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Ben Chilwell has revealed that he and Chelsea team-mate Reece James have been bitten by the chess bug.

England defender Chilwell has admitted things are extremely tough at the moment due to the coronavirus pandemic restricting peoples movements andinteractions, andimpacting on their daily lives.

He admits to being in a fortunate position as his job as a professional footballer allows him to go to training every day and interact with friends and team-mates.

While footballers are in a fortunate position, they too are living under Covid-19 restrictions and Chilwell says he is doing different things to ensure his mind remains stimulated.

Chess is one activity that has captured Chilwells imagination. While the standard is unlikely to be on a par with Beth Harmon of The Queens Gambit, it appears the defender and fellow Chelsea star James take it pretty seriously.

"Obviously it's a very tough time at the moment," Chilwell told the Premier League's website. "I'm in a very fortunate position where I am able to come into work and see my friends and do what I enjoy, but there are a lot of people not in that position and are stuck at home with nothing to do.

"There are a few things I've found to keep myself busy [after training] ... activities that are really going to challenge your brain and keep you interested through very tough times.

"Me and Reece James play online chess against each other quite a lot. He wins a few, I win a few. We played a game on the way back from Russia in the Champions League. I think it was one game, but it took four hours - the whole flight!

"I actually asked my mum for some chess books and a chess board for Christmas! That has obviously helped me."

While there isnt another trip to Russia on the horizon for James and Chilwell to sharpen their chess games, Chelsea do travel to Atletico Madrid in the UEFA Champions League on February 23 - which should hand them the opportunity to play.

The focus this week for the pair is a trip to Premier League title contenders Leicester on Tuesday.

See the article here:

Reece James and I played chess for four hours on the way back from Russia! - Chelsea's Chilwell - Goal.com

OVER 2.1 million live views and an average of almost 70,000 viewers watching a game of chess?

Thats the kind of draw the Botez sisters command on Twitch, an online streaming platform. While Twitch is more known for hosting gaming streams (its most popular streamer is Tyler Ninja Blevins, who usually plays Fortnite and Valorant), its also become a haven of sorts for a new generation of tech-savvy, esports-influenced chess players.

Continue reading below

Today we became the chess stream with the most concurrent viewers of ALL TIME, tweeted Alexandra Botez this week. Both the World FIDE Master (WFM) and her sister Andrea hosted BlockChamps, a six-hour chess-meets-Minecraft stream that had popular streamers Pokimane and LilyPichu as guests.

Continue reading below

Recommended Videos

The chess games were also run concurrently on a Minecraft server, with 1,000 players enthusiastically logging in with their block-like characters to watch the matches.

Continue reading below

In their streams, the Botez sisters combine a funny, engaging patter (plus a healthy dose of meme culture) with a seriously beginner-friendly approach to chess. They even got to tutor Game of Thrones actor and Worlds Strongest Man Hafthor The Mountain Bjornsson.

They bring some legit chess chops to the table, too. According to FIDE, 25-year-old Alexandra is currently ranked #2020 in the world, and #169 among active players in her home federation of Canada. According to a profile by the New York Posts Kirsten Fleming, her father taught her the sport at the age of six.

Continue reading below

At eight years old, she already won a national championship. At 15, she won the US Girls National championship. Alexandra enrolled at Stanford University and became the chess clubs first female president. She attained her WFM rank in 2013.

Her 18-year-old sister Andrea does not yet boast international chess credentials.

Like many in the chess orbit, their viewership numbers got a big bump from The Queens Gambit, the immensely popular show on Netflix.

In the beginning of 2020, they only had 61,000 followers on Twitch. They now have more than 581,000. Their YouTube account, BotezLive, has 237,000 subscribers.

Continue reading below

Chess exploded on Twitch, and I was one of the top streamers. I remember being so excited, I couldnt sleep. I was so high on adrenaline, Alexandra told the New York Post.

The sisters popularity on Twitch is emblematic of a new generation of digital savvy chess players whove seized upon the tactics of esports players streams, memes, and all to pump some Gen Z energy into the ancient sport.

In fact, the Botez sisters signed on with esports organization Team Envy last December.

Continue reading below

The Botez sisters are the most entertaining creators in chess right now, and theyve played a major role in popularizing the game on Twitch, said Andrew Peterman, chief content officer at Envy Gaming, in a statement on Chess.com. Signing Alexandra and Andrea to launch our new Envy creator network is about much more than chess, however. Its about giving people access to the personalities that represent the future of entertainment.

They are, surprisingly, not the most popular FIDE ranked streamer on the platform.

In terms of follower count, they are dwarfed on Twitch by Hikaru "GMHikaru" Nakamura, a FIDE Grandmaster who has more than 857,000 followers.

Read more:

Who are the Botez Sisters, one of chess's most popular streamers? - Sports Interactive Network Philippines

Video games are weird. I dont just mean in the traditional hey look at this wacky nonsense over here way either. The development of games and entire genres can be just as crazy as the games that come from them. Nowhere is this more true than with modding. A mod of a game can become a new mode. That mode can become a new game. Then that game can become a genre. In the case of MOBAs however, that genre became a powerhouse. Auto Chess MOBAis the next step in the development ouroboros.

