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Objectives Short sleep duration and poor sleep quality are more prevalent among African Americans (AAs) and may be a modifiable risk factor for cardiometabolic disorders. However, research is limited about sleep-related attitudes, beliefs, and practices among AAs. Our objective was to evaluate these practices and beliefs surrounding sleep among urban-dwelling AAs. Design Qualitative study comprised of five 90-minute focus groups using a semistructured interview guide. Setting Five churches located on the west side of Chicago. Participants Adults (N = 43) ages 25-75 years. Measurements Transcripts were voice recorded, transcribed, and then coded for content analysis using NVivo 12 Pro to capture themes in the discussions. Results Most participants (86%) reported sleeping less than the recommended 7 or more hours. The discrepancy between actual and desired sleep duration was nearly 3 hours per night. Participants reported that sleep is essential for mental and physical health. Napping and consuming caffeine were frequently reported techniques for coping with lack of sleep. Noise, physical discomfort, and stress were reported as barriers to sleep, and participants reported using TV and other electronics to cope with racing thoughts or worry. Many participants were diagnosed with or knew someone with obstructive sleep apnea, but few participants had been diagnosed with insomnia or were aware of nonpharmacologic insomnia treatments. Conclusion A cycle of stress/disruptive environment, stress, rumination at night, and coping by use of electronics and daytime napping may perpetuate sleep disparities in this community. Results suggest that sleep-related interventions should include stress reduction and environmental improvements in addition to the typical sleep hygiene–related behavioral recommendations.

Bedrock ground stone features, found throughout the world, are particularly concentrated in the canyons of the Southern Plains of North America. Morphological analysis offers powerful tools for developing descriptions of bedrock ground stone (BGS) which can be used to discuss how prehistoric landscapes were inhabited. Metric representations of morphological variation can be used to test hypotheses about the nature of BGS features, which are often difficult to investigate and analyze. This paper presents a morphological approach to describe and analyze BGS surfaces in a side canyon of southeastern Colorado which can be applied by researchers to datasets in other regions. Results indicate that while variation exists, the BGS design (as determined by shape and size) are similar across the side canyon supporting the hypothesis that the canyon was occupied by a group of closely related people through time; although not all sites were used in the same manner.

Bedrock ground stone features are ubiquitous along the canyons of the Chaquaqua Plateau in southeastern Colorado, U.S.A, however, we know very little about their distribution, function or relationship to the regional archaeology. While some argue that prehistoric inhabitants of southeastern Colorado constructed permanent milling spaces to process local food resources, others think they may have processed corn. Most assume they were used by groups of women to process food resources together. Recent research suggests that the bedrock ground stone features differ depending on where they occur on the landscape, but may also vary because of socio-cultural ideals, as yet unknown. Sub-features are used as heuristic categories to discuss ways in which bedrock ground stone features are indicative of social processes such as group work or social reproduction of knowledge through collective labor. In this paper, we use close-range photogrammetry to examine the use of the sub-feature category as a means to refine the archaeology of bedrock ground stone surfaces in the region. Results illustrate that CRP offers an objective means to critically analyze the relationship of ground stone surfaces on bedrock features.

We sought to determine whether Australasian health professionals' opinions regarding early mobilization after stroke changed between 2008 and 2014, when a large international trial of early mobilization (A Very Early Rehabilitation Trial, AVERT) was underway.Attendees at the two major Australasian stroke conferences in 2008 and 2014 were surveyed. Participants rated their agreement with statements about the risks and benefits of commencing mobilization within 24 hours of hemorrhagic and ischemic stroke using a 5-point Likert scale. Participants in 2014 were asked about their awareness of AVERT. Logistic regressions were performed to determine whether the time point (2008 versus 2014) or awareness of AVERT influenced opinions about early mobilization.Surveys were completed by 443 health professionals (2008: N = 202; 2014: N = 241). Most respondents in 2014 reported that early mobilization was beneficial and not harmful to people with ischemic and hemorrhagic stroke. Opinions regarding mobilization after ischemic stroke did not change significantly between 2008 and 2014. In 2014, a significantly greater proportion of respondents believed that early mobilization after hemorrhagic stroke was helpful (2008: n = 98 of 202 [49%] versus 2014: n = 170 of 241 [71%], P .01). Awareness of AVERT was significantly associated with the opinion that early mobilization was beneficial and not harmful to patients with stroke (P .05).Australasian health professionals' opinions of early mobilization after hemorrhagic stroke changed between 2008 and 2014, prior to reporting of the AVERT trial. Our results suggest that awareness of an ongoing research trial can lead to changes in opinions before the efficacy of the experimental intervention is known.

