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We studied 15 men (8 treatment, 7 control) before and after 21 days of 6º head-down tilt to determine whether daily, 1-h exposures to 1.0 G(z) (at the heart) artificial gravity (AG) would prevent bed rest-induced cardiovascular deconditioning. Testing included echocardiographic analysis of cardiac function, plasma volume (PV), aerobic power (VO(2)pk) and cardiovascular and neuroendocrine responses to 80º head-up tilt (HUT). Data collected during HUT were ECG, stroke volume (SV), blood pressure (BP) and blood for catecholamines and vasoactive hormones. Heart rate (HR), cardiac output (CO), total peripheral resistance, and spectral power of BP and HR were calculated. Bed rest decreased PV, supine and HUT SV, and indices of cardiac function in both groups. Although PV was decreased in control and AG after bed rest, AG attenuated the decrease in orthostatic tolerance [pre- to post-bed rest change; control: -11.8 ± 2.0, AG: -6.0 ± 2.8 min (p = 0.012)] and VO(2)pk [pre- to post-bed rest change; control: -0.39 ± 0.11, AG: -0.17 ± 0.06 L/min (p = 0.041)]. AG prevented increases in pre-tilt levels of plasma renin activity [pre- to post-bed rest change; control: 1.53 ± 0.23, AG: -0.07 ± 0.34 ng/mL/h (p = 0.001)] and angiotensin II [pre- to post-bed rest change; control: 3.00 ± 1.04, AG: -0.63 ± 0.81 pg/mL (p = 0.009)] and increased HUT aldosterone [post-bed rest; control: 107 ± 30 pg/mL, AG: 229 ± 68 pg/mL (p = 0.045)] and norepinephrine [post-bed rest; control: 453 ± 107, AG: 732 ± 131 pg/mL (p = 0.003)]. We conclude that AG can mitigate some aspects of bed rest-induced cardiovascular deconditioning, including orthostatic intolerance and aerobic power. Mechanisms of improvement were not cardiac-mediated, but likely through improved sympathetic responsiveness to orthostatic stress. [ABSTRACT FROM AUTHOR]

Nurses can play a crucial role as trusted advocates., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Continuous application of dairy manure to soils can lead to excessive phosphorus (P) accumulation (legacy P), which requires understanding for managing nutrient availability and leaching. This study was conducted in Kimberly, ID, where dairy manure or conventional fertilizer was applied to calcareous soil plots under continuous crop rotations for 8 years (2013-2020), followed by 2 years with no amendment. To understand legacy P behavior in the soils, total P, organic/inorganic P, and plant-available Olsen bicarbonate P and Truog extraction measurements were made from surface and subsurface samples. Additionally, P in soluble and less soluble calcium phosphate (Ca-P) minerals was estimated using selective extractions, and P desorption was measured in a flow-through reactor. Manure amendments resulted in increased total soil P and plant-available P, particularly in the initial 5 years. In the 0- to 30-cm depth, 54%-65% of the soil P added from manure amendments was readily soluble by the Truog P test. Phosphorus released from the 2022 manure-amended soil in the desorption experiments was about five times greater than the fertilizer-amended soil, suggesting high leaching potential. After 8 years of manure amendment, subsurface Olsen-P levels exceeded the 40 mg kg -1 management threshold, suggesting P adsorption potential of the surface had become saturated, allowing for P leaching. In the manure-amended surface soils, calcium phosphate minerals increased compared to the controls. Even after 2 years without manure amendment, soluble Ca-P mineral phases persisted in the soils, which can be a long-term source of P leaching., (© 2024 The Authors. Journal of Environmental Quality published by Wiley Periodicals LLC on behalf of American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America.)

Aims: While internet search engines have been the primary information source for patients' questions, artificial intelligence large language models like ChatGPT are trending towards becoming the new primary source. The purpose of this study was to determine if ChatGPT can answer patient questions about total hip (THA) and knee arthroplasty (TKA) with consistent accuracy, comprehensiveness, and easy readability., Methods: We posed the 20 most Google-searched questions about THA and TKA, plus ten additional postoperative questions, to ChatGPT. Each question was asked twice to evaluate for consistency in quality. Following each response, we responded with, "Please explain so it is easier to understand," to evaluate ChatGPT's ability to reduce response reading grade level, measured as Flesch-Kincaid Grade Level (FKGL). Five resident physicians rated the 120 responses on 1 to 5 accuracy and comprehensiveness scales. Additionally, they answered a "yes" or "no" question regarding acceptability. Mean scores were calculated for each question, and responses were deemed acceptable if ≥ four raters answered "yes.", Results: The mean accuracy and comprehensiveness scores were 4.26 (95% confidence interval (CI) 4.19 to 4.33) and 3.79 (95% CI 3.69 to 3.89), respectively. Out of all the responses, 59.2% (71/120; 95% CI 50.0% to 67.7%) were acceptable. ChatGPT was consistent when asked the same question twice, giving no significant difference in accuracy (t = 0.821; p = 0.415), comprehensiveness (t = 1.387; p = 0.171), acceptability (χ 2 = 1.832; p = 0.176), and FKGL (t = 0.264; p = 0.793). There was a significantly lower FKGL (t = 2.204; p = 0.029) for easier responses (11.14; 95% CI 10.57 to 11.71) than original responses (12.15; 95% CI 11.45 to 12.85)., Conclusion: ChatGPT answered THA and TKA patient questions with accuracy comparable to previous reports of websites, with adequate comprehensiveness, but with limited acceptability as the sole information source. ChatGPT has potential for answering patient questions about THA and TKA, but needs improvement., Competing Interests: No authors have any relevant disclosures or conflicts of interest. H. Mir reports consulting fees from Smith & Nephew and Synthes DePuy, unrelated to this article. H. Mir also reports a role on the board of directors for the Orthopaedic Trauma Association and the Center for Orthopaedics., (© 2024 Wright et al.)