For those unaware, this all really started withWarcraft 3. While it may be hard for some of you to believe, there was a time whenWarcraftwasnt an MMO. All joking aside, whenWarcraft 3 came out, just like withStarcraft before it, the modding scene was huge. One such mod of the game had players controlling one single hero instead of an army of grunts, and facing off against another players group of heroes. Sound familiar? Well this mod became known as Defense of the Ancients, orDotA.

Flash forward a few years and DotAis its own franchise, while Riot Games has the equally popular League of Legends franchise. Even Blizzard tried to jump on the MOBA bandwagon with Heroes of the Storm, although it achieved far less success than its contemporaries. Modders werent content to stop there though, no way. Soon enough a new game type emerged from DotA 2 calledDotA Auto Chess. In this game mode, players place their heroes on predetermined paths and have them fight automatically like a hybrid of Poker and Chess.

Thus was the birth of the autobattler. Shortly after, the games industry did what the games industry does best, and a plethora of imitators emerged. Riot Games came out with Teamfight Tactics, Valve created DotA Underlord, and Blizzard even added a autobattler type mode to its TCGHearthstone. Well, the team who originally created DotA Auto Chess went out to make its own version of the game, but unattached to the DotA franchise. Thus,Auto Chess was brought into the world. This brings us full circle to now. Publisher Dragonest and developer Drodo Studio, the creators of Auto Chess, have announced a MOBA based on Auto Chess, the aptly titledAuto Chess MOBA.

A game based on a game based on a mod based on a game based on a mod. Confused yet? Well, all you need to know is that all of the heroes in Auto Chess MOBAwill be completely free, the game will have no paid rune system, and will feature a day and night cycle as well as destructible objects. There is no word yet on when exactly this game will drop, but you can keep an eye on the Auto ChessTwitter page as more updates become available. If you want to see where it all (kinda) started, you can get Auto Chess right now via the Epic Games Store.

Continued here:

Auto Chess MOBA is a new MOBA based on Auto Chess - PC Invasion

New Years resolutions are often thought of as individual self-improvement goals that frequently include aspirational health and wellness, financial discipline, habit forming or breaking, and similar goals. But these aspirational, improvement-focused goals do not need to be limited to personal goals. In fact, the New Year, New You mantra applies equally to the business world. The new year is a great time to push the reflect and reset button and to use the results of this reflection to accomplish business goals, including goals related to the companys trademark portfolio. Finding time in the new year to conduct reflection in the form of an in-depth review of your trademark portfolio (often referred to as a trademark audit) can be a meaningful and important exercise for a number of reasons, including ensuring there are no significant gaps in coverage or other issues associated with your trademark portfolio that could negatively impact your business, such as compliance issues with requirements and deadlines for maintaining trademark rights, chain-of-title concerns, or improper use of trademarks that could impact the companys rights. In addition, an audit, when performed correctly, can also provide a critical roadmap for the company for its trademark portfolio going forward.

Some important considerations to keep in mind for trademark audits include:

Whatever the form, a trademark audit can be a powerful tool and should be part of your companys New Years resolutions.We hope you fulfill both your personal and business-related New Years resolutions.

Excerpt from:
New Years Resolutions Dont Have to Be about Weight Loss: Why Conducting a Trademark Audit Should Be Part of Your Companys New Years Resolutions - JD...

Introduction

Diabetes mellitus refers to a severe global public health concern. As revealed from the International Diabetes Federation (IDF), 9.3% of adults worldwide are subjected to diabetes, of which 79.4% live in underdeveloped nations, and nearly 90% developed type 2 diabetes mellitus (T2DM).1 In addition, 12.8% of adults have been reported to suffer from diabetes mellitus in mainland China.2 Diabetes patients may develop various chronic and acute complications (eg, cardiovascular diseases, renal diseases and diabetes ketoacidosis), and it was estimated that health expenses related to diabetes were 760 billion US dollars in 2019 globally and 109 billion US dollars for China, which has imposed a significant economic burden on society.1 Thus, proper disease management covering the glycemic control and blood pressure and blood lipid control with a series of self-management behaviors (eg, sensible diet, regular exercise, self-monitoring, as well as adherence to taking medicine according to physicians advice) is crucial for diabetes patients.

A good diabetes education program is capable of sufficiently motivating patients to develop self-management behaviors, improve the blood sugar levels of patients and reduce the risk of chronic and acute complications.3 The structured education, for its standardized, practicable and replicable characteristics, has been recommended by the global and national guidelines to help patients manage diabetes.47 Diabetes education in mainland China has long been unsatisfactory, and the study on structured education for diabetes patients in the nation remains preliminary.8,9 To our best knowledge, a nurse-led structured education program developed by our research team previously, recognized as the first well-designed program for Chinese T2DM patients not on insulin therapy, has been confirmed to be feasible and acceptable.8,9 Subsequently, the structured education program was supplemented by complying with self-efficacy theory, and a six-month follow-up multicenter randomized control trial was performed, with the positive results of metabolic outcomes and psychosocial aspects,10 thereby strongly evidencing the effectiveness of the self-efficacy-focused structured education program (SSEP) among Chinese T2DM patients. However, as with some other studies on diabetes education,1113 the short-term effect rather than the intermediate- and long-term effect of the SSEP was identified.

