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BackgroundThere is increasing interest in finding novel approaches to reduce health disparities in readmissions for acute decompensated heart failure (ADHF). Text messaging is a promising platform for improving chronic disease self-management in low-income populations, yet is largely unexplored in ADHF. ObjectiveThe purpose of this pre-post study was to assess the feasibility and acceptability of a text message–based (SMS: short message service) intervention in a largely African American population with ADHF and explore its effects on self-management. MethodsHospitalized patients with ADHF were enrolled in an automated text message–based heart failure program for 30 days following discharge. Messages provided self-care reminders and patient education on diet, symptom recognition, and health care navigation. Demographic and cell phone usage data were collected on enrollment, and an exit survey was administered on completion. The Self-Care of Heart Failure Index (SCHFI) was administered preintervention and postintervention and compared using sample t tests (composite) and Wilcoxon rank sum tests (individual). Clinical data were collected through chart abstraction. ResultsOf 51 patients approached for recruitment, 27 agreed to participate and 15 were enrolled (14 African-American, 1 White). Barriers to enrollment included not owning a personal cell phone (n=12), failing the Mini-Mental exam (n=3), needing a proxy (n=2), hard of hearing (n=1), and refusal (n=3). Another 3 participants left the study for health reasons and 3 others had technology issues. A total of 6 patients (5 African-American, 1 White) completed the postintervention surveys. The mean age was 50 years (range 23-69) and over half had Medicaid or were uninsured (60%, 9/15). The mean ejection fraction for those with systolic dysfunction was 22%, and at least two-thirds had a prior hospitalization in the past year. Participants strongly agreed that the program was easy to use (83%), reduced pills missed (66%), and decreased salt intake (66%). Maintenance (mean composite score 49 to 78, P=.003) and management (57 to 86, P=.002) improved at 4 weeks, whereas confidence did not change (57 to 75, P=.11). Of the 6 SCHFI items that showed a statistically significant improvement, 5 were specifically targeted by the texting intervention. ConclusionsOver half of ADHF patients in an urban, largely African American community were eligible and interested in participating in a text messaging program following discharge. Access to mobile phones was a significant barrier that should be addressed in future interventions. Among the participants who completed the study, we observed a high rate of satisfaction and preliminary evidence of improvements in heart failure self-management.

The bacterium Helicobacter pylori is remarkable for its ability to persist in the human stomach for decades without provoking sterilizing immunity. Since repetitive DNA can facilitate adaptive genomic flexibility via increased recombination, insertion, and deletion, we searched the genomes of two H. pylori strains for nucleotide repeats. We discovered a family of genes with extensive repetitive DNA that we have termed the H. pylori RD gene family. Each gene of this family is composed of a conserved 3' region, a variable mid-region encoding 7 and 11 amino acid repeats, and a 5' region containing one of two possible alleles. Analysis of five complete genome sequences and PCR genotyping of 42 H. pylori strains revealed extensive variation between strains in the number, location, and arrangement of RD genes. Furthermore, examination of multiple strains isolated from a single subject's stomach revealed intrahost variation in repeat number and composition. Despite prior evidence that the protein products of this gene family are expressed at the bacterial cell surface, enzyme-linked immunosorbent assay and immunoblot studies revealed no consistent seroreactivity to a recombinant RD protein by H. pylori-positive hosts. The pattern of repeats uncovered in the RD gene family appears to reflect slipped-strand mispairing or domain duplication, allowing for redundancy and subsequent diversity in genotype and phenotype. This novel family of hypervariable genes with conserved, repetitive, and allelic domains may represent an important locus for understanding H. pylori persistence in its natural host. doi:10.1128/JB.00706-09

Stream temperature is a fundamental physical characteristic of rivers, influencing biological productivity and water quality. Given the implications of climate warming for stream thermal regimes, it is an important consideration in river management plans. Energy exchanges at the water-air interface, channel geomorphology, riparian vegetation and advective heat transport from the different sources of discharge can all influence stream temperature. A simple mixing equation was used to investigate heat transport and to estimate daily mean and maximum stream temperatures on the basis of mixing groundwater and near-surface flows from riparian wetlands as end-members in a peatland catchment. The resulting data were evaluated against energy balance components and saturation extent to investigate the importance of riparian wetlands in determining stream temperatures. Data fit was generally good in periods with extensive saturation and poorest in dry periods with less hydrological connectivity, when reduced saturation and low flows increased the relative influence of energy exchange at the stream-atmosphere interface. These findings have implications in terms of climate change and land management, where the planting of riparian buffer strips to moderate water temperatures may be less effective when saturation area is extensive and hydrological connectivity is high. [ABSTRACT FROM AUTHOR]

Fieldwork is often cited as one of the most important and effective parts of geography education, despite increasing scrutiny over its environmental and financial cost. As a result, it is imperative that any overseas fieldwork is as impactful as possible, enabling deep experiential learning. Here, we investigate the success of a joint field trip (Liverpool John Moores University, UK and Southern Connecticut State University, USA) to East Iceland. Such field trips are rare but have the potential to be extremely impactful on both cohorts of students. We outline the origins of the field trip, the considerations taken into account during planning, and the student skills we embedded into teaching. Surveys and interviews demonstrated that the field trip was highly successful, with students reporting excellent development of environmental and global awareness as well as research and leadership skills. Students also developed strong, lasting social networks, including those in the alternate university, and in Iceland. Cohorts responded similarly, suggesting that the trip presents similar opportunities to all students. We demonstrate that undertaking a joint field trip can deliver huge benefits to students, becoming a “perspective changing, and a once in a lifetime opportunity” affecting future study and career choices. [ABSTRACT FROM AUTHOR]