Understandings Barriers and Facilitators of Dietary Change Following Stroke: A Qualitative Analysis

Background: Stroke remains one of the leading causes of long-term disability in the United States. Healthy lifestyle factors, such as eating a balanced diet high in fiber and low in sodium may decrease the risk of secondary stroke. The interactions between barriers and facilitators of dietary change, are not well understood. The objective of this study was to describe the experiences of individuals regarding their dietary habits post-stroke. Methods: Individuals who previously experienced a stroke participating in a study of stroke support (n = 10) completed a semi-structured interview virtually. Individuals were interviewed approximately 4-6 weeks following hospital discharge. Interviews were guided using a set of consistent questions and transcribed. Key themes were identified through an inductive coding approach. Themes were checked against the transcribed interviews, and a team based iterative approach was used to refine the final set of themes. Results: Key themes included post-stroke changes (e.g., changes in physical mobility, dexterity, taste, and cravings), the impact of social support (ranging from live-in caregivers to no consistent caregiver, including subthemes of gratitude, self-reliance), and motivation and desire for dietary change. Conclusion: Post-stroke is a complex and pivotal time to implement dietary changes. Providing education and resources can aid participants in making lasting dietary changes even after leaving the inpatient rehabilitation facility.Bachelor of Science in Public Healt

A Survey of PCN-Based Admission Control and Flow Termination

Pre-congestion notification (PCN) provides feedback\ud about load conditions in a network to its boundary nodes. The PCN working group of the IETF discusses the use of PCN to implement admission control (AC) and flow termination (FT) for prioritized realtime traffic in a DiffServ domain. Admission control (AC) is a well-known flow control function that blocks admission requests of new flows when they need to be carried over a link whose admitted PCN rate already exceeds an admissible rate. Flow termination (FT) is a new flow control function that terminates some already admitted flows when they are carried over a link whose admitted PCN rate exceeds a supportable rate. The latter condition can occur in spite of AC, e.g., when traffic is rerouted due to network failures.\ud This survey gives an introduction to PCN and is a primer for\ud this new technology. It presents and discusses the multitude of architectural design options in an early stage of the standardization process in a comprehensive and streamlined way before only a subset of them is standardized by the IETF. It brings PCN from the IETF to the research community and serves as historical record

Empowering stroke survivors beyond inpatient rehabilitation: the STRIDE program

Objective The timeframe from hospital discharge to the commencement of outpatient therapies represents a crucial yet often overlooked period in post-stroke recovery. We designed an eight-week post-stroke management program (STRIDE, Stroke Management Training and Inpatient Rehabilitation Discharge Education) targeting individuals discharging from an inpatient rehabilitation facility to home. The primary aims of this pilot study were to determine STRIDE feasibility and participant engagement. Methods Participants with first or recurrent stroke were enrolled. Each week, participants monitored and recorded their daily activity, completed a 15-min educational module and quiz, and partook in weekly and biweekly communication with a fellow participant and STRIDE coordinator, respectively. Feasibility was evaluated by successful initiation of STRIDE and enrollment of the target population. We also assessed participant adherence and conducted semi-structured exit interviews. Results Of the 99 individuals screened, 20 individuals were enrolled (7 females, 28.6 ± 15.7 days post-stroke). Several participants were unable to begin the program (n = 6) or complete the program (n = 4). Overall, participants completing at least 1 week of STRIDE (n = 14) demonstrated adherence with education module and quiz completion and communication with the STRIDE coordinator. Participant feedback from interviews was largely positive, underscoring the value of STRIDE during early post-stroke recovery. Conclusions These findings support the feasibility of an initiated multi-faceted stroke management program. Participant dropout was a limitation and serves as a consideration when designing future iterations of STRIDE. With the long-term goal of promoting autonomy and investment in one's continued recovery beyond the inpatient setting, STRIDE bridges the transition from hospital to home