Moreover, as indicated from a systemic review and meta-analysis, a self-efficacy-focused education program may positively impact blood sugar level and psychosocial indicators in the short term (36 months) follow-up.14 However, several studies reported that the effect of diabetes education lasted only 36 months, and it would attenuate subsequently;1518 for instance, a meta-analysis of 16 randomized contrail trials reported that the HbA1c improvements in the 36 months, 612 months and above 12 months reached 0.49%, 0.44% and 0.07%, respectively.16 Thus far, what the intermediate- and long-term effects of the SSEP for Chinese T2DM patients are remain unclear. Thus, this study aimed to assess the benefits of SSEP among T2DM patients not on insulin at a twelve-month follow-up.

The research refers to a robust multicenter, parallel, superiority, randomized controlled trial performed in four hospitals in China. The four hospitals, with levels not above grade III-B, were chosen by convenience sampling. The study was conducted from April 2017 to December 2018, and the recruitment of participants was conducted between April to November 2017. Patients were recruited if diagnosed with T2DM, aged between 1875 years, with their HbA1c in the past 12 weeks no less than 7.5%, as well as not on insulin in the past three months. Patients being pregnant or preparing for pregnancy, with psychological problems or cognition disorders, or developing severe diabetes complications, or participating in other researches if they reported or the nurses or the physicians registered were excluded here. The sample of the original study was calculated based on a standard deviation of HbA1c (1%) in the target population, an inter-group difference (0.4%), the two-tailed power (0.8), alpha (0.05) as well as attrition rate (20%). So, one hundred and nineteen patients were required in each group respectively after calculation.

The recruitment of participants was completed by a physician and research nurse in each hospital. The research nurse, acting as the coordinator of the research in each hospital would explain the research aim, process, risks and benefits and others to the patients after they were referred from the physician. Subsequently, the patients would be registered and included by research nurses after they agreed to be recruited by the study. The block randomization with blocks of eight was conducted at the patients individual level to split the patients at a ratio of 1:1 to an intervention or control group. The random allocation sequence generated with programming of SPSS 17.0 (Armonk, NY: IBM Corporation) by the researcher was sealed in opaque envelopes. The research nurse was charged with grouping. When the recruitment number of patients reached eight, each patient got a serial number, and the research nurse opened an opaque envelope to figure out the group the patients belonged to. All the research staff in the respective center received the training before research began as well as the monitoring by the central researchers every three months. The details of trial design, research sample, participants, recruitment and enrolment, randomization methods, intervention, outcome measures, quality control and others were previously reported in the other publication.10

The development of the SSEP complied with the guidelines of T2DM in China, related literature and the findings of patients needs assessment.8,19 In addition, SSEP followed a sound theoretical foundation.8,19 It abided by a series of educational theories, ie, the basic principles of curriculum and instructions by Tyler, the taxonomy of educational objectives, as well as the principles of adult learning.8,19 Subsequently, SSEP was further founded on self-efficacy theory based on a series of existing studies.8,10,14,20 The SSEP was composed of four structured curriculums and regular follow-ups. The program consisted of a written curriculum, and it was delivered by the trained registered nurses and physicians to ensure the quality of a range of research centers. SSEP was delivered in a group format (with 48 patients in the respective group), one time per week and continued in four weeks, and the one group education would begin when the number of group members reached 48 patients after the recruitment and grouping were completed. After the four-week modules, patients received follow-ups by face to face/telephone format every three months. The contents of follow-up covered the patients self-management behaviors aspects and individualized problems posed by the patients.21 Each module lasted for nearly 6090 min, and each follow-up was basically 1015 min. The program aimed to promote patients recruited in the learning, motivate patients to change, develop and sustain self-management behaviors by primarily stressing the enhancement of patients self-efficacy. Moreover, the contents of the structured curriculums and the program training were reported elsewhere.10

The control group received the routine education reported in an existing study.10 This primarily covered the individual face-to-face diabetes education presented by physicians during each medical clinic visits, as well as the conventional class education delivered by physicians and nurses per month. In addition, the follow-up/3 months was offered by nurses via face-to-face/telephone.

The metabolic and psychosocial outcome indicators were measured at baseline, three, six- and twelve-month follow-ups when the patients received medical visits in the clinics. The indicators of the plasma lipid profile were only measured at baseline, six- and twelve-months. All the outcome measures were completed by the trained nurses in the respective research center. Metabolic outcomes covered HbA1c, weight, body mass index (BMI), waist circumference (WC), blood pressure (systolic pressure, BP; diastolic pressure, DP), as well as plasma lipid profiles (triglycerides, TG; total cholesterol, TC; high-density lipoprotein cholesterol, HDL-C; low-density lipoprotein cholesterol, LDL-C). HbA1c referred to the primary outcome, and the other indicators were the secondary outcomes in the study. The indicators in the intervention group (IG) and control group (CG) were investigated at the identical time point. HbA1c and plasma lipid profiles were drawn from the medical records in four hospitals. Weight, height, waist circumference and blood pressure were manually measured with the identical instruments.