Background Changes in reproductive hormones during menopause are associated with accumulation of intra-abdominal adipose tissue (IAAT), a subclinical indicator of cardiometabolic disease risk. Independent of reproductive hormones, unhealthy lifestyle contributes to IAAT gain. The Women in the Southside Health and Fitness (WISHFIT) Study aims to develop a lifestyle approach to slowing IAAT accumulation as women begin the menopausal transition. Methods The primary aim is to develop and conduct a proof-of-concept test of a multi-component, multi-level behavioral intervention targeting jointly physical activity, diet, and psychological well-being. Participants attend group sessions over 2 years to experiment with healthy living through both experiential and didactic learning, cultivate a health network, and draw on community resources to sustain change. The primary endpoint is 2-year IAAT progression, assessed using computerized tomography. Behavioral targets of treatment and secondary endpoints will be evaluated at 6, 12, 18 and 24 months. Change in social networks and community support will be assessed at 2 years. Results WISHFIT recruited 71 pre- and peri-menopausal Caucasian and African American women (mean ± SD age = 47.6 ± 3.4 yrs; BMI = 33.6 ± 7.3 kg/m2; 52% African American). Baseline IAAT was 2104.1 ± 1201.3 cm3. IAAT, physical activity, BMI, and self-reported family income and resilience differed by ethnicity at baseline. Conclusions WISHFIT is a multi-component, multi-level intervention aimed at producing a sustained improvement in physical activity, diet, and psychological well-being early in the menopausal transition to slow menopause-related accumulation of IAAT. It provides a model for the process of developing a behavioral treatment to manage a chronic disease.

Fossil pollen assemblages provide information about vegetation dynamics at time scales ranging from centuries to millennia. Pollen-vegetation models and process-based models of dispersal typically assume stable relationships between source vegetation and corresponding pollen in surface sediments, as well as stable parameterizations of dispersal and productivity. These assumptions, however, are largely unevaluated. This paper reports a test of the stability of pollen-vegetation relationships using vegetation and pollen data from the Midwestern region of the United States, during a period of large changes in land use and vegetation driven by Euro-American settlement. We compared a dataset of pollen records for the early settlement-era with three other datasets of pollen and forest composition for two time periods: before Euro-American settlement, and the late 20th century. Results from generalized linear models for thirteen genera indicate that pollen-vegetation relationships significantly differ (p Fagus, Betula, Tsuga, Quercus, Pinus , and Picea . The estimated pollen source radius for the 8 km gridded vegetation data and associated pollen data is 25–85 km, consistent with prior studies using similar methods and spatial resolutions. Hence, the rapid changes in land cover associated with the Anthropocene affect the accuracy of ecological predictions for both the future and the past. In the Anthropocene, paleoecology should move beyond the assumption that pollen-vegetation relationships are stable over time. Multi-temporal calibration datasets are increasingly possible and enable paleoecologists to better understand the complex processes governing pollen-vegetation relationships through space and time.

Background Factors at multiple ecological levels, including the child, family, home, medical care, and community, impact adolescent asthma outcomes. Objective This systematic review characterizes behavioral interventions at the child, family, home, medical system, and community level to improve asthma management among adolescents. Methods A systematic search of PubMed, SCOPUS, OVID, PsycINFO, CINAHL, and reference review databases was conducted from January 1, 2000, through August 10, 2014. Articles were included if the title or abstract included asthma AND intervention AND (education OR self-management OR behavioral OR technology OR trigger reduction), and the mean and/or median age of participants was between 11 and 16 years. We compared populations, intervention characteristics, study designs, outcomes, settings, and intervention levels across studies to evaluate behavioral interventions to improve asthma management for adolescents. Results Of 1230 articles identified and reviewed, 24 articles (21 unique studies) met inclusion criteria. Promising approaches to improving adherence to daily controller medications include objective monitoring of inhaled corticosteroid adherence with allergist and/or immunologist feedback on medication-taking behavior and school nurse directly observed therapy. Efficacy at increasing asthma self-management skills was demonstrated using group interactive learning in the school setting. This systematic review is not a meta-analysis, thus limiting its quantitative assessment of studies. Publication bias may also limit our findings. Conclusions Novel strategies to objectively increase controller medication adherence for adolescents include allergist and/or immunologist feedback and school nurse directly observed therapy. Schools, the most common setting across studies in this review, provide the opportunity for group interactive learning to improve asthma knowledge and self-management skills.