Professional fact-checkers and fact-checking organizations provide a critical public service. Skeptics of modern media, however, often question the accuracy and objectivity of fact-checkers. The current study assessed agreement among two independent fact-checkers, The Washington Post and PolitiFact, regarding the false and misleading statements of then President Donald J. Trump. Differences in statement selection and deceptiveness scaling were investigated. The Washington Post checked PolitiFact fact-checks 77.4% of the time (22.6% selection disagreement). Moderate agreement was observed for deceptiveness scaling. Nearly complete agreement was observed for bottom-line attributed veracity. Additional cross-checking with other sources (Snopes, FactCheck.org), original sources, and with fact-checking for the first 100 days of President Joe Biden's administration were inconsistent with potential ideology effects. Our evidence suggests fact-checking is a difficult enterprise, there is considerable variability between fact-checkers in the raw number of statements that are checked, and finally, selection and scaling account for apparent discrepancies among fact-checkers., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Markowitz et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Power line communication within a lithium-ion battery allows for high fidelity sensor data to be transferred between sensor nodes of each instrumented cell within the battery pack to an external battery management system. In this paper, the changing characteristics of the lithium-ion cell at various states of charge are measured, analysed, and compared to understand their effectiveness on the communication channel of a power line communication system for carrier frequencies of 10 MHz to 6 GHz. Moreover, the use of quadrature amplitude modulation (QAM) is investigated to determine its effectiveness as a state-of-the-art modulation method for the same carrier frequency range. The overall results indicate that certain carrier frequencies and QAM orders may not be suitable for the in situ battery pack power line communication due to changes in battery impedance with certain lithium-ion cell states of charge, which cause an increase in error vector magnitude, bit error ratio, and symbol error ratio. Recommendations and trends on the impact of these changing characteristics based upon empirical results are also presented in this paper.

Introduction: The purpose of this study was to determine whether total ankle arthroplasty (TAA) and ankle/hindfoot fusion patients receiving tranexamic acid (TXA) exhibit fewer wound complications., Methods: A retrospective review was conducted of 212 patients (217 feet) undergoing TAA (n = 72), ankle (n = 36), tibiotalocalcaneal (n = 20), pantalar (n = 1), or hindfoot fusion (ie, subtalar = 47, double = 33, and triple = 8) between 2015 and 2020 by a fellowship-trained foot and ankle surgeon at an academic medical center. Demographics, medical history, complications, and union status were compared between TXA (n = 101) and non-TXA (n = 116) cohorts. The mean follow-up was 1.24 years (range, 0.25 to 4.68)., Results: The TXA group had significantly less postoperative infections (5.9% versus 15.5%, P = 0.025). Within a subgroup analysis of ankle/hindfoot fusions, the TXA group exhibited significantly more Charcot neuroarthropathy (20.7% versus 5.7%, P = 0.006) and shorter follow-up duration (0.96 versus 1.30 years, P = 0.030); however, TXA was associated with shorter time to fusion (146 versus 202 days, P = 0.049) and fewer revision surgeries (8.6% versus 21.8%, P = 0.036). Subgroup analysis excluding feet with Charcot also demonstrated less postoperative infections (4.5% versus 14.4%, P = 0.020). Subgroup analysis of TAAs showed fewer cases of superficial infections (2.3% versus 27.6%, P = 0.002) and delayed wound healing (25.6% versus 48.3%, P = 0.047) in the TXA cohort., Discussion: TXA use in ankle/hindfoot surgery was correlated with a reduction in superficial infections and radiographic time to union. The use of TXA in TAA correlated with fewer superficial infections and cases of delayed wound healing. Thus, in addition to other areas of orthopaedics, TXA seems to be beneficial in hindfoot and ankle surgery., Data Availability and Trial Registration Numbers: All data were obtained from our institution's medical records. This study is not associated with a clinical trial., (Copyright © 2022 by the American Academy of Orthopaedic Surgeons.)

To explore how prayers were used as expressions of spirituality among community-dwelling African Americans in response to life-threatening illness. Fifty-eight older African American adults residing in the Southeastern US participated in a qualitative descriptive study. Through prayers, participants requested the strength to endure, protection, healing and expressed gratitude. Prayers were expressions of spirituality through dimensions of connectedness: transpersonally to God or the unseen; intrapersonally to one's inner-self; and, interpersonally to others. Prayers are an important aspect of spirituality and the mental health of older African Americans particularly during serious, life-threatening illness. An understanding of the ways in which prayers are used might enhance the cultural relevance of mental health interventions in this population.

Background and Aims: Recent studies have unveiled an association between ADAMTS7 gene variation and coronary artery disease (CAD) caused by atherosclerosis. We investigated if the ADAMTS7 Serine214-to-Proline substitution arising from a CAD-associated variant affected angiogenesis, since neovascularization plays an important role in atherosclerosis., Methods and Results: ADAMTS7 knockdown in vascular endothelial cells (ECs) attenuated their angiogenesis potential, whereas augmented ADAMTS7-Ser214 expression had the opposite effect, leading to increased ECs migratory and tube formation ability. Proteomics analysis showed an increase in thrombospondin-1, a reported angiogenesis inhibitor, in culture media conditioned by ECs with ADAMTS7 knockdown and a decrease of thrombospondin-1 in media conditioned by ECs with ADAMTS7-Ser214 overexpression. Cleavage assay indicated that ADAMTS7 possessed thrombospondin-1 degrading activity, which was reduced by the Ser214-to-Pro substitution. The pro-angiogenic effect of ADAMTS7-Ser214 diminished in the presence of a thrombospondin-1 blocking antibody., Conclusions: The ADAMTS7 Ser217-to-Pro substitution as a result of ADAMTS7 polymorphism affects thrombospondin-1 degradation, thereby promoting atherogenesis through increased EC migration and tube formation., Competing Interests: Declaration of competing interest The authors declared they do not have anything to disclose regarding conflict of interest with respect to this manuscript., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: Much of the research on African-Americans' HPV vaccine acceptance has largely focused on racial/ethnic differences related to cognitive, socio-economical, and structural factors that contribute to differences in HPV vaccine acceptance and completion. A growing body of literature suggest that cultural factors, such as mistrust of healthcare providers (HCPs) and the healthcare system, religion, and social norms related to appropriate sexual behaviors, also plays a prominent role in their HPV vaccine acceptance. However, these studies were limited in their use of theoretical approaches necessary to conceptualize and operationalize culture., Objective: To explore the influence of culture on African-American mothers' and daughters' HPV vaccine acceptance using the PEN-3, a culturally-centered conceptual framework., Methods: Grounded theory techniques were used to explore cultural factors that influenced the acceptance of the HPV vaccine among African-American mothers (n = 28) and their daughters (n = 34)., Results: Positive attitudes towards vaccination stemmed from beliefs that the HPV vaccine has cancer prevention benefits and that vaccinations in general protected against infectious diseases. Negative attitudes stemmed from beliefs that the HPV vaccine was too new, not effective, daughters were too young, and that vaccines were not a one-size-fits-all intervention. Majority of mothers and daughters indicated that their religious doctrine did not impede their HPV vaccination decisions. For a few mothers, religious beliefs could not be separated from their HPV vaccination decisions and ultimately deterred HPV vaccine acceptance. HCP recommendations were valued however mothers were often dissatisfied with the detail of information communicated. Support networks provided both positive and negative types of social support to mothers and daughters. The media highlighted the cancer prevention benefits of the HPV vaccine and unintentionally communicated negative information of the HPV vaccine, which deterred HPV vaccine acceptance., Conclusion: Study findings can inform the development of culturally appropriate interventions that advances the evidence on cervical cancer prevention.