Moreover, psychosocial outcomes included diabetes self-efficacy (DSE), diabetes self-management (DSM) behaviors, diabetes knowledge and diabetes distress, which were evaluated by employing the validated Chinese version scales or questionnaires. The DSE was assessed based on a nine-item and five point Likert-type scale of Self-efficacy for Diabetes, as translated by Wei et al.22 DSM behaviors were evaluated according to a eleven-item and eight point Likert-type scale of the Summary of Diabetes Self-Care Activities, which was validated by Wan et al.23 The diabetes knowledge was measured by employing a ten-question Diabetes Knowledge Questionnaire, which was translated by Liu et al.24 Diabetes distress was assessed by using a seventeen-item and six point Likert-type scale of Diabetes Distress, as validated by Li et al.25 The indicator measurements were further elucidated in the previous publication.10 Furthermore, the basic demographic information of participants (eg, age, gender, marital status, employment status, educational level, individual monthly income and medical insurance) and diabetes-related information (eg, T2DM duration, years of taking medicine, diabetes medication use and diabetes-related complications) were collected by employing the self-designed questionnaire at baseline. The diabetes medication use was also collected at 12-month follow-up point.

The study was confirmed to comply with the guidelines outlined in the Declaration of Helsinki. The research was authorized and managed by the Review Board of Peking University (IRB0000105217031). Moreover, it was registered in China (ChiCTRIOR17011007). The study was initiated after the ethical approval and the official admission letters were gained from each research center. Furthermore, the informed consent was conducted by the research nurse, and all the participants signed the written informed consent forms after agreeing to be recruited by the study.

The data analysis was conducted with SPSS 25.0 (Armonk, NY: IBM Corporation) and base on intention to treat (ITT). Descriptive statistics were adopted to present the demographic characteristics of the participants. Inferential statistics covered independent t-test and chi-square tests to determine consistency of the demographic characteristics, diabetes-related information and the comparison of diabetes medication use. Robust generalized estimation equations with an unstructured form were exploited to process the repeated measurement data. The variables of group and measurement time were fitted as a major effect as well as an interaction, and baseline data were adjusted in all estimating models. The missing data for the indicators of TC, TG, LDL-C and HDL-C were assumed randomly lost, and they were not substituted. The value of P, below 0.05, was considered statistically significant.

Two hundred and sixty-four of 265 patients received the 12-month follow-up. One patient was lost during the follow-up due to falling to their death and the data in the 12th month was substituted by the last follow-up time. In addition, the data of HbA1c, weight, waist circumference, blood pressure, diabetes knowledge, diabetes distress, diabetes self-efficacy and DSM behaviors were collected from 264 patients. Moreover, the data of TC, TG, HDL-C, and LDL-C in the 12-month were collected from 207, 207, 204, and 203 patients, respectively. Furthermore, this study, focusing on the 12-month follow-up time point, is a part of studies on the topic of the self-efficacy-focused structured education program. In the existing study,10,21 the demographic characteristics, and the comparisons of age, gender, marital status, education level, employment status, individual income, medical insurance, years of taking medicine, medication use and diabetes complications that was comparable between the two groups were reported. The flowchart of the participants is displayed in Figure 1.

Figure 1 The flowchart of the participants.

The interaction effect of group by time for the primary outcome of HbA1c was significant (P < 0.001). And the main effect of time, and the main effect of group were significant (P < 0.001). In comparison with the control group, HbA1c in the intervention group was ameliorated significantly (1.13%, 95% CI: 1.42%, 0.83%, P < 0.001) with considering the baseline, measurement correlation, and the interaction effect of group by time. The variations in the primary outcome of HbA1c during the 12-month follow-up are listed in Table 1.

Table 1 Changes in Metabolic and Psychosocial Outcomes of Patients with T2DM at 12 Months

The interaction effects of group by time for weight, BMI, WC, TC and TG were significant (P < 0.01), whereas these were not significant for HDL and LDL (P > 0.05). The main effects of time for weight, BMI, WC, TC and TG were significant (P < 0.01), whereas these were not significant for HDL and LDL (P > 0.05). The main effects of group for weight, BMI, TC, TG and HDL were not significant (P > 0.05), whereas these were significant for WC and LDL (P < 0.05). As opposed to the control group, the secondary outcomes of WC, TC, and LDL-C were clearly improved (3.14 cm, 95% CI: 4.91 cm, 1.36 cm, P = 0.001); (0.30 mmol/L, 95% CI: 0.58 mmol/L, 0.03 mmol/L, P = 0.032); (0.25 mmol/L, 95% CI: 0.44 mmol/L, 0.07 mmol/L, P = 0.008) respectively after the baseline, measurement correlation, and the interaction effect of group by time were considered. The non-significant difference in the other secondary indicators of weight, BMI, systolic pressure, diastolic pressure, TG and HDL-C were identified between the two groups (P > 0.05). The variations of the other metabolic outcomes during the 12-month follow-up are listed in Table 1.

