Opportunities for Promoting Physical Activity in Rural Communities by Understanding the Interests and Values of Community Members

PURPOSE

Physical activity (PA) has well-established health benefits, but most Americans do not meet national guidelines. In southeastern Missouri, trails have been developed to increase rates of PA. Although this has had success, broad-scale interventions will be needed to improve rates further. In this study, we surveyed residents of southeastern Missouri to identify ways to improve rates of PA.

METHODS

We conducted a telephone survey in 2015 of adults (n = 524) from eight rural Missouri towns that had walking trails, regarding their activities and interests.

FINDINGS

Forty percent of respondents reported both walking and meeting PA recommendations, 29% reported walking but not meeting PA recommendations, and the remainder did not walk or did not answer. Respondents who used the trails were significantly more likely to meet PA recommendations (odds ratio = 2.7; 95% confidence interval = 1.7, 4.5). Certain values and interests that may encourage PA or draw people to trails were common.

CONCLUSIONS

The group that walked but did not meet PA recommendations would be the ideal group to target for intervention, which could focus on their reported values and interests (e.g., personal relationships, being outdoors). Use of walking trails was associated with meeting PA recommendations.

Tuning the ferromagnetic phase in the CDW compound SmNiC2 via chemical alloying

We report a study on tuning the charge density wave (CDW) ferromagnet SmNiC2 to a weakly coupled superconductor by substituting La for Sm. X-ray diffraction measurements show that the doped compounds obey Vegard's law, where La (Lu) alloying expands (shrinks) the lattice due to its larger (smaller) atomic size than Sm. In the series Sm1-xLaxNiC2, CDW transition (TCDW = 148 K) for SmNiC2 is gradually suppressed, while the ferromagnetic (FM) ordering temperature (TC) at 17 K slightly increases up to x = 0.3. For x > 0.3, TC starts to decrease and there is no signature that could be related with the CDW phase. Electrical resistivity, magnetic susceptibility and specific heat measurements point toward the possible presence of a FM quantum critical point (QCP) near x = 0.92, where the TC is extrapolated to zero temperature. Superconductivity in LaNiC2 (Tsc = 2.9 K) is completely suppressed with small amount of Sm inclusion near the proposed FM critical point, indicating a competition between the two ordered phases. The tunable lattice parameters via chemical substitution (La,Lu) and the ensuing change among the ordered phases of ferromagnetism, CDW and superconductivity underscores that SmNiC2 provides a rich avenue to study the rare example of a FM QCP, where the broken symmetries are intricately correlated.

Urban Health Project: A Sustainable and Successful Community Internship Program for Medical Students

BACKGROUND

Urban Health Project (UHP) is a mission and vision-driven summer internship at the University of Cincinnati College of Medicine that places first-year medical students at local community agencies that work with underserved populations. At the completion of their internship, students write Final Intern Reflections (FIRs).

METHODS

Final Intern Reflections written from 1987 to 2012 were read and coded to both predetermined categories derived from the UHP mission and vision statements and new categories created from the data themselves.

RESULTS

Comments relating to UHP's mission and vision were found in 47% and 36% of FIRs, respectively. Positive experiences outweighed negative by a factor of eight. Interns reported the following benefits: educational (53%), valuable (25%), rewarding (25%), new (10%), unique (6%), and life-changing (5%).

CONCLUSIONS

Urban Health Project is successful in providing medical students with enriching experiences with underserved populations that have the potential to change their understanding of vulnerable populations.

Human rights of the mentally ill in Indonesia

BACKGROUND

The mentally ill are vulnerable to human rights violations, particularly in Indonesia, where shackling is widespread.

AIM

The aim of this study was to understand the provision of mental health care in Indonesia, thereby identifying ways to improve care and better support carers.

METHODS

Grounded theory methods were used. Study participants included health professionals, non-health professionals and individuals living with a mental disorder who were well at the time (n = 49). Data were collected through interviews conducted in 2011 and 2012.

RESULTS

The core category of this grounded theory is 'connecting care' a term coined by the authors to describe a model of care that involves health professionals and non-health professionals, such as family members. Four main factors influence care-providers' decision-making: competence, willingness, available resources and compliance with institutional policy. Health professionals are influenced most strongly by institutional policy when deciding whether to accept or shift responsibility to provide care. Non-health professionals base their decisions largely on personal circumstances. Jointly-made decisions can be matched or unmatched. Unmatched decisions can result in forced provision of care, increasing risks of human rights violations.