Intubating a neonate under non-emergent conditions may be quite stressful, even for experienced providers, due to the potential for rapid oxygen desaturation. Pulmonary physiology and increased metabolic oxygen demand in this patient population contribute to accelerated oxygen desaturation during induction of anaesthesia and intubation. Using a nasal cannula, placed prior to induction of anaesthesia and left in place until the airway is secured, is a simple and effective way to provide apneic oxygenation and may help maintain adequate oxygen saturation. This technique may be particularly useful for patients who require additional time for intubation, including those with suspected difficult airways., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: To increase our understanding about the health beliefs of African-American parents and their daughters toward HPV infection and HPV vaccine acceptance., Methods: The Health Belief Model was used as a guiding framework. Principles of grounded theory, theoretical sampling, and constant comparison analysis were used to qualitatively analyze data generated from personal interviews of African-American parents (n = 30) and their 12- to 17-year-old daughters (n = 34)., Results: Mothers and daughters perceived low susceptibility to HPV infection and perceived the HPV vaccine as beneficial in protecting against genital warts and cervical cancer. Compared to daughters, parents placed particular emphasis on the vaccine's protection against genital warts. A major HPV vaccine acceptance barrier among parents and daughters was the politicization of the HPV vaccine by government figures. In addition, concerns about unknown side effects, safety, and effectiveness of HPV vaccination emerged. Cues to action varied among parents and daughters, and self-efficacy was higher among parents than daughters., Conclusion: Understanding the health beliefs that promote HPV vaccine acceptance, while identifying and addressing beliefs that are barriers among parents and daughters, will assist in the development of appropriate HPV vaccine promotion initiatives for African-American parents and daughters., (© 2018 Wiley Periodicals, Inc.)

Highly variable climates induce large variability in the supply of forage for livestock and so farmers must manage their livestock systems to reduce the risk of feed gaps (i.e. periods when livestock feed demand exceeds forage supply). However, mixed crop-livestock farmers can utilise a range of feed sources on their farms to help mitigate these risks. This paper reports on the development and application of a simple whole-farm feed-energy balance calculator which is used to evaluate the frequency and magnitude of feed gaps. The calculator matches long-term simulations of variation in forage and metabolisable energy supply from diverse sources against energy demand for different livestock enterprises. Scenarios of increasing the diversity of forage sources in livestock systems is investigated for six locations selected to span Australia's crop-livestock zone. We found that systems relying on only one feed source were prone to higher risk of feed gaps, and hence, would often have to reduce stocking rates to mitigate these risks or use supplementary feed. At all sites, by adding more feed sources to the farm feedbase the continuity of supply of both fresh and carry-over forage was improved, reducing the frequency and magnitude of feed deficits. However, there were diminishing returns from making the feedbase more complex, with combinations of two to three feed sources typically achieving the maximum benefits in terms of reducing the risk of feed gaps. Higher stocking rates could be maintained while limiting risk when combinations of other feed sources were introduced into the feedbase. For the same level of risk, a feedbase relying on a diversity of forage sources could support stocking rates 1.4 to 3 times higher than if they were using a single pasture source. This suggests that there is significant capacity to mitigate both risk of feed gaps at the same time as increasing 'safe' stocking rates through better integration of feed sources on mixed crop-livestock farms across diverse regions and climates.

Simulation models are extensively used to predict agricultural productivity and greenhouse gas emissions. However, the uncertainties of (reduced) model ensemble simulations have not been assessed systematically for variables affecting food security and climate change mitigation, within multi-species agricultural contexts. We report an international model comparison and benchmarking exercise, showing the potential of multi-model ensembles to predict productivity and nitrous oxide (N 2 O) emissions for wheat, maize, rice and temperate grasslands. Using a multi-stage modelling protocol, from blind simulations (stage 1) to partial (stages 2-4) and full calibration (stage 5), 24 process-based biogeochemical models were assessed individually or as an ensemble against long-term experimental data from four temperate grassland and five arable crop rotation sites spanning four continents. Comparisons were performed by reference to the experimental uncertainties of observed yields and N 2 O emissions. Results showed that across sites and crop/grassland types, 23%-40% of the uncalibrated individual models were within two standard deviations (SD) of observed yields, while 42 (rice) to 96% (grasslands) of the models were within 1 SD of observed N 2 O emissions. At stage 1, ensembles formed by the three lowest prediction model errors predicted both yields and N 2 O emissions within experimental uncertainties for 44% and 33% of the crop and grassland growth cycles, respectively. Partial model calibration (stages 2-4) markedly reduced prediction errors of the full model ensemble E-median for crop grain yields (from 36% at stage 1 down to 4% on average) and grassland productivity (from 44% to 27%) and to a lesser and more variable extent for N 2 O emissions. Yield-scaled N 2 O emissions (N 2 O emissions divided by crop yields) were ranked accurately by three-model ensembles across crop species and field sites. The potential of using process-based model ensembles to predict jointly productivity and N 2 O emissions at field scale is discussed., (© 2017 John Wiley & Sons Ltd.)