The interaction effect of group by time, the main effect of time and the major effect of group for psychosocial outcomes were significant (P < 0.001). As compared with the control group, an obvious increase in the indicator of diabetes knowledge was observed (mean (SE): 6.79 (0.26) vs 3.37 (0.29), 3.42, 95% CI: 2.91, 3.92, P < 0.001), and the indicator of diabetes distress was detected to decrease significantly in the intervention group (mean (SE): 25.58 (1.31) vs 30.55 (1.31), 4.97, 95% CI: 7.10, 2.83, P < 0.001) after considering the baseline, measurement correlation, and the interaction effect of group by time. The differences in the indicators of diabetes self-efficacy and DSM behaviors between the two groups also exhibited statistical significance (mean (SE): 4.42 (0.09) vs 3.55 (0.10), 0.87, 95% CI: 0.67, 1.06, P < 0.001); (mean (SE): 43.28 (1.66) vs 32.61 (1.75), 10.67, 95% CI: 7.64, 13.70, P < 0.001), respectively after considering the baseline, measurement correlation, and the interaction effect of group by time. Table 1 lists the variations in psychosocial outcomes during the 12-month follow-up.

The glycemic control for both intervention and control groups in the 3rd, 6th and 12th months during the 12-month follow-up were achieved improvements. As compared with the regimens of antihyperglycemic drugs (AHDs) in baseline, 54 (40.60%) in the intervention group maintained the same treatment regimen; 36 (27.07%) had a decrease in the use of antihyperglycemic drugs (AHDs) or use of the less effective AHDs; 43 (32.33%) had an increase in the use of AHDs or use of the more effective AHDs after 12 months. While 65 (49.24%) in the control group had not changed the treatment regimen; 25 (18.94%) decreased the AHDs usage, or changed to an AHD with weak effect; 42 (31.82%) increased the AHDs usage, or changed to an AHD with strong effect. And among them, there were five patients in the intervention group and the control group in the 12th month of the 12-month follow-up who started using insulin therapy, respectively. There was no significant difference in the medication use of diabetes between the two groups (P > 0.05).

As revealed from this study, a self-efficacy-focused structured education program (SSEP) can improve metabolic outcomes (eg, HbA1c, waist circumference, total cholesterol and low-density lipoprotein cholesterol), as well as psychosocial outcomes (eg, diabetes self-efficacy, diabetes self-management behaviors, diabetes knowledge and diabetes distress) until a 12-month follow-up. The noteworthy finding is that the improvement of HbA1c increased slightly. Besides, an unsatisfactory result is that the diabetes self-management behaviors were found to start to attenuate in the 12th month of the 12-month follow-up.

Previously, HbA1c difference at the 6-month between the intervention group and the control group was 0.740% (95% CI: 1.045%, 0.434%).10 The 12-month study increased slightly in the difference between the two groups (1.13%, 95% CI: 1.42%, 0.83%). This was superior over the findings of the existing studies on diabetes education.1518 As demonstrated from the result of the current study, the effect of the program on HbA1c could sustain until 12 months, and the effect on HbA1c was improved, which could be explained by three reasons. First, SSEP refers to a well-designed program with a structured format and theoretical driven principle. As suggested by a systemic review and meta-analysis, a program supported with structured curriculum and theory would achieve satisfactory results in blood sugar level.16 Besides, SSEP is patient-centered, culturally sensitive, by complying with on need assessments of patients and offering regular follow-up, which applies to T2DM patients in mainland China. Second, better DSM behaviors were associated with a lower blood sugar level. The intervention that is self-efficacy focused is capable of enhancing the self-efficacy of patients, and then further promoting patients to develop and maintain the DSM behaviors. Third, diabetes distress shows a close relation to cortisol or glycemic control,26,27 so the decrease in diabetes distress may be conducive to the patients glycemic control by improving the secretion of cortisol. Moreover, the diabetes medications in the 12th month of the 12-month follow-up were also analyzed, and the non-significant difference was identified between the two groups. Accordingly, the effect of medication use difference on HbA1c can be excluded. According to the UK prospective diabetes study, the improvement of HbA1c would mitigate the diabetes-related complications and premature death considerably,28 which would save considerable health expenditures.

The indicator of WC in the intervention group improved significantly in comparison with the control group. This is inconsistent with the existing studies on diabetes education.29,30 The improvement of WC might facilitate glycemic control by ameliorating insulin resistance. It was reported that WC has a close relationship with glycemic control. It was reported that compared with the T2DM patients without central obesity (< 80 cm in female and < 85 cm in the male), the insulin resistance of T2DM patients with central obesity (80 cm in female and 85 cm in the male) was more inadequate, thereby leading to high glycemic control.31 In addition, a study found that regional adipose tissue was a valid predictor of insulin resistance.32 The improvement of WC may help improve glycemic control by reducing the insulin resistance. Thus, this is probably why the indicator of HbA1c can sustain in the 12-month follow-up here. In comparison with the control group, visible improvement of TC and LDL-C was achieved in the intervention group in the 12th month, which was not observed in the 6th month. Satisfactory results in the intervention group might be attributed to the improvement of DSM behaviors, especially in the aspect of diet, and the longer term follow-up. Besides, existing studies suggested that insulin resistance and insulin dysfunction were the leading causes of dyslipidemia.33,34 The improvement of WC can alleviate insulin resistance to some extent and then facilitate the blood lipid control (eg, the TC and LDL-C). Specific to the other indicators of weight, BMI, blood pressure, TG and HDL-C, the improvements were observed in the intervention group, whereas non-significant difference was identified between the two groups.