A shift from home-prepared to away-from-home and ready-to-eat foods has occurred in recent decades, which has implications for obesity and health. This study tested whether delay discounting, a facet of impulsivity reflecting sensitivity to immediate reward, is associated with the frequency of consumption and typical amount consumed of home-prepared, away-from-home, and ready-to-eat foods among overweight and obese women. Seventy-eight participants completed a binary choice task assessing discounting of delayed monetary rewards. Nutrient analysis of weighed food records characterized dietary intake over seven consecutive days. Foods were categorized as home-prepared, away-from-home, or ready-to-eat by a registered dietitian from information provided by participants. Delay discounting was not associated with the frequency of consuming home-prepared, away-from-home, and ready-to-eat foods as reflected in the percentages of recorded foods or total energy intake from each category. However, once consuming away-from-home and ready-to-eat foods (but not home-prepared foods), impulsive women consumed more energy than less impulsive women. Exploratory analyses indicated that more impulsive women chose away-from-home foods with a higher energy density (kcal/g). Impulsivity was associated with the quantity of away-from-home and ready-to-eat foods consumed, but not the frequency of their consumption. Home food preparation may be critical to weight control for impulsive individuals.

The current studies explore causal models of heart attack and depression generated from American healers whom use distinct explanatory frameworks. Causal chains leading to two illnesses, heart attack and depression, were elicited from participant groups: registered nurses (RNs), energy healers, RN energy healers, and undergraduates. The domain-specificity hypothesis predicted that psycho-social and physical causes would not interact in illness models. Across illnesses, RNs and undergraduates rarely cited interactions between mental and physical causes, consistent with the domain specificity hypothesis. In contrast, energy healers frequently mentioned interactions. Study 2 showed that these differences were not due to salience. These results suggest that domain-specificity theory is supported for groups with extensive exposure to western medicine but does not explain energy models of illness. Implications for other cultural models of illness are discussed.

The development of asthmatic inflammation involves a complex array of cytokines that promote the recruitment and activation of a number of different immune cells. While factors involved in initiating and establishing inflammation are well characterized, the process by which this pro-inflammatory cascade is regulated is less well understood. The identification and characterization of immunomodulatory cytokines in asthma has been a difficult proposition. Many of the putative regulatory factors have pleiotropic bioactivities and have been characterized as pro-inflammatory in association with certain pathologic conditions. This chapter addresses the potential role of several endogenous factors which appear to attenuate asthmatic inflammation. Understanding the integration of these factors into the regulation of the inflammatory process will likely result in novel therapeutic approaches.

Objective To report and synthesize the experiences, needs, and preferences of carers of stroke survivors undergoing inpatient rehabilitation. Data Sources MEDLINE, CINAHL, Embase, PsycINFO, and Web of Science were searched to March 2016. Reference lists of relevant publications were searched. No language restrictions were applied. Study Selection Eligible qualitative studies reported the experiences of carers of stroke survivors who underwent inpatient rehabilitation. The search yielded 3532 records; 93 full-text publications were assessed for eligibility, and 34 documents (33 studies) were included. Comprehensiveness of reporting was assessed using the Consolidated Criteria for Reporting Qualitative Health Research framework. Data Extraction Data on the characteristics of included studies were independently extracted by 2 authors. Differences in data extraction between authors were resolved through discussion or by a third author. All text in studies' results and discussion sections were extracted for analysis. Data Synthesis Extracted texts were analyzed inductively using thematic synthesis. Seven analytical themes were developed that related to the carers' experiences, needs, and preferences: (1) overwhelmed with emotions; (2) recognition as a stakeholder in recovery; (3) desire to be heard and informed; (4) persisting for action and outcomes; (5) being legitimate clients; (6) navigating an alien culture and environment; and (7) managing the transition home. Conclusions This systematic review provides new insights into the experiences, needs, and preferences of carers of stroke survivors undergoing inpatient rehabilitation. Carers experienced distress as they navigated a foreign culture and environment without adequate communication and processes in place for their inclusion. We recommend deliberate efforts to provide a more inclusive environment that better supports and prepares carers for their new role.