Background: Student affect plays a considerable role in mathematical problem solving performance, yet is rarely formally assessed. In this manuscript, an instrument and its properties are discussed to enable educational psychologists the opportunity to assess student affect., Aims: The study was conducted to norm the CAIMPS (instrument) with gifted students. In so doing, educational psychologists are informed of the process and the instrument's properties., Sample: The sample was comprised of 160 middle-grade (7 and 8) students, identified as gifted, in the United States., Methods: After completing one of four model-eliciting activities (MEAs), all participants completed the CAIMPS (Chamberlin Affective Instrument for Mathematical Problem Solving). Data were analysed using confirmatory factor analysis to ascertain the number of factors in the instrument. The normed fit index (0.6939), non-normed fit index (0.8072), and root mean square error approximation (.076) were at or near the acceptable levels. Alpha levels for factors were also robust (.637-.923)., Results and Conclusion: Data suggest that the instrument was a good fit for use with mathematics students in middle grades when solving problems. Perhaps the most impressive characteristic of the instrument was that the four factors (AVI: anxiety, value, and interest), SS (self-efficacy and self-esteem), ASP (aspiration), and ANX (anxiety) did not correlate highly with one another, which defies previous hypotheses in educational psychology., (© 2017 The British Psychological Society.)

Purpose: To assess the efficacy of embedded theta brainwave frequency in music using binaural beat technology (BBT) compared to music alone on the cardiovascular stress response in military service members with postdeployment stress., Design: A double-blinded, randomized, pre- and postintervention trial., Methods: Seventy-four military services members with complaint of postdeployment stress were randomized to either music with BBT or music alone. Each group listened to their respective intervention for a minimum of 30 min at bedtime for three consecutive nights a week for a total of 4 weeks. A 20-min pre- and postintervention heart rate variability (HRV) stress test and daily perceived stress via diaries assessed intervention efficacy., Findings: There was a statistical difference (p = .01) in low-frequency HRV between the music with BBT group compared to the music only group. The average low-frequency HRV decreased in the music with BBT group 2.5 ms 2 /Hz, while in the music only group it increased 7.99 ms 2 /Hz. There was also a significant difference (p = .01) in the high-frequency HRV measures, with the music with BBT group showing an increase in HRV by 2.5 ms 2 /Hz compared to the music only group, which decreased by 7.64 ms 2 /Hz. There were significant (p = .01) differences found in total power measures, with the music only group decreasing by 1,113.64 ms 2 /Hz compared to 26.68 ms 2 /Hz for the music with BBT group. Finally, daily diaries consistently showed that participants who used BBT reported less stress over the course of the 4 weeks., Conclusions: When placed under an acute stressor, participants who used music with embedded BBT showed a decrease in sympathetic responses and an increase in parasympathetic responses, while participants who used music alone had the opposite effect., Clinical Relevance: The use of BBT in the theta brainwave frequency embedded into music decreases physical and psychological indications of stress. BBT embedded with beta and delta frequencies may improve cognitive functioning and sleep quality, respectively., (© 2017 Sigma Theta Tau International.)

Agricultural modeling has long suffered from fragmentation in model implementation. Many models are developed, there is much redundancy, models are often poorly coupled, model component re-use is rare, and it is frequently difficult to apply models to generate real solutions for the agricultural sector. To improve this situation, we argue that an open, self-sustained, and committed community is required to co-develop agricultural models and associated data and tools as a common resource. Such a community can benefit from recent developments in information and communications technology (ICT). We examine how such developments can be leveraged to design and implement the next generation of data, models, and decision support tools for agricultural production systems. Our objective is to assess relevant technologies for their maturity, expected development, and potential to benefit the agricultural modeling community. The technologies considered encompass methods for collaborative development and for involving stakeholders and users in development in a transdisciplinary manner. Our qualitative evaluation suggests that as an overall research challenge, the interoperability of data sources, modular granular open models, reference data sets for applications and specific user requirements analysis methodologies need to be addressed to allow agricultural modeling to enter in the big data era. This will enable much higher analytical capacities and the integrated use of new data sources. Overall agricultural systems modeling needs to rapidly adopt and absorb state-of-the-art data and ICT technologies with a focus on the needs of beneficiaries and on facilitating those who develop applications of their models. This adoption requires the widespread uptake of a set of best practices as standard operating procedures.

We have previously predicted that the decrease in maximal oxygen uptake (V̇o 2max ) that accompanies time in microgravity reflects decrements in both convective and diffusive O 2 transport to the mitochondria of the contracting myocytes. The aim of this investigation was therefore to quantify the relative changes in convective O 2 transport (Q̇o 2 ) and O 2 diffusing capacity (Do 2 ) following long-duration spaceflight. In nine astronauts, resting hemoglobin concentration ([Hb]), V̇o 2max , maximal cardiac output (Q̇ Tmax ), and differences in arterial and venous O 2 contents ([Formula: see text]-[Formula: see text]) were obtained retrospectively for International Space Station Increments 19-33 (April 2009-November 2012). Q̇o 2 and Do 2 were calculated from these variables via integration of Fick's Principle of Mass Conservation and Fick's Law of Diffusion. V̇o 2max significantly decreased from pre- to postflight (-53.9 ± 45.5%, P = 0.008). The significant decrease in Q̇ Tmax (-7.8 ± 9.1%, P = 0.05), despite an unchanged [Hb], resulted in a significantly decreased Q̇o 2 (-11.4 ± 10.5%, P = 0.02). Do 2 significantly decreased from pre- to postflight by -27.5 ± 24.5% ( P = 0.04), as did the peak [Formula: see text]-[Formula: see text] (-9.2 ± 7.5%, P = 0.007). With the use of linear regression analysis, changes in V̇o 2max were significantly correlated with changes in Do 2 ( R 2  = 0.47; P = 0.04). These data suggest that spaceflight decreases both convective and diffusive O 2 transport. These results have practical implications for future long-duration space missions and highlight the need to resolve the specific mechanisms underlying these spaceflight-induced changes along the O 2 transport pathway. NEW & NOTEWORTHY Long-duration spaceflight elicited a significant decrease in maximal oxygen uptake. Given the adverse physiological adaptations to microgravity along the O 2 transport pathway that have been reported, an integrative approach to the determinants of postflight maximal oxygen uptake is needed. We demonstrate that both convective and diffusive oxygen transport are decreased following ~6 mo International Space Station missions., (Copyright © 2017 the American Physiological Society.)