In addition, the psychosocial outcomes of diabetes self-efficacy and DSM behaviors between the intervention group and the control group in the 12th month during the 12-month follow-up remained significant. The program was self-efficacy focused and applied a series of self-efficacy promoting strategies after finding self-efficacy as a promising point for intervention.10,20 Thus, the patients diabetes self-efficacy kept increasing. In accordance with self-efficacy theory,35 self-efficacy is a crucial predictor of human behaviors. As a result, DSM behaviors during the 12-month follow-up improved obviously. The results effectively evidenced the benefits of the SSEP in the indicators of diabetes self-efficacy and DSM behaviors in the 12th month during the 12-month follow-up. Furthermore, the mean score of DSM behaviors at the 12-month follow-up was slightly declining compared with the mean score at 6-month follow-up. It was therefore indicated that some other factors are affecting the persistence of DSM behaviors, so these factors should be determined and considered in the improvement of the SSEP.

In addition, the difference in the psychosocial indicator of diabetes knowledge was also significant during the 12-month follow-up between the two groups. This was consistent with a randomized controlled trial on structured education.36 The positive result in the study was largely attributed to the knowledge SSEP provided and the regular follow-up. A novel finding in the study was that diabetes distress presented a positive result, inconsistent with the result in the 6-month study.10 The positive effect in the 12th month during the 12-month follow-up was primarily attributed to the intervention of SSEP, which was self-efficacy theory-based. By complying with the self-efficacy theory,37 physiological/emotional arousal refers to one of the sources of information affecting self-efficacy. Thus, SSEP is patient-centered and incorporated with relevant contents and strategies in the program to relieve the negative emotion of the patients. Besides, patients negative emotion may require a longer time to eliminate, and the improvement of glycemic control may mitigate the diabetes distress of patients in reverse.

The trial involved a robust design that strongly evidenced the intermediate- and long-term effect of SSEP. Moreover, the well-designed nature and the effectiveness of SSEP made it likely to be generalized in other similar populations and settings. Besides, the data analysis complied with ITT and using generalized estimating equations to minimize the reporting bias. In addition, several limitations were found. The first one was that the 12-month follow-up remained insufficient to determine the long-term sustained effect of SSEP. The other was that the program has not undergone health economic assessment, so the generalization of the program was restricted to some extent.

The group-based self-efficacy-focused structured education program continuously impacted the metabolic outcomes (eg, HbA1c, waist circumference, total cholesterol and low-density lipoprotein cholesterol) and psychosocial outcomes (eg, diabetes self-efficacy, diabetes self-management behaviors, diabetes knowledge and diabetes distress) for T2DM patients not on insulin over 12 months. It was therefore suggested that SSEP will be an effective education model capable of being generalized nationwide. In addition, the SSEP can be referenced for managing diabetes in low- and middle-income nations and regions. Specific to subsequent studies, the long-term effect exerted by the program will be determined in depth, and the cost-effectiveness analysis of the program should be conducted. Furthermore, a further improvement of the program is worth exploring to help patients maintain DSM behaviors and HbA1c.

The authors dont intend to share any data besides that which are included in the manuscript.

Many thanks to the physicians and nurses from Wuyishan Municipal Hospital in Fujian province, Peoples Hospital of Leping City in Jiangxi province, Yanhua Hospital in Beijing, and Jimenli Primary Hospital in Beijing. The authors also thank the two hundred and sixty-five participants.

The authors declare that the consort checklist was used as a guide to report the study (Supplementary File 1).

The study was supported by Hainan Provincial Natural Science Foundation of China (820RC631, 819QN229), Young Talents Science and Technology Innovation Project of Hainan Association for Science and Technology (QCXM202019), the Project of Science Research Project in Hainan University of Higher Education (Hnky2020-36), and Hainan Health Commission Health Industry Research Project (20A200286).

The authors declare no conflicts of interest.

1. International Diabetes Federation. IDF Atlas. 9th ed. 2019:2000.

2. Li Y, Teng D, Shi X, et al. Prevalence of diabetes recorded in mainland China using 2018 diagnostic criteria from the American Diabetes Association: national cross sectional study. BMJ;2020:m997. doi:10.1136/bmj.m997

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Originally posted here:
[Full text] The Effectiveness of a Self-Efficacy-Focused Structured Education Prog | DMSO - Dove Medical Press

Imagine it's 2045. You start hearing rumors from your well-heeled friends about a mysterious corporation based on an undisclosed island that's offering an unprecedented service: the ability to genetically design your baby.