Empowering stroke survivors beyond inpatient rehabilitation: the STRIDE program

ObjectiveThe timeframe from hospital discharge to the commencement of outpatient therapies represents a crucial yet often overlooked period in post-stroke recovery. We designed an eight-week post-stroke management program (STRIDE, Stroke Management Training and Inpatient Rehabilitation Discharge Education) targeting individuals discharging from an inpatient rehabilitation facility to home. The primary aims of this pilot study were to determine STRIDE feasibility and participant engagement.MethodsParticipants with first or recurrent stroke were enrolled. Each week, participants monitored and recorded their daily activity, completed a 15-min educational module and quiz, and partook in weekly and biweekly communication with a fellow participant and STRIDE coordinator, respectively. Feasibility was evaluated by successful initiation of STRIDE and enrollment of the target population. We also assessed participant adherence and conducted semi-structured exit interviews.ResultsOf the 99 individuals screened, 20 individuals were enrolled (7 females, 28.6 ± 15.7 days post-stroke). Several participants were unable to begin the program (n = 6) or complete the program (n = 4). Overall, participants completing at least 1 week of STRIDE (n = 14) demonstrated adherence with education module and quiz completion and communication with the STRIDE coordinator. Participant feedback from interviews was largely positive, underscoring the value of STRIDE during early post-stroke recovery.ConclusionsThese findings support the feasibility of an initiated multi-faceted stroke management program. Participant dropout was a limitation and serves as a consideration when designing future iterations of STRIDE. With the long-term goal of promoting autonomy and investment in one's continued recovery beyond the inpatient setting, STRIDE bridges the transition from hospital to home

Genetic barriers to historical gene flow between cryptic species of alpine bumblebees revealed by comparative population genomics

Evidence is accumulating that gene flow commonly occurs between recently diverged species, despite the existence of barriers to gene flow in their genomes. However, we still know little about what regions of the genome become barriers to gene flow and how such barriers form. Here, we compare genetic differentiation across the genomes of bumblebee species living in sympatry and allopatry to reveal the potential impact of gene flow during species divergence and uncover genetic barrier loci. We first compared the genomes of the alpine bumblebee Bombus sylvicola and a previously unidentified sister species living in sympatry in the Rocky Mountains, revealing prominent islands of elevated genetic divergence in the genome that colocalize with centromeres and regions of low recombination. This same pattern is observed between the genomes of another pair of closely related species living in allopatry (B. bifarius and B. vancouverensis). Strikingly however, the genomic islands exhibit significantly elevated absolute divergence (dXY) in the sympatric, but not the allopatric, comparison indicating that they contain loci that have acted as barriers to historical gene flow in sympatry. Our results suggest that intrinsic barriers to gene flow between species may often accumulate in regions of low recombination and near centromeres through processes such as genetic hitchhiking, and that divergence in these regions is accentuated in the presence of gene flow

Unexpected Inheritance: Multiple Integrations of Ancient Bornavirus and Ebolavirus/Marburgvirus Sequences in Vertebrate Genomes

Vertebrate genomes contain numerous copies of retroviral sequences, acquired over the course of evolution. Until recently they were thought to be the only type of RNA viruses to be so represented, because integration of a DNA copy of their genome is required for their replication. In this study, an extensive sequence comparison was conducted in which 5,666 viral genes from all known non-retroviral families with single-stranded RNA genomes were matched against the germline genomes of 48 vertebrate species, to determine if such viruses could also contribute to the vertebrate genetic heritage. In 19 of the tested vertebrate species, we discovered as many as 80 high-confidence examples of genomic DNA sequences that appear to be derived, as long ago as 40 million years, from ancestral members of 4 currently circulating virus families with single strand RNA genomes. Surprisingly, almost all of the sequences are related to only two families in the Order Mononegavirales: the Bornaviruses and the Filoviruses, which cause lethal neurological disease and hemorrhagic fevers, respectively. Based on signature landmarks some, and perhaps all, of the endogenous virus-like DNA sequences appear to be LINE element-facilitated integrations derived from viral mRNAs. The integrations represent genes that encode viral nucleocapsid, RNA-dependent-RNA-polymerase, matrix and, possibly, glycoproteins. Integrations are generally limited to one or very few copies of a related viral gene per species, suggesting that once the initial germline integration was obtained (or selected), later integrations failed or provided little advantage to the host. The conservation of relatively long open reading frames for several of the endogenous sequences, the virus-like protein regions represented, and a potential correlation between their presence and a species' resistance to the diseases caused by these pathogens, are consistent with the notion that their products provide some important biological advantage to the species. In addition, the viruses could also benefit, as some resistant species (e.g. bats) may serve as natural reservoirs for their persistence and transmission. Given the stringent limitations imposed in this informatics search, the examples described here should be considered a low estimate of the number of such integration events that have persisted over evolutionary time scales. Clearly, the sources of genetic information in vertebrate genomes are much more diverse than previously suspected