This qualitative study explored strategies family members of African-American cancer patients used to overcome their fears and fatalistic attitudes toward cancer. Twenty-four family members were recruited through criterion purposeful sampling. Data were collected and analyzed using open-ended interviews and thematic analysis. Fears and fatalistic attitudes could be traced to personal experiences with cancer and information being communicated within their networks. Strategies used to overcome fears and fatalistic attitudes toward cancer included an awareness of advances in cancer treatments, information obtained from their health-care providers, and faith in God. Family members supported the patient through efforts of encouraging them to talk about what they were going through, to be strong, to maintain a positive environment and normalcy, and to use spirituality as a source of strength. Family members also suggested that health-care providers and researchers tailor intervention studies to consider that the patient is a part of a larger family system and that the entire family needs support to overcome long-held fears and fatalistic attitudes toward cancer. These findings suggest that despite advances in cancer care and widespread media coverage to change perceptions about cancer, fears and fatalistic attitudes toward cancer persist and likely influence the family members' ability to optimally support the cancer patient. At the time of diagnosis, both patient and the entire family unit should be educated of advances in cancer care, that cancer is no longer a death sentence, and supported to overcome fears and fatalistic attitudes.

Emergence delirium (ED) is a complex of perceptual disturbances and psychomotor agitation that occurs most commonly in preschool-aged children in the early postanesthetic period. The incidence of ED varies between 10 and 80% in children and is perceived as a troublesome clinical situation by 42% of pediatric anesthesiologists. Although these events are often short lived, they increase the risk of self-injury and delayed discharge, require additional nursing staff and can increase medical care costs, all of which are causes for concern. The prevalence of ED has increased with the introduction and growing use of sevoflurane and desflurane, two low-solubility inhalational anesthetics. These agents promote early arousal post anesthetic, which contributes to ED. Physiological factors, pharmacological factors, the type of procedure, the anesthetic agent administered, painful stimuli, and various patient factors can all contribute to ED and thus need to be considered. Recent literature debates the cause-effect relationship between ED and pain, suggesting that they often occur concurrently but are sometimes independent findings. The consistent relation between ED and sevoflurane-based anesthesia has guided many studies to investigate its incidence compared with using other anesthetic techniques or various adjuncts. The risk of ED is lowest when propofol is used as a single-agent anesthetic compared with sevoflurane-based anesthetics. Adjunctive agents can be rated in the following order of most effective to least effective interventions: dexmedetomidine, fentanyl, ketamine, clonidine, and propofol bolus at the end of sevoflurane-based anesthesia. This review summarizes the factors that may predict ED and provides an intervention algorithm to guide effective prevention and treatment.

National Committee for Quality Assurance recommends patient-centered medical homes incorporate input from patient populations; however, many health care organizations do not. This qualitative study used two open-ended questions from 148 active duty Army Soldiers and their family members to illicit recommendations for primary care providers and clinic leadership that would improve their health care experiences. Content analysis and descriptive statistics were used to analyze responses. Participant responses were related to four major themes: Access to Care, Interpersonal Interaction, Satisfaction of Care, and Quality of Care. Participants were overall satisfied with their care; however, spending less time waiting for appointments and to see the provider or specialist were the most frequently requested improvements related to Access to Care. For Interpersonal Interaction, 82% of the responses recommended that providers be more attentive listeners, courteous, patient, caring, and respectful. Decreasing wait times and improving interpersonal skills would improve health care experiences and patient satisfaction., (Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.)

Purpose: Heart rate (HR), pulmonary and muscle oxygen uptake ([Formula: see text]O2pulm, [Formula: see text]O2musc) kinetics after changes of work rate (WR) indicate regulatory characteristics related to aerobic metabolism. We analysed whether the kinetics of HR, [Formula: see text]O2pulm and [Formula: see text]O2musc are slowed after missions to the International Space Station (ISS). The changes of the kinetics were correlated with [Formula: see text]O2peak data., Methods: 10 astronauts [4 females, 6 males, age: 48.0 ± 3.8 years, height: 176 ± 7 cm, mass: 74.5 ± 15.9 kg (mean ± SD)] performed an incremental test to determine [Formula: see text]O2peak (before missions on L-110 days, after return on R+1/+10/+36 days), and a cardio-respiratory kinetics test (CRKT) with randomized 30-80 W WR changes to determine HR, [Formula: see text]O2pulm and [Formula: see text]O2musc kinetics by time-series analysis (L-236/-73, R+6/+21). Kinetics were summarized by maximum and related lag of cross-correlation function (CCFmax, CCFlag) of WR with the analysed parameter., Results: Statistically, significant changes were also found for CCFmax([Formula: see text]O2musc) between L-236 and R+6 (P = 0.010), L-236 and R+21 (P = 0.030), L-72 and R+6 (P = 0.043). Between pre-to-post mission change in [Formula: see text]O2peak and CCFmax(HR), a correlation was shown (r SP = 0.67, P = 0.017)., Conclusion: The [Formula: see text]O2musc kinetics changes indicate aerobic detraining effects which are present up to 21 days following space flight. The correlations between changes in [Formula: see text]O2peak and HR kinetics illustrate the key role of cardiovascular regulation in [Formula: see text]O2peak. The addition of CRKT to ISS flight is recommended to obtain information regarding the potential muscular and cardiovascular deconditioning. This allows a reduction in the frequency of higher intensity testing during flight.