The baby will have some of your genetics, and some genetics from a sperm or egg donor, selected by you. But the rest of your child's genetic profile will be engineered by science. These changes will make it impossible for your child to develop genetic diseases. They'll also allow you to customize your child for dozens of traits, including intelligence level, emotional disposition, sexual orientation, height, skin tone, hair color, and eye color, to name a few.

This raises unsettling philosophical questions for some customers. "When does my child stop being my child?" they ask the corporate representatives. These wary customers are reminded of how risky it is to reproduce the old-fashioned way. The Better Genetics Corporation's motto sums it up: "Only God plays dicehumans don't have to."

This is the world described in a new science-fiction series by Eugene Clark titled "Genetic Pressure", which explores the moral and scientific implications of a future in which designer babies are becoming a major industry. The first book begins with the story of Rachel, a renowned horse breeder who befriends a billionaire client, and soon gets the funding to visit the tropical island on which the Better Genetics Corporation is headquartered.

There, corporate executives walk her through the process of designing a babyan experience that feels like an uncanny mix between visiting a doctor and designing a luxury car. The series is told from multiple perspectives, serving as a deep dive into a complex moral web that today's scientists may already be weaving.

[T]he introduction of designer babies would create a labyrinth of philosophical dilemmas that society is only beginning to explore.

Case in point: In 2018, Chinese scientist He Jiankui announced that he had helped create the world's first genetically engineered babies. Using the gene-editing tool CRISPR on embryos, He Jiankui modified a gene called CCR5, which enables HIV to enter and infect immune system cells. His goal was to engineer children that were immune to the virus.

It's unclear whether he succeeded. But what's certain is that the experiment shocked the international scientific community, which generally agreed that it's unethical to conduct gene-editing procedures on humans, given that scientists don't yet fully understand the consequences.

"This experiment is monstrous," Julian Savulescu, a professor of practical ethics at the University of Oxford, told The Guardian. "The embryos were healthy. No known diseases. Gene editing itself is experimental and is still associated with off-target mutations, capable of causing genetic problems early and later in life, including the development of cancer."

Importantly, He Jiankui wasn't treating a disease, but rather genetically engineering babies to prevent the future contraction of a virus. These kinds of changes are heritable, meaning the experiment could have major downstream effects on future generations. So, too, would a designer-baby industry, even if scientists can do it safely.

With major implications on inequality, discrimination, sexuality, and our conceptions of life, the introduction of designer babies would create a labyrinth of philosophical dilemmas that society is only beginning to explore.

Read more:
Why it's important to admit when you're wrong - Big Think

As Joe Biden takes over as president, the issue of how to deal with Russia will be one of the defining aspects of his foreign policy. Much of the Russia debate in Europe and the United States in the last decade or so has focused on whether to reset relations with Russia. This debate has come in many guises: the 2009 initial Obama-Clinton reset; the EU-Russia partnership for modernisation; the German-led Meseberg Initiative of the early 2010s; the EUs offer of selective engagement with Russia in 2016; the 2019 French-led effort to engage Russia in dialogue after a summit in Breganon.

This focus creates the illusion of a policy pendulum oscillating between phases of engagement and diplomatic hostility. But a deeper trend has been taking hold that of Russia and the West each pursuing a policy of mutual weakening. This is likely to dominate Bidens presidency and the next decade.

Throughout much of the 2000s, Russia viewed its resurgence through the prism, and expectation, of rising energy prices, economic growth and modernisation, and the creation of globally powerful state companies selling strategic resources, wielding political influence by doing so. But the 2010s led to a complete shift of strategy. Hopes of economic modernisation were all but ditched. As its economy settled into its sclerotic ways, Russias route to power through growth disappeared.

As a result, Moscow has increasingly concentrated on, arguably, a shorter route to power revival, based much less on self-improvement and much more on the weakening of its geopolitical opponents. This has taken multiple forms: courting mainstream politicians, supporting and financing all kinds of extreme left or right political parties; online disinformation and propaganda, sometimes in support of specific political forces, and sometimes simply in support of encouraging political chaos.

All of this has been topped off by a policy of peeling off allies and friends of the West, including within NATO and the European Union. Russia has gone a long way to diplomatically and economically court Turkey and Hungary, which are both NATO member states. It has also sought to weaken the West wherever possible: in EU candidate country Serbia which recently announced the opening of a Russian military liaison office at its defence ministry; in the Central African Republic where Russia supplies mercenaries and a top security adviser to the countrys president; and in Libya, Syria, the Gulf countries, Egypt, Israel, and many other states. This policy has been reasonably successful from a Russian standpoint. But it has failed in one big respect that of preventing the West from responding in kind.