The whole genome sequence of the Mediterranean fruit fly, Ceratitis capitata (Wiedemann), reveals insights into the biology and adaptive evolution of a highly invasive pest species

The Mediterranean fruit fly (medfly), Ceratitis capitata, is a major destructive insect pest due to its broad host range, which includes hundreds of fruits and vegetables. It exhibits a unique ability to invade and adapt to ecological niches throughout tropical and subtropical regions of the world, though medfly infestations have been prevented and controlled by the sterile insect technique (SIT) as part of integrated pest management programs (IPMs). The genetic analysis and manipulation of medfly has been subject to intensive study in an effort to improve SIT efficacy and other aspects of IPM control

Genome of the Asian Longhorned Beetle (\u3cem\u3eAnoplophora glabripennis\u3c/em\u3e), a Globally Significant Invasive Species, Reveals Key Functional and Evolutionary Innovations at the Beetle-Plant Interface

Background: Relatively little is known about the genomic basis and evolution of wood-feeding in beetles. We undertook genome sequencing and annotation, gene expression assays, studies of plant cell wall degrading enzymes, and other functional and comparative studies of the Asian longhorned beetle, Anoplophora glabripennis, a globally significant invasive species capable of inflicting severe feeding damage on many important tree species. Complementary studies of genes encoding enzymes involved in digestion of woody plant tissues or detoxification of plant allelochemicals were undertaken with the genomes of 14 additional insects, including the newly sequenced emerald ash borer and bull-headed dung beetle. Results: The Asian longhorned beetle genome encodes a uniquely diverse arsenal of enzymes that can degrade the main polysaccharide networks in plant cell walls, detoxify plant allelochemicals, and otherwise facilitate feeding on woody plants. It has the metabolic plasticity needed to feed on diverse plant species, contributing to its highly invasive nature. Large expansions of chemosensory genes involved in the reception of pheromones and plant kairomones are consistent with the complexity of chemical cues it uses to find host plants and mates. Conclusions: Amplification and functional divergence of genes associated with specialized feeding on plants, including genes originally obtained via horizontal gene transfer from fungi and bacteria, contributed to the addition, expansion, and enhancement of the metabolic repertoire of the Asian longhorned beetle, certain other phytophagous beetles, and to a lesser degree, other phytophagous insects. Our results thus begin to establish a genomic basis for the evolutionary success of beetles on plants

Sex difference and intra-operative tidal volume: Insights from the LAS VEGAS study

BACKGROUND: One key element of lung-protective ventilation is the use of a low tidal volume (VT). A sex difference in use of low tidal volume ventilation (LTVV) has been described in critically ill ICU patients.OBJECTIVES: The aim of this study was to determine whether a sex difference in use of LTVV also exists in operating room patients, and if present what factors drive this difference.DESIGN, PATIENTS AND SETTING: This is a posthoc analysis of LAS VEGAS, a 1-week worldwide observational study in adults requiring intra-operative ventilation during general anaesthesia for surgery in 146 hospitals in 29 countries.MAIN OUTCOME MEASURES: Women and men were compared with respect to use of LTVV, defined as VT of 8 ml kg-1 or less predicted bodyweight (PBW). A VT was deemed 'default' if the set VT was a round number. A mediation analysis assessed which factors may explain the sex difference in use of LTVV during intra-operative ventilation.RESULTS: This analysis includes 9864 patients, of whom 5425 (55%) were women. A default VT was often set, both in women and men; mode VT was 500 ml. Median [IQR] VT was higher in women than in men (8.6 [7.7 to 9.6] vs. 7.6 [6.8 to 8.4] ml kg-1 PBW, P < 0.001). Compared with men, women were twice as likely not to receive LTVV [68.8 vs. 36.0%; relative risk ratio 2.1 (95% CI 1.9 to 2.1), P < 0.001]. In the mediation analysis, patients' height and actual body weight (ABW) explained 81 and 18% of the sex difference in use of LTVV, respectively; it was not explained by the use of a default VT.CONCLUSION: In this worldwide cohort of patients receiving intra-operative ventilation during general anaesthesia for surgery, women received a higher VT than men during intra-operative ventilation. The risk for a female not to receive LTVV during surgery was double that of males. Height and ABW were the two mediators of the sex difference in use of LTVV.TRIAL REGISTRATION: The study was registered at Clinicaltrials.gov, NCT01601223