Introduction: Aerobic deconditioning may occur during International Space Station (ISS) flights. This paper documents findings from exercise testing conducted before, during, and after ISS expeditions., Methods: There were 30 male and 7 female astronauts on ISS missions (48 to 219 d, mean 163 d) who performed cycle exercise protocols consisting of 5-min stages eliciting 25%, 50%, and 75% peak oxygen uptake (Vo(2peak)). Tests were conducted 30 to 90 d before missions, on flight day 15 and every 30 flight days thereafter, and on recovery (R) days +5 and +30. During pre- and postflight tests, heart rate (HR) and metabolic gas exchange were measured. During flight, extrapolation of the HR and Vo2 relationship to preflight-measured peak HR provided an estimate of Vo(2peak), referred to as the aerobic capacity index (ACI)., Results: HR during each exercise stage was elevated (P < 0.05) and oxygen pulse was reduced (P < 0.05) on R+5 compared to preflight; however, no other metabolic gas analysis values significantly changed. Compared to preflight, the ACI declined (P < 0.001) on R+5, but recovered to levels greater than preflight by R+30 (P = 0.008). During flight, ACI decreased below preflight values, but increased with mission duration (P < 0.001)., Conclusions: Aerobic deconditioning likely occurs initially during flight, but ACI recovers toward preflight levels as flight duration increases, presumably due to performance of exercise countermeasures. Elevated HR and lowered oxygen pulse on R+5 likely results from some combination of relative hypovolemia, lowered cardiac stroke volume, reduced cardiac distensibility, and anemia, but recovery occurs by R+30.

Folate deficiency has been associated with numerous diseases and birth defects including orofacial defects. However, whether folate has a role in the face during early orofacial development has been unclear. The present study reveals that pharmacological and antisense oligonucleotide mediated inhibition of DHFR, an integral enzyme in the folate pathway, results in specific changes in the size and shape of the midface and embryonic mouth. Such defects are accompanied by a severe reduction in the muscle and cartilage jaw elements without significant change in neural crest pattern or global levels of methylation. We propose that the orofacial defects associated with DHFR deficient function are the result of decreased cell proliferation and increased cell death via DNA damage. In particular, localized apoptosis may also be depleting the cells of the face that express crucial genes for the differentiation of the jaw structures. Folate supplementation is widely known to reduce human risk for orofacial clefts. In the present study, we show that activating folate metabolism can reduce median oral clefts in the primary palate by increasing cell survival. Moreover, we demonstrate that a minor decrease in DHFR function exacerbates median facial clefts caused by RAR inhibition. This work suggests that folate deficiencies could be a major contributing factor to multifactorial orofacial defects., (Published by Elsevier Inc.)

Introduction: The existence of health disparities in military populations has become an important topic of research. However, to our knowledge, this is the first study to examine health disparities, as related to access to care and health status, among active duty soldiers and their families. Specifically, the purpose of this analysis was to evaluate whether health disparities exist in access to care and health outcomes of patient satisfaction, physical health status, and mental health status according to race, gender, and sponsor rank in the population of active duty soldiers and their family members., Methods: In this cross-sectional study, active duty army soldiers and family members were recruited from either one particular army health clinic where they received their health care or from an adjacent shopping center frequented by eligible participants. Data were collected using validated measures to assess concepts of access to care and health status. Statistical analysis, including one-way analysis of variance (ANOVA) was performed to investigate differences in study outcome measures across four key demographic subgroups: race, gender, sponsor rank, and component (active soldier or family member)., Results: A total of 200 participants completed the study questionnaires. The sample consisted of 45.5 % soldiers and 54.5 % family members, with 88.5 % reporting a sponsor rank in the category of junior or senior enlisted rank. Mean scores for access to care did not differ significantly for the groups race/ethnicity (p = 0.53), gender (p = 0.14), and sponsor rank (p = 0.10). Furthermore, no significant differences were observed whether respondents were active soldiers or their family members (p = 0.36). Similarly, there were no statistically significant subgroup (race/ethnicity, gender, sponsor rank, or component) differences in mean patient satisfaction, physical health, and mental health scores., Discussion: In a health equity system of care such as the military health care system, active duty soldiers and their family members did not experience disparities in access to care or in important health outcomes of patient satisfaction, physical health status, or mental health status.

This investigation was designed to measure aerobic capacity (V̇o2peak) during and after long-duration International Space Station (ISS) missions. Astronauts (9 males, 5 females: 49 ± 5 yr, 77.2 ± 15.1 kg, 40.6 ± 6.4 ml·kg(-1)·min(-1) [mean ± SD]) performed peak cycle tests ∼90 days before flight, 15 days after launch, every ∼30 days in-flight, and on recovery days 1 (R + 1), R + 10, and R + 30. Expired metabolic gas fractions, ventilation, and heart rate (HR) were measured. Data were analyzed using mixed-model linear regression. The main findings of this study were that V̇o2peak decreased early in-flight (∼17%) then gradually increased during flight but never returned to preflight levels. V̇o2peak was lower on R + 1 and R + 10 than preflight but recovered by R + 30. Peak HR was not different from preflight at any time during or following flight. A sustained decrease in V̇o2peak during and/or early postflight was not a universal finding in this study, since seven astronauts were able to attain their preflight V̇o2peak levels either at some time during flight or on R + 1. Four of these astronauts performed in-flight exercise at higher intensities compared with those who experienced a decline in V̇o2peak, and three had low aerobic capacities before flight. These data indicate that, while V̇o2peak may be difficult to maintain during long-duration ISS missions, aerobic deconditioning is not an inevitable consequence of long-duration spaceflight., (Copyright © 2014 the American Physiological Society.)