LIMITATIONS

Generalization of this grounded theory is difficult as the research was conducted in two provinces of Indonesia.

CONCLUSION

Institutional policy was important in the process of connecting care for the mentally ill in Indonesia and needs to be underpinned by legislation to protect human rights.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Strengthening mental health legislation in Indonesia will allow nurses to connect care more effectively.

PATHOME: an algorithm for accurately detecting differentially expressed subpathways

The translation of high-throughput gene expression data into biologically meaningful information remains a bottleneck. We developed a novel computational algorithm, PATHOME, for detecting differentially expressed biological pathways. This algorithm employs straightforward statistical tests to evaluate the significance of differential expression patterns along subpathways. Applying it to gene expression data sets of gastric cancer (GC), we compared its performance with those of other leading programs. Based on a literature-driven reference set, PATHOME showed greater consistency in identifying known cancer-related pathways. For the WNT pathway uniquely identified by PATHOME, we validated its involvement in gastric carcinogenesis through experimental perturbation of both cell lines and animal models. We identified HNF4α-WNT5A regulation in the cross-talk between the AMPK metabolic pathway and the WNT signaling pathway, and further identified WNT5A as a potential therapeutic target for GC. We have demonstrated PATHOME to be a powerful tool, with improved sensitivity for identifying disease-related dysregulated pathways.

Validation of international consensus guidelines for the resection of branch duct-type intraductal papillary mucinous neoplasms

Background

Classifications of intraductal papillary mucinous neoplasm (IPMN) remain ambiguous, especially for the mixed type. Factors predicting malignancy remain unclear. The aim of this study was to evaluate the usefulness of factors predicting malignancy in the new international consensus guidelines for resection of branch duct-type (BD)-IPMN and to compare them with those in the previous version.

Methods

A prospectively collected database of patients with biopsy-proven BD-IPMN was analysed to compare factors between the first and second consensus guidelines, particularly as predictors of malignancy.

Results

Of 350 patients with BD-IPMN, sensitivity (0·724) and balanced accuracy (0·751) of the second guidelines were superior to those (0·639 and 0·730) in the first version at the expense of slightly reduced specificity (0·779 versus 0·822 for the first version) by random forest models. Multiple logistic regression analysis showed that main pancreatic duct dilatation greater than 5 mm (hazard ratio (HR) 4·54, 95 per cent confidence interval 2·45 to 8·41; P < 0·001), mural nodules (HR 6·27, 3·27 to 12·01; P < 0·001) and carbohydrate antigen 19–9 level above 37 units/ml (HR 4·03, 1·83 to 8·90; P = 0·001) were independent predictors of BD-IPMN malignancy.

Conclusion

The new consensus guidelines provide better sensitivity, performance of factors predicting malignancy, and balanced accuracy in the diagnosis of BD-IPMN malignancy. Size alone was limited in predicting malignancy. Variability in clinical significance of the individual factors associated with a risk of malignancy indicates the need for a tailored approach in the management of patients with BD-IPMN.

Poor sleep in organ transplant recipients: self-reports and actigraphy

Solid organ transplant recipients are at increased risk of poor sleep due to pharmacotherapy and co-morbidities, but sleep problems are often unrecognized and untreated. Study aims were to measure rates of occurrence, characteristics, and correlates of poor sleep in recipients. The Pittsburgh Sleep Quality Index (PSQI) and sleep parameters measured by wrist actigraphy were obtained at baseline from 143 kidney, liver, heart, lung, or pancreas transplant recipients enrolled in a psychosocial intervention trial to improve symptoms and quality of life. Rates of poor sleep were determined using accepted clinical cutoffs; 41% (58 of 143) were poor sleepers (PSQI > 8) and 36% used sleep medications in the past month. Fifteen percent reported having obstructive sleep apnea (OSA) and 4% reported restless legs syndrome (RLS). Based on actigraphy (n = 73), 69% lacked sleep efficiency (SE), 32% took >30 min to fall asleep, 88% awakened during the night for more than 30 min, and 25% slept less than six h per night. Obesity and use of psychotropics or sleep medications, and pain were independent risk factors for poor objectively measured sleep. Poor sleep is an undertreated problem in transplantation. Screening for sleep problems and behavioral therapies with sleep hygiene instruction may benefit recipients.

