hierarchical multiple regression analysis and after controlling for sociodemographic and clinical factors, we determined that HRQoL was independently influenced by depression (β = .443, P < .001), New York Heart Association classification (β = .148, P < .05), and functional status (β = -.403, P < .001). Depression and functional status explained about 26% of the variance in HRQoL. CONCLUSIONS: Depression and functional status were significantly associated with HRQoL in elderly patients with HF. Our findings emphasize the need for careful clinical screening of both depression and functional status in older patients with HF. More research needs to be conducted to develop effective intervention strategies to improve HRQoL and, in turn, HF outcomes.

Objective The purpose of this study was (1) to characterize the primary sources of social support and the extent of unmet needs for support (defined as the gap between social support needs and the receipt of social support) in a sample of Korean Americans (KAs) with type 2 diabetes and (2) to examine the effect of unmet needs for support on their self-care activities. Methods Baseline data obtained from a community-based intervention trial were used for this study of 83 middle-aged KAs with type 2 diabetes. Study design and data analysis were guided by social cognitive theory. The key variables were dictated the order of the variables in multivariate regression analysis. Results Our findings indicated that for diabetic KAs, the primary source of social support differed according to gender. Unmet needs for support were significantly associated with self-care activities, but the amount of support needs and of social support received were not. Multivariate analysis also confirmed that unmet needs for social support are a significant strong predictor of inadequate type 2 diabetes self-care activities, after controlling for other covariates. The hierarchical regression model explained about 30% of total variance in self-care activities. Conclusions The findings highlight the importance of considering unmet needs for social support when addressing self-care activities in type 2 diabetes patients. Future interventions should focus on filling gaps in social support and tailoring approaches according to key determinants, such as gender or education level, to improve self-care activities in the context of type 2 diabetes care.

Background . Recruitment of hard-to-reach ethnic minorities such as Korean Americans (KAs) requires substantial time, cost, and strategic effort. A point-of-care (POC) A1c test could facilitate the recruitment of such populations for diabetes research in community settings. Methods . A two-step approach for participant screening was employed: Potential participants were first screened using the POC A1c test at a community location. Only those with POC A1c levels ≥7.5% were referred for a confirmatory lab test within two weeks. Results . In total, 237 KAs were screened using the POC A1c test; 92 were referred for confirmatory testing and 83 who got the laboratory A1c measurement were confirmed eligible (A1c ≥7.5%). There was a strong positive correlation between the POC and reference laboratory measurements (ρ=0.83, p≤.001). Conclusion . Using a POC A1c method as a front-line screening test can facilitate the recruitment of KAs with type 2 diabetes, while saving cost, time, and effort.

Background Diabetes is a major cause of cardiovascular morbidity and mortality. Ethnic minorities experience a disproportionate burden of diabetes; however, few studies have critically analyzed the effectiveness of a culturally tailored diabetes intervention for these minorities. Objective The aim of this study was to evaluate the effectiveness of a culturally tailored diabetes educational intervention (CTDEI) on glycemic control in ethnic minorities with type 2 diabetes. Method We searched databases within PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Education Resources Information Center (ERIC), PsycINFO, and ProQuest for randomized controlled trials (RCTs). We performed a meta-analysis for the effect of diabetes educational intervention on glycemic control using glycosylated hemoglobin (HbA(1c)) value in ethnic minority groups with type 2 diabetes. We calculated the effect size (ES) with HbA(1c) change from baseline to follow-up between control and treatment groups. Results The 12 studies yielded 1495 participants with a mean age of 63.6 years and a mean of 68% female participants. Most studies (84%) used either group education sessions or a combination of group sessions and individual patient counseling. The duration of interventions ranged from 1 session to 12 months. The pooled ES of glycemic control in RCTs with CTDEI was -0.29 (95% confidence interval, -0.46 to -0.13) at last follow-up, indicating that ethnic minorities benefit more from CTDEI when compared with the usual care. The effect of intervention was greatest and significant when HbA(1c) level was measured at 6 months (ES, -0.41; 95% confidence interval, -0.61 to -0.21). The ES also differed by each participant's baseline HbA1c level, with lower baseline levels associated with higher ESs. Conclusions Based on this meta-analysis, CTDEI is effective for improving glycemic control among ethnic minorities. The magnitude of effect varies based on the settings of intervention, baseline HbA1c level, and time of HbA1c measurement. More rigorous RCTs that examine tailored diabetes education, ethnically matched educators, and more diverse ethnic minority groups are needed to reduce health disparities in diabetes care.

Despite significant advances in diagnosis and treatment, the persistence of inadequate metabolic control continues. Poor glycemic control may be reflected by both the failure of diabetes self-management by patients as well as inadequate intervention strategies by clinicians. The purpose of this systematic review is to summarize existing knowledge regarding various barriers of diabetes management from the perspectives of both patients and clinicians. A search of PubMed, CINAHL, ERIC, and PsycINFO identified 1454 articles in English published between 1990 and 2009, addressing type 2 diabetes, patient's barriers, clinician's barriers, and self-management. Patients' adherence, attitude, beliefs, and knowledge about diabetes may affect diabetes self-management. Culture and language capabilities influence the patient's health beliefs, attitudes, health literacy, thereby affecting diabetes self-management. Other influential factors include the patient's financial resources, co-morbidities, and social support. Clinician's attitude, beliefs and knowledge about diabetes also influence diabetes management. Clinicians may further influence the patient's perception through effective communication skills and by having a well-integrated health care system. Identifying barriers to diabetes management is necessary to improve the quality of diabetes care, including the improvement of metabolic control, and diabetes self-management. Further research that considers these barriers is necessary for developing interventions for individuals with type 2 diabetes.