Unlabelled: DoMosaics is an application that unifies protein domain annotation, domain arrangement analysis and visualization in a single tool. It simplifies the analysis of protein families by consolidating disjunct procedures based on often inconvenient command-line applications and complex analysis tools. It provides a simple user interface with access to domain annotation services such as InterProScan or a local HMMER installation, and can be used to compare, analyze and visualize the evolution of domain architectures., Availability and Implementation: DoMosaics is licensed under theApache License, Version 2.0, and binaries can be freely obtained from www.domosaics.net.

Motivation: Homology search methods are dominated by the central paradigm that sequence similarity is a proxy for common ancestry and, by extension, functional similarity. For determining sequence similarity in proteins, most widely used methods use models of sequence evolution and compare amino-acid strings in search for conserved linear stretches. Probabilistic models or sequence profiles capture the position-specific variation in an alignment of homologous sequences and can identify conserved motifs or domains. While profile-based search methods are generally more accurate than simple sequence comparison methods, they tend to be computationally more demanding. In recent years, several methods have emerged that perform protein similarity searches based on domain composition. However, few methods have considered the linear arrangements of domains when conducting similarity searches, despite strong evidence that domain order can harbour considerable functional and evolutionary signal., Results: Here, we introduce an alignment scheme that uses a classical dynamic programming approach to the global alignment of domains. We illustrate that representing proteins as strings of domains (domain arrangements) and comparing these strings globally allows for a both fast and sensitive homology search. Further, we demonstrate that the presented methods complement existing methods by finding similar proteins missed by popular amino-acid-based comparison methods., Availability: An implementation of the presented algorithms, a web-based interface as well as a command-line program for batch searching against the UniProt database can be found at http://rads.uni-muenster.de. Furthermore, we provide a JAVA API for programmatic access to domain-string–based search methods.

Purpose/objectives: To determine whether psychosocial factors predict depression among older African American patients with cancer., Design: A descriptive correlational study., Setting: Outpatient oncology clinic of a National Cancer Institute-designated cancer center in the southeastern United States., Sample: African American patients with cancer aged 50-88 years., Methods: Fisher's exact and Wilcoxon rank-sum tests were used to evaluate differences between patients who were possibly depressed (Geriatric Depression Scale) or not. Multivariate linear regression statistics were used to identify the psychosocial factors that predicted higher depression scores. Education and gender were included as covariates., Main Research Variables: Religiosity, emotional support, collectivism, perceived stigma, and depression., Findings: Participants (N = 77) had a mean age of 61 years (SD = 8.4), and a majority were well-educated, insured, religiously affiliated, and currently in treatment. Participants who were in the lowest income category, not married, or male had higher depression scores. The multivariable model consisting of organized religion, emotional support, collectivism, education, and gender explained 52% (adjusted R2) of the variation in depression scores. Stigma became insignificant in the multivariable model., Conclusions: Psychosocial factors are important predictors of depression. Emotional support and organized religious activities may represent protective factors against depression, whereas collectivism may increase their risk., Implications for Nursing: Nurses need to be particularly aware of the potential psychological strain for patients with collectivist values, experienced stigma, disruptions in church attendance, and lack of emotional support. In addition, the treatment plans for these patients should ensure that family members are knowledgeable about cancer, its treatment, and side effects so they are empowered to meet support needs., Knowledge Translation: Among older African American patients with cancer, emotional support and reassurance from family and friends that they will not abandon them decreases the likelihood of depressive symptoms and minimizes the impact of stigmatizing responses, but the perception that the illness is placing a strain on the family increases the likelihood of such symptoms. Emotional support likely is a stronger predictor of depressive symptoms than religious service attendance.

Background: The use of religious practices to promote mental health among African Americans is well documented. African Americans are more likely to report strong religious affiliations and to use religion over prescribed medications for mental health problems. However, few studies have explored how African Americans use religious practices in response to stressful life events., Objective: The aim of this study is to examine how African American women and men find comfort in using scripture passages from The Bible., Methods: Fifty-four African American adults residing in the Southeastern United States participated in a qualitative descriptive study using open-ended semistructured interviews. Participants were asked to describe their use of scripture passages from The Bible and the personal meanings associated with these scriptures in the context of a family death or life-threatening illness., Results: These participants used scripture passages categorized as God as Protector, God as Beneficent, Praise and Thanksgiving, God as Healer, Memory of Forefathers, Prayers to God, and Life after Death. Few gender differences were noted. However, women were more likely to use scripture passages of God as Protector and Life after Death, whereas men were more likely to use God as Beneficent and God as Healer., Discussion: The religious practice of reading scripture passages from The Bible is a mental health-promoting strategy used during stressful life events. The findings of this study have practical uses for nurses and can be used to inform acceptable and sensitive approaches in addressing mental health issues and spiritual care needs in African American patients.

Modularity is a hallmark of molecular evolution. Whether considering gene regulation, the components of metabolic pathways or signaling cascades, the ability to reuse autonomous modules in different molecular contexts can expedite evolutionary innovation. Similarly, protein domains are the modules of proteins, and modular domain rearrangements can create diversity with seemingly few operations in turn allowing for swift changes to an organism's functional repertoire. Here, we assess the patterns and functional effects of modular rearrangements at high resolution. Using a well resolved and diverse group of pancrustaceans, we illustrate arrangement diversity within closely related organisms, estimate arrangement turnover frequency and establish, for the first time, branch-specific rate estimates for fusion, fission, domain addition and terminal loss. Our results show that roughly 16 new arrangements arise per million years and that between 64% and 81% of these can be explained by simple, single-step modular rearrangement events. We find evidence that the frequencies of fission and terminal deletion events increase over time, and that modular rearrangements impact all levels of the cellular signaling apparatus and thus may have strong adaptive potential. Novel arrangements that cannot be explained by simple modular rearrangements contain a significant amount of repeat domains that occur in complex patterns which we term "supra-repeats". Furthermore, these arrangements are significantly longer than those with a single-step rearrangement solution, suggesting that such arrangements may result from multi-step events. In summary, our analysis provides an integrated view and initial quantification of the patterns and functional impact of modular protein evolution in a well resolved phylogenetic tree. This article is part of a Special Issue entitled: The emerging dynamic view of proteins: Protein plasticity in allostery, evolution and self-assembly., (Copyright © 2013 Elsevier B.V. All rights reserved.)

