Programs and Communities

The purpose of this project was to evaluate the utilization of a smartphone application for diabetes self-management education (DSME) into a family practice office. Cochrane review of technological options for DSME identified the smartphone as the most effective option. All patients with diabetes presenting in a family practice office for appointments with the clinical pharmacist or the physician were asked if they would participate in the project if they met the inclusion criteria including the diagnosis of diabetes, owning a smart-phone, and over 18 years old. Exclusion criteria were pregnancy, end-stage kidney disease, or use of an insulin pump.

The goal was to enroll at least 10 patients and have them utilize the smartphone application Care4life for education and blood glucose tracking. HbA1c, heart rate, blood pressure, weight, and body mass index were collected at the initiation of the trial in addition to a demographic survey. A survey was obtained at the end of the trial. Ten patients were enrolled in the project; 50% women. One patient discontinued participation after enrollment. Six patients returned their surveys.

The feedback was primarily positive with individuals liking the text messaging reminders and ability to track their matrix (blood pressure, blood glucose, weight, medication adherence, exercise). Continued utilization of the smartphone application within the practice is likely for those patients who enjoy the technology as a reminder. Further opportunities for implementation would be in a hospital setting where patients face a delay post discharge for an appointment with a diabetes educator. Additionally, due to the complexity of the disease this application could be used to educate caregivers.

Randomized controlled trials and systematic reviews of paired education involving both diet and activity recommendations have shown significant reductions in the advancement of adult (age 18 to 80) prediabetes to type 2 diabetes mellitus (T2DM). Paired education on diet and activity has been effective for persons from diverse races, ethnicities, and levels of education. For this project, the paired education focused on the dietary guidance of the Whole 30 plan and the current exercise/activity recommendations of the American Diabetes Association (ADA). The ADA recommends 30 min 5 x week or 60 min 3 x week of exercise, with no more than 48 hours between exercise occurrences.

Ten adults with HbA1C between 5.7%-6.4%, levels specified by the ADA as prediabetes, were invited to participate in the project at an outpatient wellness practice. Participants took a pretest on basic food and activity knowledge, received educational sessions on the Whole 30™ plan and activity recommendations from the ADA, then completed a posttest. Participants were scheduled for one month follow ups. At the 3 month follow up appointment, repeat HbA1C was drawn. Most of the patients (7/10) completed return appointments at the 3-month time frame. Statistically significant results were seen in diet and exercise knowledge using a paired T-test. Clinically significant reductions were seen in HbA1C averages as well as weight, BMI, and glucose levels.

Dramatic changes in land use were associated with the rise of agriculture in the mid Holocene in the Mediterranean region. Both surface properties and drainage networks were changed along with direct modifications to surface properties (vegetation removal and change, sediment liberation and compaction); consequent drainage alteration (terracing, canals) and up and downstream responses in the watersheds communicated these changes throughout the landscape.

The magnitude, rate, and feedbacks with the growing human populations are critical questions in our effort to assess human-landscape interactions. To investigate these relationships, recent field work in the Penaguila Valley of southeast Spain included landform mapping, alluvial deposit description, and sample collection emphasizing areas of active erosion, remnant land surfaces and their relation to archaeological sites.

We have updated our geomorphic maps by refining the delineation of alluvial terraces, steep-walled (40m deep) drainages ("barrancos"), and hollows ("barrancos de fondo plano"). Hollows are curved, elongate, flat-bottomed gullies with steep walls (2-30m tall) and extend headward from the main barrancos. This work enables more accurate terrace correlations necessary for both landscape evolution modeling and interpretation of the development history of the basin.

Alluvial terraces are crucial to this research because they record periods of past stable topography. In the Penaguila, sites dating back to late Mesolithic and early Neolithic (around 6600 BP) and subsequent periods (Chalcolithic and Bronze Age) are exposed on a prominent terrace surface mapped as Terrace A. This broad low relief surface is scarred by deep barrancos and hollow formation that expose bedrock marls and overlying alluvial deposits. Stratigraphic profiles and texture analyses of Terrace A deposits reveal overland flow facies and channel networks in reworked and CaCO3-encrusted marls, and several organic-rich paleosols. Small remnant surfaces mapped as Terrace Z (below Terrace A) were observed within the main barrancos and indicate a later, brief accumulation period with subsequent incision to the modern channel.

Holocene landscape development in the Penaguila appears to have progressed from a period of stability to slope denudation with aggradation (stream infilling) followed by rapid incision which initiated sometime near the time of occupation. This change from a low relief alluvial surface to one cut by narrow channels may have been an important shift for local populations. Their response to that environmental modification may be associated with the horticulturalist to agricultural intensification noted in the archaeological record. Tighter chronology and better understanding of the driving processes for barranco incision and hollow formation will improve our ability to correlate the changing landscape with land use practices. Such an improved correlation leads to better understanding of human-landscape interactions.