Study objective: To determine the safety of intramuscular ketamine when administered by emergency physicians for pediatric procedures in accordance with a defined protocol. Methods: We assembled a consecutive case series of children aged 15 years or younger who were given ketamine in the emergency departments of a university medical center and an affiliated county hospital over a 9-year period. A protocol for ketamine use (4 mg/kg, intramuscularly) was followed. Treating physicians were instructed to complete data forms recording complications and adequacy of sedation concurrent with patient care. Subsequent chart review was used to determine indications, adjunctive drugs, time to discharge, and adverse reactions for all patients. Results: Intramuscular ketamine was administered 1,022 times, mainly for laceration repair and fracture reduction. Physicians completed data forms for 431 of treated children (42%). Transient airway complications occurred in 1.4%: airway malalignment (n=7), laryngospasm (n=4), apnea (n=2), and respiratory depression (n=1). All were quickly identified and treated without intubation or sequelae. Emesis occurred in 6.7%, without evidence of aspiration. Mild recovery agitation occurred in 17.6%, moderate to severe agitation in 1.6%. No child required hospitalization for complications caused by ketamine. Ketamine produced acceptable sedation in 98% of patients. The median time from injection to emergency department discharge was 110 minutes for children given a single dose of ketamine. Conclusion: Intramuscular ketamine may be administered safely by emergency physicians to facilitate pediatric procedures in accordance with a defined protocol and with appropriate monitoring. Ketamine is highly effective, has a wide margin of safety, does not require intravenous access, and uniquely preserves protective airway reflexes. [Green SM, Rothrock SG, Lynch EL, Ho M, Harris T, Hestdalen R, Hopkins GA, Garrett W, Westcott K: Intramuscular ketamine for pediatric sedation in the emergency department: Safety profile in 1,022 cases. Ann Emerg Med June 1998;31:688-697.]

Pollen ratios and linear discriminant analysis were used to detect fine-scale vegetation patterns in the subalpine zone of the central Rocky Mountains, USA. The vegetation of this zone is a mosaic of conifer forests and treeless parks dominated by sagebrush (Artemisia spp.) and grasses. Previous work with pollen surface samples in the region has correlated modern pollen rain to broad-scale vegetation zones (e.g. steppe, montane forest, subalpine forest, and tundra), but little effort has been made to detect fine-scale (hundreds to thousands of meters) patterns within these vegetation zones. Previous theoretical studies suggest that vegetation patterns on the scale of hundreds of meters should be recorded in the pollen deposited in small ponds. Pollen surface samples were collected from small ponds and lakes (30–350 m diameter) from subalpine vegetation in Colorado and Wyoming. An additional set of samples was collected from small ponds in a park and the surrounding forest in the Wind River Range of northwest Wyoming. Pollen percentages were not dramatically different in park and forest assemblages, but the ratio of conifer to herb and Artemisia pollen (C:H) and the linear discriminant score were successful in separating park and forest pollen assemblages.

As a response to Citizens United v. FEC, the House of Representatives sought to base legislation limiting Citizens United’s impact on U.S. elections. Known as, “Democracy is Strengthened by Casting Light on Spending in Elections,” Act (the DISCLOSE Act or H.R. 5175), the Committee on House Administration hosted a series of discussions regarding the efficacy of the DISCLOSE Act.This testimony concerns the potential influence of foreign governments, through whole-owned corporations with U.S. subsidiaries, on U.S. elections post-Citizens United. In particular, the testimony focuses on socialist and post-socialist countries, like Russia, Vietnam and China, where ties between business and government are particularly strong. Indeed, many of these countries’ most successful corporations are controlled outright by the government. For example, in the case of China, three of its most profitable global corporations, Haier, China Telecom and China State Construction Engineering Corporation (CSCE), all of which have U.S. subsidiaries incorporated in Delaware, are officially government-run. While the Chinese government does not meddle in the corporation’s daily affairs, it will exert its influence if it suits the government’s self-interest. At times, that self-interest could be buying influencing in U.S. elections. Citizens United now creates a loophole where such meddling could happen. The DISCLOSE Act sought to address this loophole created by Citizens United. However, it never passed Congress.

It is well known that reproductive function is impaired in humans and animals when nutrient intake is inadequate. Fasting, one of the most severe nutritional insults, has been used experimentally to identify the major effects of nutritional deficiencies on reproductive processes. In the rat, circulating reproductive hormone concentrations are reduced during fasting. Although decreased luteinizing hormone-releasing hormone (LHRH) secretion from the hypothalamus may be responsible for the lower serum concentrations of reproductive hormones, pituitary and testicular function of fasted rats have not been considered in detail. We studied the luteinizing hormone (LH) dynamics (storage, secretion, circulation and excretion) in the male rat to determine if fasting alters the responsiveness of the testes or the pituitary to hormonal stimulation. Our results indicate that after a 4-d fast: 1) serum LH and testosterone (T) concentrations are reduced (P less than or equal to 0.001); 2) hypothalamic LHRH, pituitary LH and follicle-stimulating hormone (FSH) concentrations are unaffected, but testicular T content is reduced (P less than or equal to 0.001); 3) urine output of LH and FSH are reduced (P less than or equal to 0.001); 4) in vitro and in vivo LH responses of the pituitary to LHRH are not affected; and 5) hCG-stimulated in vitro T production by the testis is not affected. These results are consistent with the hypothesis that fasting inhibits LHRH secretion.