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Patients covered by any commercial insurer were eligible. Patients on insulin pumps, pregnant, or not meeting other clinical criteria were excluded because their type 2 diabetes required different clinical management. Of the patients identified as eligible, 42% were enrolled (213) and 77% of those enrolled completed the study and were included in the analyses.

The intervention was a patient-coaching system and provider clinical decision support ( AquataliaLandon PqzuIukO
). The patient-coaching system included a mobile diabetes management software application and a web portal. The mobile software allowed patients to enter diabetes self-care data (blood glucose values, carbohydrate intake, medications, other diabetes management information) on a mobile phone and receive automated, real-time educational, behavioral, and motivational messaging specific to the entered data. The patient web portal augmented the mobile software application and consisted of a secure messaging center (for patient-provider communication), personal health record with additional diabetes information (e.g., laboratory values, eye examinations, foot screenings), learning library, and logbook to review historical data. The provider portal had different views of patient data on the basis of study group assignment. The data-only view (group 3, CPP) allowed providers to access unanalyzed patient data. Group 4 (CPDS) providers had access to analyzed patient data linked to standards of care and evidence-based guidelines.

Patients received a One Touch Ultra 2 (LifeScan, Milpitas, CA) glucose meter and supplies. Patients in the three active treatment groups received identical study materials: mobile phones, 1-year unlimited data and service plan, study mobile diabetes management software, and access to the web-based patient portal. The mobile diabetes management software incorporated over 1,000 automated self-management messages into a feedback algorithm. The algorithm displayed educational and motivational messages to patients after patients self-reported data into the mobile phone application ( Vionic with Orthaheel Technology Lorne Heeled Slide Womens nuLw6R
). Diabetes educators were “virtual” case managers that intermittently reviewed patient data. Educators could supplement automated messages with electronic messages sent to the patient portal. Educator messages were based on longitudinal data trends. Patients in all three treatment groups were allowed to make telephone calls to educators but were encouraged to communicate electronically. On average, <50% of active patients made or received live phone calls, with an average of one phone call per month. Lastly, patients received an electronic action plan every 2.5 months to support improved diabetes self-management and to serve as previsit summaries for physician office visits. Providers were not informed of the level of communication to patients but knew whether patients were assigned to an intervention or to the UC group.

All providers received the most recent American Diabetes Association guidelines for diabetes care and were notified when patients enrolled in the study ( Sperry Pier View Stripe eOr6X6Lfnc
, Dr Scholls Fierce Original Collection Tqbr9ntuJq
). Providers assigned to UC were asked to care for patients as usual. Active treatment providers were informed that their patients received a mobile and web-based patient–coaching system. Providers in the CO group received data from their patients if patients chose to share it. Providers in the CPP and CPDS groups were trained on accessing the provider Internet portal on office compatible computers (PCs), allowing visual access to patients’ unanalyzed data. Providers in the CPDS group were trained on accessing the provider Internet portal to view patient data on office PCs and also received quarterly reports (more often if needed) that summarized patients’ glycemic and metabolic control, adherence to medication, self-management skills, and relevant evidence-based guidelines. Reports were accessible by Internet portal or facsimile. Enrolled providers were reimbursed modestly for research effort ($250 per patient enrolled).

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Is China a developed country?
Is China a developed country?
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Is China a developed country? Lucky Brand Makenna VP7SjK

Highly developed countries are often able to effectively convert their power resources into desired outcomes,but determining what exactly constitutes a developed country is subject to debate. The World Bank considers countries with a per capita income of less than $12,275 as developing countries. According to the World Bank, China’s per capita nominal GDP was $7,594 in 2014, which ranked 79th among 183 countries. Yet in other ways, China might be considered a developed country. Over 97 percent of Chinese have access to tap water and over 95 percent of Chinese over the age of 15 can read and write. Additionally, 95 percent of the Chinese population owns a mobile phone.

What do the experts think?

David M. Lampton

Hyman Professor and Director of SAIS-China and China Studies at Johns Hopkins SAIS, Chairman of the Asia Foundation

Jeremy Wallace

Associate Professor in Cornell University's Department of Government

Björn Conrad

Vice President of the Mercator Institute for China Studies

As of June30, 2014, Bank cumulative lending (IBRD and IDA) to China was about $54 billion for 376 projects . The portfolio is concentrated in environment, transportation, urban development, rural development, energy, water resources management, and human development.

Wallace: In many ways China is both a developed and a developing country… the vast majority of Chinese people are poor. . . . Yet, because China is such a huge country it is still the case that there are huge number of rich people in China. There are more rich people in China than there are people in the United Kingdom. Watch

Lampton: Precisely what makes China a difficult policy problem is that it’s both. . . . In important respects China is a developing country. A developed country has institutions; political institutions among the most important of which are succession institutions. China really has no well-accepted, describable, constitutionally grounded succession process. Watch

Thomas et al. [ Walking Cradles Keaton Loafer Womens I2NJ84RsIZ
] hypothesized that the inconsistent association between subsequent shock and clinical outcome may be caused by different etiologies of CA. In a subsequent study, Goto et al. [ Bruno Magli Lansdale W0SMPBt
] tested for an association of altered clinical outcomes with subsequent shock including presumed cardiac cause or not as a covariate, which was collected by EMS personnel; they reported an association between presumed cardiac cause and increased 1-month favorable outcomes (OR, 1.28; 95 % CI, 1.20–1.37). In their discussion, they also pointed out the insufficiency of relevant information to analyze etiologies more precisely owing to their prehospital-based dataset [ 17 ]. Etiologies in the current study were precisely collected by physicians; cardiac etiology was significantly associated with increased 1-month favorable neurological outcome in initially nonshockable rhythms ( P = 0.028; OR, 1.82; 95 % CI, 1.07–3.09) (Table 3 ). Moreover, the cardiac etiology was significantly associated with increased prevalence of subsequent shock (Table 4 ), suggesting that cardiac etiology is likely to be of importance in patients with initially nonshockable rhythms.

This study has some limitations. First, the integrity and validity of the data, unmeasured confounders, as well as ascertainment bias are potential limitations of our observational study. The use of uniform Utstein template data collection, which was developed by international experts, and the large sample size should minimize these potential sources of bias. Second, this study was hospital driven but was not a population-based study; therefore, our findings might not be representative of all hospitals or other local regions. However, the large number of participating hospitals should minimize this limitation. Fourth, as in previous studies [ 11 , 12 , 14 , Skechers Ultra Flex Sneaker Womens osykS5OB
, 16 ,
17 ], we tested for an association of altered clinical outcome with EMS shock delivery, which is a surrogate indicator of rhythm conversion of nonshockable rhythms to VF/ pulseless VT. In real-world emergency situations, there are inevitably some violations of protocol or just mistaken rhythm identifications. Even though the EMS providers used semiautomated external defibrillators during the EMS resuscitation, there was a very small possibility that inappropriate shocks were given. The significant association of altered clinical outcome with EMS shock in this study is thus not likely to prove the association of rhythm conversions with altered outcome.

In this study of CA patients with initially nonshockable rhythms, patients who received early defibrillation by EMS had increased 1-month favorable neurological outcomes. In patients with initially nonshockable rhythms, cardiac etiology, younger age, witnessed arrest, and initial PEA rhythms were associated with increased subsequent shock.

In this study of cases of initially nonshockable CA rhythms, patients who received subsequent shock by EMS providers had significantly increased 1-month favorable neurological outcomes compared with those who received no subsequent shock.

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