Throughout much of the 1990s and 2000s, the EU and US did not aim to weaken Russia in any sense. European and American interests certainly lay in the country not being as strong as the USSR, but they still wanted it to be stronger than in the 1990s. They did not want a large failed state with nuclear weapons, threaten to upset all kinds of geopolitical balances. In 2010, after the 2008 war in Georgia but in tune with Barack Obamas own reset, the EU and Russia even launched a partnership for modernisation, whose aim was clearly to strengthen Russia economically and politically, not weaken it. Of course, the military invasion of Ukraine and annexation of Crimea in 2014 put an end to that strategy. The US and the EU introduced sanctions on Russia and sought to isolate it diplomatically. At least for the EU, the initial goal of sanctions was not necessarily to weaken Russia, but to incentivise it to stop destabilising Ukraine. As Russia continued its destabilisation tactics there, sanctions stayed and have gradually evolved, somewhat unintentionally, into a tool of weakening Russia as well. With sanctions in place, the country certainly possesses not only fewer chances to modernise its economy but also less money to invest in its military or its allies. Russia is not short of cash, but the hostile environment it has created around itself forces it to accumulate a significant war-chest for the darker days it expects ahead. The situation certainly limits its geopolitical options and Russia has been increasingly stingy when it comes to financially supporting its allies.

As both Russia and the West engaged in strategies of mutual weakening, both have also weakened themselves. The rise of populists in the US, United Kingdom, and throughout the EU has done massive damage to the credibility, cohesion, and foreign policy capacity of the West.

This self-destructive streak in Western politics has been matched only by the self-destructive streak in Russia, where its leadership has subordinated the countrys resources and economic future to foreign policy and military goals throughout large parts of the world. For now, Russia has been better than the USSR at restraining its impulse to overstretch in foreign policy, but it has still been over-exposing itself at a pretty fast rate.

The Wests self-destructive streak has been matched only by Russias self-destructive streak.

The Kremlin has been obsessed with foreign policy to the detriment of pressing domestic matters it has run Russias political and economic systems dry in the process. Russia has enough resources to stay the course for a few decades, but the longer it does so the worse the hangover will be from its foreign policy adventurism.

As the Biden administration begins to discuss Russia strategy with its European allies, this mutual weakening will probably continue. Neither Russia nor the West seem on the verge of revising their approach. Opportunities to re-engage will arise, but for that to happen one side has to feel that it is losing the race. Alternatively, both sides simultaneously need to decide that the policy is failing and both need to change course. For now, that is unlikely.

Russia thinks it has been doing pretty well in foreign policy. And from a Western standpoint, several overtures to Russia in the last decade not have not really paid off. Multiple reset offers, the freezing of NATO enlargements to Ukraine and Georgia, the decade-long repudiation of humanitarian interventions as a guide to policy, and the softening of human rights promotion policies under the presidencies of both Obama and Donald Trump have not improved relations with Russia.

So the policy of mutual weakening is likely to dominate approaches on both sides under the Biden presidency and possibly beyond. The US State Department stated in mid-2020 that, when engaging with Russia (and China), we must work to help the United States and its allies run faster in that competition, as it were, and we must also help make those who seek to compete with us run more slowly. There is also plenty of scope for transatlantic cooperation when it comes to making the alliance run faster. The road to that is, of course, through domestic political and economic transformations, which are beyond the scope of this article. But when it comes to foreign policy, one way to outcompete your adversaries is not just by rekindling the transatlantic alliance itself. It will also need to involve investing much more resource in new security partnerships with selected states from the post-Soviet space or the Middle East, while also taking steps to limit Russias ability to peel off allies and partners of the West.

The European Council on Foreign Relations does not take collective positions. ECFR publications only represent the views of its individual authors.

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How Russia and the West try to weaken each other - European Council on Foreign Relations

We all have room to grow and become better, healthier, and happier versions of ourselves. Whether you're struggling to dismantle cultural norms that don't work for you, scared to make the career change you've been dreaming about, or have to work through trauma, there are so many inspiring self-improvement books to help you tackle the physical, mental, and emotional stumbling blocks in your way.

For decades, many of these texts have catered to a predominantly white audience, but increasingly writers of color with backgrounds in counseling, spirituality, business, and social justice have been scribing reads for marginalized communities in particular. Here, we've selected some of our favorite self-help books by Latinx writers that are at once insightful, affirming, valuable, and culturally relevant. In these pages, you'll gain guidance and practices to help you become a healthier and happier version of yourself.

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These Self-Help Books by Latinxs Are the Best Guides to Start the New Year Right - POPSUGAR

James Maddison does not give boring interviews.

The Leicester City midfielder provided one of the highlights of the season to date on Tuesday while talking to broadcast media after their 2-0 win over Chelsea (for those who cannot view the video and would like to see some of the transcript head here).

It was an insightful and entertaining conversation, watching a footballer speak without the monosyllabic answers and stock replies we are so used to hearing, and instead giving his true opinion on things. Maddison gave tactical information, describing a half-time switch where Leicester went to a bit of a 4-4-2 out of possession, 4-3-3 in possession. He credited his managers ethos, saying you dont play for Brendan Rodgers if you dont do the dirty work, while also namedropping Jack Lyons, an opposition-analyst at Leicester who started as a blogger before joining Rodgers set-up at Celtic.

It was yet...

Read more from the original source:
James Maddison: talented, engaging and the essence of the 2021 footballer - The Athletic