Broadacre livestock production is a major but highly diverse component of agriculture in Australia that will be significantly exposed to predicted changes in climate over coming decades. We used the GRAZPLAN simulation models to assess the impacts of climate change under the SRES A2 scenario across southern Australia. Climate change impacts were examined across space (25 representative locations) and time (1970-99, 2030, 2050 and 2070 climate) for each of five livestock enterprises. Climate projection uncertainty was considered by analysing projections from four global circulation models (GCMs). Livestock production scenarios were compared at their profit-maximizing stocking rate, constrained to ensure that risks of soil erosion were acceptable. Impacts on net primary productivity (ANPP) varied widely between GCM projections; the average declines from historical climate were 9% in 2030, 7% in 2050 and 14% in 2070. Declines in ANPP were larger at lower-rainfall locations. Sensitivity of ANPP to changes in rainfall ranged from 0.4 to 1.7, to temperature increase from -0.15 to +0.07 °C(-1) and to CO2 increase from 0.11 to 0.32. At most locations the dry summer period lengthened, exacerbating the greater erosion risk due to lower ANPP. Transpiration efficiency of pastures increased by 6-25%, but the proportion of ANPP that could safely be consumed by livestock fell sharply so that operating profit (at constant prices) fell by an average of 27% in 2030, 32% in 2050 and 48% in 2070. This amplification of ANPP reductions into larger profitability declines is likely to generalize to other extensive livestock systems. Profit declines were most marked at drier locations, with operating losses expected at 9 of the 25 locations by 2070. Differences between livestock enterprises were smaller than differences between locations and dates. Future research into climate change impacts on Australian livestock production needs to emphasise the dry margin of the cereal-livestock zone., (© 2013 Blackwell Publishing Ltd.)

Objective: To determine which individual characteristics (religious participation, mistrust, racism/discrimination, spirituality, perceived access to care, and continuity of care) were predictors of patient outcomes (patient satisfaction, physical health, and mental health status) for an Army health care clinic transitioning to the Patient-Centered Medical Home (PCMH)., Method: A descriptive, correlational design using stepwise multivariate regression analyses to assess the effect of individual characteristics on patient outcomes for 200 Army Soldiers and family members receiving health care services., Results: Perceived access to care was positively and mistrust was negatively related to patient satisfaction (p < 0.001 for both variables). Participants who reported more support from God and more mistrust also reported poorer physical health status (p < 0.008 and p < 0.003, respectively). Perceived access to care was the only individual characteristic that showed a significant (p < 0.019) positive association with a better mental health status., Conclusion: This study suggests that better access to care improves patient satisfaction and mental health status; however, those with higher levels of mistrust tend to have lower patient satisfaction and poorer health. Participants with poorer health also tend to rely on more support from God. These important individual characteristics should be the considered when implementing the PCMH., (Reprint & Copyright © 2013 Association of Military Surgeons of the U.S.)

Objective: The purpose of this study was to explore whether a particular combination of individual characteristics influences patient satisfaction with the health care system among a sample of African American men in North Carolina with prostate cancer. Patient satisfaction may be relevant for improving African American men's use of regular care, thus improving the early detection of prostate cancer and attenuating racial disparities in prostate cancer outcomes., Methods: This descriptive correlation study examined relationships of individual characteristics that influence patient satisfaction using data from 505 African American men from North Carolina, who prospectively enrolled in the North Carolina-Louisiana Prostate Cancer Project from September 2004 to November 2007. Analyses consisted of univariate statistics, bivariate analysis, and multiple regression analysis., Results: The variables selected for the final model were: participation in religious activities, mistrust, racism, and perceived access to care. In this study, both cultural variables, mistrust (p=<.0001, F=95.58) and racism (p=<.002, F=5.59), were significantly negatively associated with patient satisfaction and accounted for the majority of the variability represented by individual characteristics., Conclusion: Mistrust and racism are cultural factors that are extremely important and have been negatively associated with patient satisfaction and decreased desires to utilize health care services for African American men. To overcome barriers in seeking health care services, health care providers need to implement a patient-centered approach by creating a clinical environment that demonstrates cultural competence and eliminating policies, procedures, processes, or personnel that foster mistrust and racism.

Purpose: To explore in a sample of older African Americans how religious songs were used to cope with stressful life events and to explore the religious beliefs associated with these songs., Design and Methods: Sixty-five African American older adults residing in the Southeastern US participated in a qualitative descriptive study involving criterion sampling, open-ended semi-structured interviews, qualitative content analysis, and descriptive statistics., Results: Religion expressed through song was a coping strategy for participants experiencing stressful life events who described feelings of being comforted, strengthened, able to endure, uplifted, and able to find peace by turning to the types of religious songs described here. Five types of songs were used including those evoking Thanksgiving and Praise, Instructive, Memory of Forefathers, Communication with God, and Life after Death., Implications: Religious songs are an important form of religious expression important to the mental health of older African Americans. The incorporation of religious songs into spiritual care interventions might enhance the cultural relevance of mental health interventions in this population.

The purpose of this study was to determine if a particular set of health behaviors of health care providers and African American men (AAM) influence patient satisfaction from the AAM's perspective. This descriptive, correlational study consisted of 505 AAM in North Carolina diagnosed with prostate cancer and enrolled in the North Carolina-Louisiana Prostate Cancer Project (PCaP). Analyses consisted of bivariate analyses and multiple regression. Patient-to-provider communication, interpersonal treatment, and provider-to-patient communication accounted for 45% (p ≤ .0001) of the variability in patient satisfaction. Interpersonal treatment (provider focusing on the patient) explained the greatest amount (F = 313.53, R² = .39) of patient satisfaction. Since interpersonal treatment focuses on the patient and demonstrated to be the strongest predictor in patient satisfaction, it is noteworthy to consider the emphasis that should be placed on patient-centered care. In addition, knowing important variables positively affecting patient satisfaction provides useful information for developing appropriate interventions to improve AAM health care experiences.