The experience of weight gain as a result of taking second-generation antipsychotic medications: the mental health consumer perspective

This interpretive qualitative study aimed to describe and construct the meaning of the experience of living with the weight gain associated with second-generation antipsychotics. A qualitative study that incorporated the tenets of phenomenology and utilized in-depth interviews was conducted with eight mental health consumers. Thematic analysis resulted in three themes: Grappling with the weight; Living with the consequences of being overweight; and Experiencing negative emotions about the weight gain. The findings indicate that consumers struggle to manage the insatiable appetite and the related weight gain associated with second-generation antipsychotic medication, as well as the numerous associated physical and emotional issues. Adherence with prescribed second-generation antipsychotic medication was also affected and a number of the participants indicated they had ceased or considered ceasing their medication because of the weight gain associated with the drugs.

Conversion of twice-daily tacrolimus to once-daily tacrolimus formulation in stable pediatric kidney transplant recipients: pharmacokinetics and efficacy

The pharmacokinetics, efficacy and safety of once-daily tacrolimus formulation (Tac-OD) were assessed in 34 stable pediatric kidney transplant recipients. Enrolled patients received their dose of twice-daily tacrolimus formulation (Tac-BID) on study Days 0 through 7. On the morning of study Day 8, the total daily doses for patients were converted to Tac-OD on a 1:1 basis and maintained on a once-daily morning dosing regimen. Tacrolimus pharmacokinetic profiles were obtained on study Days 7, 14 and 28 (after dose adjustment). Although the mean C0 concentrations (4.10 ± 1.16-3.53 ± 1.10 ng/mL, p = 0.004), and AUC0-24 (151.8 ± 41.6-129.8 ± 39.3 ng h/mL, p < 0.001) were decreased significantly after a 1:1 based conversion, there was high interindividual variability. The dose of Tac-OD was decreased in 26.5% and increased in 44.1% of patients. The resultant tacrolimus dose and pharmacokinetic profiles on study Day 28 were comparable to those on Day 7. There were no serious adverse events. In conclusion, Tac-BID can be safely converted to Tac-OD in stable pediatric kidney transplant patients with the heightened therapeutic drug monitoring. Effects of drug conversion on the cardiovascular risk factors, neurological side effects and adherence should be further evaluated.

Neural transdifferentiation of human bone marrow mesenchymal stem cells on hydrophobic polymer-modified surface and therapeutic effects in an animal model of ischemic stroke

Human bone marrow-derived mesenchymal stem cells (MSCs) have multi-lineage differentiation potential and can become cells of mesodermal and neural lineages. These stem cells thus hold considerable clinical promise for the treatment of neurodegenerative diseases. For successful regeneration of damaged neural tissues, directed differentiation of neural or neuronal precursor cells from MSCs and integration of transplanted cells are pivotal factors. We induced MSCs into neurogenesis using a modified protocol. The therapeutic potency of the resulting neural progenitor cells in a rat model of ischemic stroke was analyzed. Using a highly hydrophobic diphenylamino-s-triazine-bridged p-phenylene (DTOPV)-coated surface and adopting a procedure for propagation of neural stem cells, we efficiently converted MSCs into neurosphere-like cellular aggregates (NS-MSCs). The spherical cells were subsequently induced to differentiate into neural cells expressing neuroectodermal markers. To determine whether these cells had neuronal fates and induced neuro-protective effects in vivo, NS-MSCs were intra-cerebrally administered to rats 48h after permanent middle cerebral artery occlusion (pMCAo). The results showed a remarkable attenuation of ischemic damage with significant functional recovery, although the cells were not fully incorporated into the damaged tissues on post-operative day 26. Improvement in the NS-MSC-transplanted rats was faster than in the MSC group and suppression of inflammation was likely the key factor. Thus, our culture system using the hydrophobic surface of a biocompatible DTOPV coating efficiently supported neural cell differentiation from MSCs. Neural-primed MSCs exhibited stronger therapeutic effects than MSCs in rat brains with pMCAo.

Electronic tuning and uniform superconductivity in CeCoIn5

We report a globally reversible effect of electronic tuning on the magnetic phase diagram in CeCoIn(5) driven by electron (Pt and Sn) and hole (Cd, Hg) doping. Consequently, we are able to extract the superconducting pair breaking component for hole and electron dopants with pressure and codoping studies, respectively. We find that these nominally nonmagnetic dopants have a remarkably weak pair breaking effect for a d-wave superconductor. The pair breaking is weaker for hole dopants, which induce magnetic moments, than for electron dopants. Furthermore, both Pt and Sn doping have a similar effect on superconductivity despite being on different dopant sites, arguing against the notion that superconductivity lives predominantly in the CeIn(3) planes of these materials. In addition, we shed qualitative understanding on the doping dependence with density functional theory calculations.